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to Section One | to Arts & Entertainment
posted Friday, June 3, 2016 - Volume 44 Issue 23
LGBTQ Health - Part I
Section One
ALL STORIES
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LGBTQ Health - Part I

by Dr. Kevin Wang, MD, Faculty
Swedish First Hill
Family Medicine
Residency Program
Special to the SGN


Before I begin this month's article, I want to thank Seattle Gay News and Swedish for providing this opportunity to reach out to my fellow LGBTQers. It is an honor and a pleasure to provide health, prevention and community information to you each month.

I would also like to encourage our readers to send us comments and suggestions for future articles! Please email us at sgn2@sgn.org with ATTN: Dr. Kevin in the subject line. I look forward to hearing from all of you!

For the months of June and July, we're going to focus on healthcare maintenance for our LGBTQ population. Because this is such a big topic, we're going to split it up. This month, we'll focus on Gay, Bisexual and Trans-male healthcare maintenance. In July, we'll talk about Lesbian, Bisexual and Trans-female healthcare maintenance.

First and foremost, whether you are cisgender or Transgender, Gay/Bisexual or straight, the vast majority of healthcare maintenance is almost all the same. We offer these screening options for our patients based upon recommendations from multiple organizations including the United States Preventive Services Task Force (USPSTF). It's primarily based on age, sex, tobacco use and sexual activity. Here are some general recommendations listed below:

Age 35 and younger
o Blood Pressure Screening

o HIV Screening (we'll get more into that below)

o STD Screening (ditto)

o Counseling to Quit Smoking

o Screening for Alcohol and Substance Use/Abuse

o Depression Screening

o Counseling on Diet & Exercise

o Hepatitis Screening

o Cholesterol Screening

Age 40 to 49
o Diabetes Screening Based On BMI (Body Mass Index)

Age 50 to 64
o Colon Cancer Screening

o Daily Aspirin

Age 65 and over
o Lung Cancer Screening for Smokers

o Abdominal Aortic Aneurysm Screening for Smokers

o Fall Prevention with Exercise and Vitamin D Supplementation

There are always exceptions to these recommendations and other organizations may offer alternatives, but, for us family doctors, we usually follow the guidelines above. There may also be reasons why these recommendations may not apply to certain folks and you will need to have a discussion with your primary care provider to make that determination.

Healthy People 2020, a document created by the Office of Disease Prevention and Health Promotion, highlighted areas regarding the healthcare disparities impacting Gay, Bisexual and Trans-men. One of the biggest highlights in this document is the need to have more research done to help provide better care for the LGBTQ population. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health/objectives But here is what we do know.

GBT men are at higher risk of HIV and other sexually transmitted infections, especially in communities of color. Current guidelines recommend testing for HIV and other STDs (gonorrhea, chlamydia, syphilis, hepatitis B are the ones we usually recommend) at least annually based upon risk factors. There are certainly ways to decrease the risk of transmission including the use of safer sex practices, immunizations for hepatitis A/B and HPV along with the use of certain medications to help decrease transmission rates of HIV, commonly known as pre-exposure prophylaxis or PrEP. We'll have more on PrEP in a future article.

Tobacco, alcohol and drug use are more prevalent in the male GBT population. In fact, younger GBT men are smoking more now than in previous years and alcoholism appears to be more prevalent in the GBT population when compared with the general population. Drug use is also a concern in the GBT population as it may result in riskier behaviors such as having unprotected sex. Trends in drug use have changed over time with an alarming epidemic in methamphetamine use. Your primary care provider can help you if you have these concerns.

Behavioral health and psychiatric disorders are also more prevalent in the GBT population. In fact, Trans people have the highest rates of depression, anxiety and suicide when compared with the general population. It's even higher in communities of color. Providers have questionnaires to screen people for depression and other psychiatric disorders but nothing beats having an established relationship with a primary care provider. Please see your healthcare provider for more information and for help.

There are also some pretty specific screening recommendations for the Trans-male population, too.

Breast cancer screening should absolutely be performed for those who haven't had top surgery or for those not interested in top surgery. The timing of having breast cancer screens with mammograms is the same as a cis-female with breasts. There are some varying recommendations but may either start at age 40 or 50. For those Trans-men who have had top surgery, residual breast tissue may still be present. Most experts agree that screening should be done with a yearly chest wall exam.

Cervical cancer screening should also be performed for Trans-men assuming they haven't had surgery to remove their uteruses and cervixes. Experts agree that they should still have cervical cancer screening as cis-females even if they are on testosterone. For those Trans-men who had their uteruses and cervixes removed for precancerous or cancerous reasons, they should still undergo screening to make sure there isn't a return of those changes. Understandably, this exam may be very uncomfortable or scary for Trans-men due to hormonal changes or even fear. Building trust with your primary care provider can help decrease anxiety with this exam. There are also medications and creams primary care providers can provide to make it less physically uncomfortable.

Trans-men, as they get older, should also get screened for osteoporosis or weakening of the bones. Screening for osteoporosis is through a special x-ray that looks at your hips and spine. Trans-men who are on testosterone therapy and over the age of 65 should get screened for osteoporosis. For those trans-men who can't be on testosterone therapy, they should get screened once they're over the age of 50 and have been off of therapy for 5 years or more.

So that, dear SGN readers, is GB & Trans-male healthcare maintenance in a nutshell. Of course there are other things to consider too, including dental and vision health along with helping provide community resources for those who don't have adequate housing or social support. I wish I could talk more about these topics so maybe we can save it for an upcoming article.

Although we don't cover the issue of provider discomfort, know that all of your healthcare advocates are working together to help educate others learn how to provide culturally competent and excellent LGBTQ care! We, at Swedish, are working hard to provide the Western Washington LGBTQ community with this type of care. Please visit our website to find a primary care provider near you! www.swedish.org/primarycare or call 1-800-Swedish.

Thank you for reading and I'll see you next month with an article on healthcare maintenance for our Lesbian, Bisexual and Trans-female population!

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