The amount of legislation targeting LGBTQ youth healthcare being pushed through various state legislatures has sky-rocketed in recent months. Many of these policies aim to ban or restrict access to gender-affirming healthcare for transgender youth. According to the American Civil Liberties Union, bills designed to prohibit healthcare for transgender youth have been introduced or considered in the state legislatures of 17 states so far this year.
Earlier this week, the transgender community and its allies won a surprising victory when the Governor of Arkansas, Asa Hutchinson, vetoed a bill that would have made it illegal for transgender minors to receive gender-affirming medication or surgery. The victory, however, was short-lived. The Arkansas General Assembly voted to override the Governor’s veto the following day, passing the nation’s first ban on medical treatment for transgender youth. Similar bills are being actively considered in the state legislatures of both Alabama and Tennessee.
While the specific targeting of transgender youth and their access to healthcare has become more prevalent in recent years, for many Queer people, especially LGBTQ+ youth, the struggle of finding adequate and affirming healthcare is, unfortunately, all too familiar.
Inadequate LGBTQ+ Primary Care
For anyone, finding a doctor you like can be challenging. For many Queer people, it can be much more difficult. Queer people have unique healthcare needs that require specific medical knowledge and cultural competency, which many doctors lack. The needs of various people within the LGBTQ+ community also vary. What a cisgender gay man may need from his doctor will surely vary from what a transgender man may need. A doctor who can adequately support one of these men might not be able to do so for the other.
More often than not, doctors don’t seem to have the knowledge to meet the healthcare needs of their Queer patients. A 2011 JAMA report found that the average time of an American doctor’s training dedicated to LGBTQ+ health issues was only five hours—that’s five hours of their entire medical training. How can doctors provide adequate care for their Queer patients when, as a whole, the American medical community has spent so little time studying LGBTQ+ needs?
It’s no surprise then that many Queer people also experience discrimination at the doctor’s office. According to a report from the National LGBTQ Task Force, 56% percent of LGBTQ individuals have confronted discrimination while seeking medical treatment. Another study found that a whopping 81% of first-year medical students showed an implicit bias against gay and lesbian people. 50% showed an explicit bias. This bias is both fueled by and contributes to the perpetuation of harmful stigmas and stereotypes of Queer people.
This insensitivity on the part of the medical providers can discourage patients from disclosing necessary health information and, in turn, can push Queer people away from care. According to a report by the LGBT Foundation, 1 in 5 lesbian, gay, and bisexual patients say that their sexual orientation is a factor in them delaying seeking care. This number even higher for transgender and non-binary patients.
Inadequate LGBTQ+ Sexual Health Education
Studies have shown that LGBTQ+ youth are more likely to engage in high-risk sexual behaviors that can lead to increased incidence of HIV and other sexually transmitted infections (STIs). Transgender and non-binary youth are even more likely to engage in unprotected sex than their cisgender counterparts. Presumably, this is all due to the negative impacts of societal stigmas preventing LGBTQ+ youth from receiving the appropriate sexual health information. Studies have also shown the single greatest way to decrease STI transmission, and other outcomes from high-risk sexual activity is to provide accurate sexual education.
Sex education across America varies greatly. 39 states and the District of Columbia mandate sex education, HIV education, or a combination of both. Only 17 of those states mandate that this sexual education material needs to be medically accurate. Furthermore, only 11 states and D.C. require that sexual education is inclusive with regard to sexual orientation. Six states actually require that only negative information be provided with regard to homosexuality and a positive emphasis be placed on heterosexuality.
Given the difficulties Queer people of all ages face when engaging with medical professionals, it is imperative that LGBTQ+ youth have access to medically-accurate information about their own bodies. This access and information would be one way in which we can better prepare LGBTQ+ people to advocate for themselves when they meet doctors.
