LGBTQ + ALLY
Historically, trans and queer folks have been marginalized, othered, and pathologized by medical and mental health communities. From conversion therapy and electroconvulsive therapy to denial of funding and care, LGBTQIA folks have faced massive discrimination in healthcare spaces as a result of their identities.
“Given this historical context — and even more particularly so if LGBTQ+ folks have other intersecting identities, such as being a person of color, having a disability, being poor, fat, elderly, etc. — there is hesitancy, reluctance, fear, trauma, and resentment that all [define] LGBTQ+ folks’ relationships to healthcare,” says Kristen Martinez, MEd, EdS, LMHCA, NCC, an LGBTQ+-affirmative counselor at Pacific NorthWell in Seattle, Washington.
Homophobia and transphobia are still an issue in medicine. Oftentimes, doctor offices can become a hotbed of painful questions, answers, and statements based on the assumption that those receiving the care were only ever heterosexual and cisgender, explains sexuality educator Erica Smith, MEd.
Examples include: What’s your preferred method of contraception? Are you pregnant? When was your last Pap smear and breast exam?
This dialogue can force LGTBQIA folks to lie about their identity if they feel unsafe disclosing that information or hesitant to come out. If they do come out, that conversation can become a string of apologies or uncomfortable laughter. At worst, those fears of discrimination are realized.
Or, according to Smith, “The LGBTQ person is forced to teach their healthcare providers about their own needs.”
The LGBT Foundation reports 1 in 5 lesbian, gay, and bisexual patients say their sexual orientation has been a factor in them delaying receiving healthcare. And, according to Ashley Spivak, co-founder of the sexual education website Cycles + Sex, “That number is ever higher for trans and gender nonconforming people and queer people of color.”
Why we need a guide for healthcare providers who are LGBTQIA allies
Ultimately, the issue of having or not having healthcare providers who are LGBTQIA allies can be a matter of life or death.
“When patients feel uncomfortable going to their care provider and giving [them] a full picture of their health, they may face adverse health outcome as a result,” explains Kecia Gaither, MD, MPH, FACOG, who’s double board-certified in OB-GYN and maternal fetal medicine and director of perinatal services at NYC Health + Hospitals/Lincoln.
Providers need to recognize that simply being “LGBTQIA-friendly” — for instance, loving their gay cousin or having lesbian neighbors — isn’t enough. Providers need to also be knowledgeable of the specific health risks and concerns that affect the LGBTQIA community.
Martinez explains, “There should be no barriers for a trans man to be able to access pelvic care and Pap smears, just like anyone else who has these particular organs that need specific care.”
Similarly, lesbian women shouldn’t be told they’re not at risk for contracting HPV if they’re not having penetrative sex with a cisgender man. Such information is incorrect, as HPV can be contracted from anyone regardless of gender and genitalia.
In many cases, lack of diversity training for doctors is to blame for these negative experiences.
“Until recently, medical training didn’t address the specific concerns and care of LGBTQ+ patients,” explains Gaither. If older medical professionals wish to learn how to best give care to their LGBTQIA patients, they often have to seek out educational opportunities on their own.
The good news? It is possible for LGBTQIA folks to find healthcare providers who are able to provide informed and culturally competent care. The question is how.
We’ve compiled various resources to search for and get LGBTQIA services. Use this guide to help find a healthcare provider who’s likely an LGBTQIA ally so you can get the care you need — and deserve.
Finding potential healthcare providers
Word of mouth
One of the best places to start is by talking to your queer friends about who they go to, says Smith.
“I rely on my network of friends to find LGBTQ+ healthcare. Thanks to them I rarely have to rely on Google to tell me if a provider or office is an ally,” Smith says.
Likewise, if you already have one trusted provider who’s an ally but need to see a new doctor or specialist, you can ask them for a referral. Many LGBTQIA-friendly doctors have a network of providers who they recommend to their patients.
If you don’t have a network of queer folks you can talk to, search for “queer exchange [name of your city]” on Facebook and request to join. Here, queer folks can post questions to their local queer community members and ask for recommendations for LGBTQIA-friendly doctors in the area.
Local clinics and LGBT centers
“Local clinics are also a great resource to find care,” says Spivak, especially those in urban areas. Examples include the Callen-Lorde Center in New York City or the Whitman Walker Clinic in Washington, D.C. Both provide services geared toward the queer community among many other services.
Find one near you by Googling “clinic near me + LGBTQIA” or similar search terms. You can also visit your local Planned Parenthood, which offers affordable care and LGBTQIA services in all 50 states.
Online resources to help you find an LGBTQIA-friendly provider
Gay and Lesbian Medical Association (GLMA)
The GLMA offers a provider directory that lists providers who are welcoming to the LGBTQIA community and knowledgeable about the unique health needs and concerns. All GLMA providers have to affirm their commitment to creating a welcoming environment for the LGBTQIA community.
National LGBT Health Education Center
Primarily for healthcare providers who are interested in becoming better educated in the health needs of the LGBTQIA community, the National LGBT Health Education Center has a ton of great, free, comprehensive resources for LGBTQIA folks. These include free webinars, a list of national LGBT health initiatives, and a list of hotlines.
CenterLink LGBT Community Center Member Directory
This is a database with info on LGBTQIA community centers all around the world. Enter your location, find the community center nearest you, and call them for healthcare provider recommendations.
World Professional Association for Transgender Health (WPATH)
WPATH’s online provider directory can help you find transgender-affirming providers. Simply enter information about where you live and the type of healthcare provider you’re looking for.
Please PrEP Me
This is a community-based service that curates providers who prescribe PrEP based on ZIP code. Simply go to their webpage and enter your ZIP code.
Care Dash recently added the option for healthcare providers to indicate if they’re LGBTQIA-friendly, a transgender-safe space, or both.
