Should You Come Out to Your Doctor as LGBTQ+?

Coming out to your healthcare provider as LGBTQ+ can be a tough decision. Unfortunately, even in this day and age, homophobia is rampant in healthcare settings. As a result, many LGBTQ+ patients lose healthcare over the decision to come out.

Yet, coming out is crucial to receive lifesaving gender-affirming care. Finding an LGBTQ+-friendly provider is an excellent place to start. This guide navigates the pros and cons of coming out, the unique health risks LGBTQ+ people face, and how to find an LGBTQ+ accepting provider.

What LGBTQ+ stands for

LGBTQ+ stands for Lesbian, Gay, Bisexual, Trans, Queer/Questioning. The term LGBTQIA+ also includes Intersex, Two-Spirit, Non-binary, and Asexual. The terms LGBTQ+, LGBTQIA+, and queer can be used interchangeably.

Stress of coming out as LGBTQ+

It's stressful to come out to your doctor. There's a risk of being banished from care.

In 2020, over a third of LGBTQ+ folks experienced discrimination from healthcare providers. Despite this, there are two compelling reasons to come out to your doctor: gender-affirming care and LGBTQ+-specific health conditions.

Healthcare for gender dysphoria and gender identity

Gender-affirming care can alleviate gender dysphoria and prevent suicide and depression. Gender-affirming care decreased depression rates by 60% for LGBTQ+ youth, and suicide rates declined by 73%.

Gender dysphoria is when a person doesn't feel at home with their gender assigned at birth. It causes great psychological distress.

Gender affirmation is how a person expresses and represents the gender they are most comfortable with. This is one way to facilitate gender euphoria or happiness and satisfaction with one's gender/gender expression.

Gender identity is how a person identifies, regardless of what sex was assigned at birth.

Gender-related care includes the following:

• Social. Changing names or pronouns.
• Medical. Puberty blockers or gender-affirming hormones, including HRT (hormone replacement therapy).
• Surgical. Surgeries including vaginoplasty, breast augmentation, masculine chest reconstruction, and facial feminization surgery (FFS).

Binding your chest to flatten it is one way to enhance gender euphoria. Binding correctly is essential to prevent pain, skin abrasions, or trouble breathing. For gender dysphoria, binding is often a lifesaving measure.

Partner with your doctor to decide what gender-affirming interventions make sense for you. Gender validation can help you feel aligned in body, mind, and spirit. And remember--there's no "right" way to express your gender!

Risks of being queer

LGBTQ+ folks are:

• Less likely to have health insurance.
• More likely to have mental health issues.
• Less likely to receive preventative screenings and care.
• More likely to face discrimination from healthcare providers.
• More at risk for certain diseases and disorders.

Mental illness is more common among LGBTQ+ people. For example, in 2022, 73% of LGBTQ+ youth experienced anxiety, and 58% of LGBTQ+ youth experienced depression.

Queer people are more likely to smoke. In 2020, 16% of LGBTQ+ people smoked compared to 12% of heterosexual people.

LGBTQ+ individuals are less likely to receive preventative care. Women in same-sex relationships are less likely to get mammograms and preventive screenings. This puts them at a greater risk for cervical and breast cancer.

LGBTQ+ people are less likely to be insured, making healthcare screenings costly.

LGBTQ+ specific health concerns related to discrimination

Healthcare inequities and discrimination disproportionately affect LGBTQ+ people. Risks for STDs, cardiovascular disease, and eating disorders are higher for specific LGBTQ+ populations.

Sexual health and HIV

LGBTQ+ folks have higher rates of sexually transmitted diseases (STDs), including HIV.

Trans folks are four times more likely to be HIV positive than non-trans people.

28% of trans people delayed medical care for fear of discrimination.

HIV disproportionately affects gay and bisexual men and transgender women.

Cardiovascular health

The stress LGBTQ+ people undergo from homophobia affects them psychologically–and physiologically. Symptoms include increased blood pressure, heart rate, and cortisol levels. Ultimately, this leads to a higher incidence of cardiovascular disease for LGBTQ+ populations.

Stress eating

Eating disorders are more common for LGBTQ+ people. A 2019 study found that lesbians were more likely to be obese than straight women. Overeating is a common coping mechanism for stress.

Coming out to your doctor alerts them of your risk factors, resulting in better preventative screening and care.

Pros and cons of coming out

The ACA (Affordable Care Act) states that discrimination is prohibited "based on race, color, national origin, sex, age or disability in certain health programs." So while it's not comprehensive, it provides some legal protection against outright discrimination.

Despite this, 3 out of 10 trans people had a negative experience with a healthcare provider about being trans. Negative experiences included being refused care, verbal or physical assault, and violence. Some even had to educate their providers about what being trans meant. The microaggressions and micro/macro invalidations experienced by LGBTQ+ folks make coming out a challenging decision.

Healthcare providers are trained professionals and should never discriminate when providing care. Nevertheless, healthcare discrimination is a real risk LGBTQ+ folks face. So if you're unsure about your provider and may have to come out for health reasons, bring a close friend or family member to your appointment for safety.

Signs of an LGBTQ+ friendly provider

Asks about pronouns.

Asks about gender and sexuality preferences, needs, and concerns.

Offers resources on gender-affirming care.

Is respectful, professional, and non-judgmental.

Displays pride flags or wears pronoun pins.

Tips for an LGBTQ+ friendly doctor visit

Research LGBTQ+ affirming providers. Consider writing down what issues you want to discuss, especially if they relate to gender-affirming care. You can also print a health sheet from the GLMA (Gay and Lesbian Medical Association) website for reference. Each sheet reviews common health problems and risks for specific LGBTQ+ populations.

Should you come out?

Coming out to your healthcare provider can empower your healthcare decisions. However, be mindful of putting your safety first. Know that it's your right to cultivate a relationship with a healthcare provider that is honest and validating.

Doctors can better screen for LGBTQ+ specific health risks when they understand your background. In addition, coming out to your provider opens the door to gender-affirming care, which can enhance your quality of life. Ultimately, it's about a healthier you