Sexual and gender minorities face unique health risks

Memory problems and confusion are just the newest in a list of health problems that appear to disproportionately affect LGBT individuals.

Published: November, 2019

Past research has shown that sexual and gender minority groups may be at higher risk for certain health conditions, including cardiovascular disease and mental health disorders such as anxiety and depression. A new study suggests that another condition — dementia — may also be on that list. Findings presented at the 2019 Alzheimer's Association International Conference showed that people who identified as a sexual or gender minority were more likely than other people to report worsening memory or increased confusion over the past year.

It's possible that some of the same underlying factors that affect risk of other diseases are playing a role in these reported cognitive changes as well, says Dr. Ole-Petter R. Hamnvik, an assistant professor of medicine at Harvard Medical School. "Almost any health outcome that you look at, you can find disparities in these groups. It's not just dementia," he says.

The cognitive changes that survey respondents described were not diagnosed by a doctor or through any kind of formal testing. So, while the findings should be confirmed through additional research, the study underscores the importance of ensuring proactive, culturally appropriate health care for sexual and gender minorities that takes into account each individual's risk factors.

A higher risk of dementia?

The study presented at the Alzheimer's conference used data collected in a telephone survey of more than 44,000 adults ages 45 and older. Among the respondents, 3% identified as a member of a sexual or gender minority group, including lesbian, gay, bisexual, or transgender (LGBT) individuals. More than 14% of these people said they had experienced worsening cognitive changes in the past year, compared with 10% of those who were heterosexual and not transgender. This difference remained even after researchers adjusted for other risk factors such as income, age, and race.

In addition to reporting higher rates of cognitive changes, sexual and gender minorities were also more likely to report that they had given up daily activities and needed assistance from others to complete household tasks.

Factors that may elevate risk

Several known risk factors could be at play in elevating the risk of cognitive changes in sexual and gender minorities, says Dr. Hamnvik. Specifically:

Higher rates of cardiovascular risk factors. Research has shown that sexual and gender minorities may have more risk factors for cardiovascular disease, which has been associated with dementia, says Dr. Hamnvik. These include a higher prevalence of

  • cigarette smoking
  • high blood pressure
  • high cholesterol.

Some research has also found that lesbian and bisexual women are more likely to be overweight or obese than their heterosexual peers, according to the U.S. Office of Disease Prevention and Health Promotion.

A study presented at the American Heart Association's 2018 Epidemiology and Lifestyle conference found that about 44% to 55% of homosexual and bisexual adults ages 20 to 49 were considered to have poor cardiovascular health, compared with about 40% of heterosexual adults in the same age range.

Access to care. In some groups, most notably people who identify as transgender, a lack of health insurance may limit access to care, says Dr. Hamnvik. In addition, some lesbian, gay, bisexual, or transgender individuals may be more reluctant to see a doctor because they've had unpleasant interactions with providers in the past. This means they may be more likely to miss out on necessary screenings and preventive care.

Chronic stress. Sexual and gender minorities may also be at higher risk for certain mental health conditions, including anxiety and post-traumatic stress disorder (PTSD) from such adverse experiences as discrimination, abuse, and hate-based violence, says Dr. Hamnvik. Being a member of any minority group can lead to chronic stress and mental health conditions, such as depression and anxiety. And both of those conditions, as well as PTSD, have been linked to a higher risk of dementia.

Lesbian and transgender individuals often miss crucial screening exams

In addition to having risk factors that may increase the likelihood of developing cognitive changes and dementia, lesbian and transgender women may also be less likely to be screened for certain health conditions, including breast and cervical cancer.

Studies have found that lesbian women are less likely than heterosexual women to get regular mammograms. This is particularly concerning, because lesbian women often have more risk factors for breast cancer, says Dr. Ole-Petter R. Hamnvik, an assistant professor of medicine at Harvard Medical School. For example, a woman who has never been pregnant has a higher risk of breast cancer than someone who's had at least one pregnancy.

In addition, doctors sometimes wrongly assume that lesbian women don't need to be screened for cervical cancer. According to a 2013 study in BMC Public Health, while 75% to 84% of American women ages 18 and over report having a cervical cancer screening test within the past three years, only 44% to 57% of lesbian women said the same, despite the fact that they are also at risk for cervical cancer. Among women who skipped the exam, around 17% reported they missed it because they didn't have a physician, and another 17% said it was because their doctor didn't refer them for the exam.

Transgender people may also experience problems related to screening failures. Misconceptions remain, even among doctors, regarding what health screenings transgender men and women should receive, says Dr. Hamnvik. The best strategy is for transgender individuals to let their doctors know which organs they have. Doctors should then screen those organs as they typically would.

However, doctors should carefully weigh the pros and cons of these screening exams, says Dr. Hamnvik. For example, a transgender woman who has a prostate might be at lower risk for prostate cancer if she is taking hormone therapy that reduces her testosterone levels. This should be considered in the risk-benefit analysis, says Dr. Hamnvik.

Improving health, reducing risk

Dr. Hamnvik recommends that LGBT individuals use the following strategies to mitigate increased risks.

Be open with your provider. When the information is relevant to your care, don't hesitate to discuss your sexual practices and gender identity with your doctor. This can help your doctor determine what screenings you need and what health conditions you may be more likely to develop.

Practice good health habits. To reduce your risk of dementia, cardiovascular disease, and other illnesses, maintain a healthy diet rich in fruits and vegetables and low in processed foods, sugar, and harmful fats. In addition, whenever possible, try to get the recommended 150 minutes of moderate exercise a week.

Focus on mental health. Get help if you are experiencing mental health problems, such as anxiety or depression. "Depression, in particular, makes it more difficult to engage in healthy behaviors," says Dr. Hamnvik. So, getting treatment can help both your mental and physical health.

Choose an LGBT-friendly provider. "One would hope that every single health care provider is welcoming and provides good care, but in reality, that is not always the case," says Dr. Hamnvik. "In general, there are professional organizations, such as gay and lesbian medical associations, that have lists of recommended providers." Plus, some hospitals and practices, particularly at larger academic medical centers, allow doctors to identify themselves as specializing in LGBT health. This can help you find the right match.

If you do have a difficult experience with a provider, it can be challenging to speak up at the time. It is sometimes easier to write a letter to the provider after the fact outlining your concerns, says Dr. Hamnvik. Or simply change to another provider.

Changing doctors may be easier for people who live in an urban area with many options than it is in a more rural setting where there are fewer choices.

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