Enter the type of health service you’re looking for in the “Find” search bar and where you’re located in “Near.” Then click one of the healthcare providers who come up and scroll right. If they’re LGBTQIA-friendly, they’ll be designated so with a rainbow emoji, like this.
National LGBT Chamber of Commerce (NGLCC)
The NGLCC is able to certify businesses as being LGBTQIA-friendly or owned and operated by LGBTQIA folks nationwide.
Their tab “Affiliate Chambers” is useful for finding a healthcare provider. Click it and you’ll see a chamber in almost every state. Simply pick your state, then search the health directory for the service you’re looking for.
“You’ll find local healthcare providers, adoption and neonatal concerns, and gender-affirming surgery and more,” notes Jonathan Lovitz, senior vice president at the NGLCC.
The goal of Out2Enroll is to connect people who are LGBTQIA or allies to health insurance coverage options, especially for things like gender-affirming care. It’s mostly focused on Affordable Care Act plans but has links to local organizations that can lend financial and insurance-related advice.
One Medical is a national primary care provider that offers practitioners who are experts in LGBTQIA health concerns.
“We can address all of a person’s health concerns, from allergies and asthma to STI testing and skin infections,” says Dr. Natasha Bhuyan, a provider with One Medical based in Arizona.
And they don’t require an office visit for STI screening. “Patients can get STI screening done through our onsite labs. We even offer video visits for patients, which may be a more comfortable platform for some,” Bhuyan says.
Planned Parenthood has a large online repository of sexual and reproductive health information for LGBTQIA patients. “They recently launched a new chatbot, Roo, which patients of any orientation and gender can use to ask questions about their body, sex, or relationships,” says Bhuyan.
Cycles + Sex
Cycles + Sex is a sex and reproductive health education platform. It will be launching a database of queer-friendly healthcare providers later this year. In the meantime, their website has a list of resources for LGBTQIA healthcare.
The Trevor Project
The Trevor Project is geared specifically toward providing crisis intervention and suicide prevention services to the LGBTQIA community.
“While their goal is to provide mental health support, they can also refer folks to other resources that meet their [other] health needs,” says mental health professional Kryss Shane, MS, MSW, LSW, LMSW.
Before the first appointment
While the above resources do some of the preliminary work for you, Gaither and Shane both advise patients to do some more research on the healthcare facility and provider before making an appointment.
Unfortunately, as Shane says, “Too often, folks stick a rainbow flag on their site and their business door and claim to be LGBTQ+-friendly but don’t actually have the supportive knowledge or programming in place to support their claim to be a safe place.”
The steps below can help you learn more.
Visit the provider’s website
Take a close look at the language used on the provider’s website. Unless they’re talking about someone specific, a provider shouldn’t gender their services, says Spivak.
Instead of directing people to “women” services, “An LGBTQ-friendly provider will use ‘pregnant person’ or ‘someone who menstruates’ instead as to not gender those experiences,” she explains.
Smith notes that many queer folks will call out if a healthcare provider is exceptionally welcoming — or not — in online reviews. These can help provide a sense of the quality of care provided.
Keep in mind reviews aren’t always reliable, though. They can be dated or misleading. But if there’s a particularly egregious review about how the doctor approached or treated someone based on their identity, that’s a big red flag.
Call the front desk
According to Spivak, a telltale sign that a provider isn’t LGBTQIA-friendly is when the front desk unnecessarily uses gendered lingo, assumes your pronouns or sexuality, or otherwise questions your identity.
“Progressive providers have ensured that their staff have undergone special trainings to work with LGBTQ+ folks as well,” Spivak says.
Further, Shane says you might even ask the staff member if they and the provider are trained in LGBTQIA client work. “If they say yes, you might ask how they were trained and how often training and continuing education occurs,” Shane says. This is a case of more is better.
Questions to ask
Do you have a
nondiscrimination policy? A provider committed to providing equal
opportunity care should have an anti discrimination policy to protect employees.
Does this doctor
regularly work with [insert identity marker(s) here], or would I be one of the
first? Whether you want to be one of the first patients with your identity
your provider has seen is up to you, but it’s a useful question.
facility have gender-neutral bathrooms? Even if they don’t, Lang says how
the employee responds is often telling.
Do any LGBTQIA
employees work on staff? Not every workplace will, but if they do it’s a
good sign, says Lang. “While providers are patient-first organizations, it’s
important that the staff members also feel affirmed and comfortable being out
at work,” Lang says.
Look at a digital patient form
Most facilities will email you intake and first-visit paperwork before your appointment if you request it, says Shane. Check to see what options are given for gender identity marker and whether there’s a place to list your preferred name and your legal name.
For instance, according to Bhuyan, One Medical uses an electronic health system that allows patients to self-identify their gender and preferred name. “They enter the info, and then it’s presented in a way that’s very visible to our staff,” she says.
Trust your instincts
Finally, Lang says, “Trust your instincts, trust yourself, and trust what you’re seeing.”
Remember: “Clinicians who provide culturally competent, judgement-free, and quality healthcare and are sensitive when it comes to creating a safe space for patients to be vulnerable and honest do exist,” Bhuyan says. “It’s just a matter of finding them.”
10 stats you need to know about LGBT healthcare. (n.d.).
Bhuyan N. (2019). Personal interview.
Boyajian A. (2019). Personal interview.
Gaither K. (2019). Personal interview.
Lang C. (2019). Personal interview.
LGBT Foundation: Pride in Practice. (n.d.).
Lovitz J. (2019). Personal interview.
Martinez K. (2019). Personal interview.
Shane K. (2019). Personal interview.
Smith E. (2019). Personal interview.
Spivak A. (2019). Personal interview.
Photo Credit: Sharon McCutcheon