Inadequate Access to Mental Healthcare
LGBTQ+ youth regularly report higher rates of depression, anxiety, and suicidal tendencies than their non-queer peers, likely due to the higher rates of bias and discrimination that they face. Despite national efforts to combat bullying, LGBTQ+ youth still report high levels of bullying by their peers. Fear of rejection from family members because of their sexual orientation or gender identity, anti-LGBTQ+ messages in media and religious communities, and the stress associated with the stigma of identifying as Queer all compound to worsen the mental health of LGBTQ+ youth. The current COVID-19 pandemic has exacerbated many of the structural inequalities that cause these disparities by reducing access to safe spaces.
According to The Trevor Project’s 2020 National Survey on LGBTQ Youth Mental Health, 40% of respondents reported attempting suicide in the previous twelve months, with more than half of transgender and non-binary youth having seriously considered suicide. 68% of respondents reported having symptoms of generalized anxiety disorders in the past two weeks. Again, this number increases for transgender and non-binary youth to 75%.
Often it’s members of communities most in need who struggle to access appropriate mental healthcare. According to the same Trevor Project report, 46% of the respondents reported wanting psychological or emotional counseling from a mental health professional but could not receive it in the prior 12 months.
There are multiple barriers LGBTQ+ youth face when trying to engage in mental healthcare, not the least of which is cost. Age restrictions and transportation issues all prevent young LGBTQ+ people from accessing care. For underage youth, another barrier is the fear of requiring parental consent and concerns that providers may disclose personal information, essentially outing youth to parents and guardians before they are ready to do so. Like LGBTQ+ adults, youth also share worries over the sensitivity and competence of doctors. Many transgender and non-binary youth report worrying about receiving gender-affirming care.
The stress that non-white LGBTQ+ youth feel as members of multiple marginalized groups also increase barriers to mental healthcare, as many young people worry their mental health provider won’t understand their specific cultural or ethnic community.
Bettering LGBTQ+ Healthcare
With more and more people identifying as part of the Queer community than ever before, it’s clear that a more intentioned approach for providing LGBTQ youth healthcare is critical. Whether it’s primary care, sexual health education, or mental healthcare, there are significant disparities between the care Queer and non-queer people receive. Further, for transgender and non-binary people, those disparities become much larger.
Additional LGBTQ-specific competency training must be required for doctors and mental health professionals alike so that they may better serve their Queer patients. The cost of these services must be subsidized or significantly reduced to remove the financial burden of entry into these spaces, especially for the most marginalized communities. We must advocate for Queer-inclusive and medically accurate sexual health education nationwide so that LGBTQ+ youth have the necessary and unique information and tools they’ll need to make informed and consensual decisions about their health. Queer youth deserve better.
Resources for LGBTQ+ Healthcare
We’ve compiled a list of helpful resources with information on how to access LGBTQ healthcare.
The Trevor Project: Trained counselors are available to support LGBTQ youth 24/7. If you are a young person in crisis, feeling suicidal, or in need of a safe and judgment-free place to talk, call the TrevorLifeline now at 1-866-488-7386.
Planned Parenthood: Planned Parenthood provides high-quality, compassionate health care that’s appropriate for your needs and concerns — no matter your gender identity or sexual orientation.
National Association of Free & Charitable Clinics: Free & Charitable Clinics and Pharmacies across the U.S. provide health care access to medically underserved people in their communities.
The LGBT National Help Center: Serving the lesbian, gay, bisexual, transgender, queer, and questioning community by providing free and confidential peer-support and local resources
Trans Lifeline Hotline: Peer support service run by trans people located all over the US and Canada, for trans and questioning callers. You can call Trans Lifeline Hotline at 877-565-8860
CDC: Resources from the CDC, other government agencies, and community organizations for LGBT Youth, their friends, educators, parents, and family members to support positive environments.
Lighthouse: A group of NYC-based healthcare providers dedicated to providing care to LGBTQ+ patients and specializing in LGBTQ+ health issues.
Q Chat Space: Bully-free online community of LGBTQ teens that can chat with other LGBTQ teens and trained staff from LGBTQ centers around the country.
Gender Spectrum Lounge: Global online community for gender-expansive teens, their families, and support professionals to connect, collaborate, and find resources.
National Runaway Safeline: Federally designated national communication system for runaway and homeless youth, available 24/7/365, providing access to resources and listening professionals. You can call NRS at 1-800-RUNAWAY.