Choosing a doctor who is right for you is an important decision for everyone, especially those with particular needs or concerns. People who identify as part of the LGBTQ community (lesbian, gay, bisexual, transgender, queer) may have unique physical and mental health needs, making a supportive provider even more essential.
We talked with UNC Health family medicine physician Rita Lahlou, MD, MPH, about what to consider if you’re LGBTQ and looking for a primary care doctor, as well as how to work with your healthcare providers most effectively.
Here are seven things to keep in mind.
1. Be honest about your medical needs and your life.
Everyone needs a doctor who can monitor their general health and treat routine illnesses or conditions, including high blood pressure, diabetes and digestive issues. But people who are lesbian, gay, bisexual or transgender may have additional concerns, Dr. Lahlou says, and it’s critical they feel comfortable sharing details of their lives and experiences with their doctors.
“It’s important for people who identify with historically marginalized communities to find a primary care provider who will be supporting, affirming and understanding of them,” she says.
Many resources are available to help people find doctors who are sensitive to the needs of LGBTQ communities, including GLMA (Health Professionals Advancing LGBTQ Equality). Local centers, such as the LGBTQ Center of Durham, may have lists of physicians in your area who are experienced in LGBTQ health.
2. Get the right care for the body parts you have.
“No matter what your gender identity, it’s important to recognize that all of your body parts deserve to be cared for and may need screening for cancer,” Dr. Lahlou says. “If you have a cervix, you should have regular Pap tests to screen for cervical cancer, whether you identify as male or female. You should have mammograms for breast cancer screening if you have breast tissue, whether you are a cisgender woman (born female and identify as female) or a transgender woman who has received hormone therapy.”
Let your primary care physician know what body parts you have. They can work with you to make screenings as comfortable as possible—physically and emotionally.
3. Tell your doctor if you’re a trauma survivor.
LGBTQ people have high rates of trauma, including interpersonal violence, Dr. Lahlou says.
A 2020 UCLA School of Law study showed that LGBTQ people are nearly four times more likely than non-LGBTQ people to be victims of violent crimes such as rape, sexual assault, and aggravated or simple assault. Last year marked a record for killings of trans people, according to the advocacy group Human Rights Campaign.
Beyond these most tragic outcomes, there’s the fact that simply living as a sexual or gender minority in our culture has never been easy.
“They’ve been living with stigma their whole lives,” Dr. Lahlou says, “and that stress can affect their health.”
People who identify as LGBTQ are at greater risk for mental health conditions and suicidality, according to the National Alliance on Mental Illness.
Your doctor can help you deal with the physical consequences of trauma and violence, and connect you with mental health resources to address the emotional consequences.
4. Share all medications, supplements and other drugs you are taking.
Doctors need to know what medications, supplements and hormone therapies their patients are taking, no matter the patient’s sexual orientation or gender identity.
It’s also important for everyone to be honest about alcohol and drug use with their provider. If you don’t feel comfortable telling your doctor about this part of your life, you should find another doctor you can open up to.
Because of the social stigma, discrimination and increased risk of violence to LGBTQ people, this community has a higher risk of substance use disorders, according to the National Institute on Drug Abuse. They also are more likely to use tobacco products and e-cigarettes.
Your doctor may be able to help you find treatment programs offering specialized groups with the same sexual identity you have or are most comfortable with.
5. Trust your doctor with details about your sex life.
It’s important to see a doctor who doesn’t make you feel judged for your personal life. Sexual health can be a crucial part of overall health. When you’re honest about the number of partners you have and your sexual behaviors, your doctor can help you make a plan to protect against sexually transmitted infections, including HIV.
Men who have sex with men and transgender women may have particular vulnerabilities to discuss with their doctors. Gay and bisexual men and transgender women are the most severely and disproportionately affected groups when it comes to HIV and AIDS, according to the Centers for Disease Control and Prevention.
Your doctor can help you understand how to avoid infections. If you are HIV-positive, they can prescribe treatments that will keep the virus under control—often indefinitely—and prevent you from spreading it to future partners.
Other sexually transmitted infections are common in all people, no matter their sexual orientation or gender identity, including HPV, which is the most common STI in the U.S. HPV can cause genital and anal warts and may lead to anal and oral cancers. Men who have sex with men are 17 times more likely to get anal cancer than men who don’t have sex with men.
“Your doctor can provide routine screenings for sexually transmitted infections,” Dr. Lahlou says. “The HPV vaccine is helpful in preventing warts and cancer, no matter what body parts you have or what your sexual orientation is.”
Additionally, she says, screening for anal cancer with an anal Pap test may be recommended; talk to your doctor to find out.
6. Talk with your doctor about fertility.
More and more LGBTQ people are choosing to become parents. Even if you haven’t decided whether you want children, you may want to give yourself options, especially if you’re transgender and considering treatment, Dr. Lahlou says.
“Have a good discussion with your provider about your future fertility plans,” she says. “If having biological children is important to you, there are some things to think about before having hormonal therapy or considering surgery.”
For example, eggs, sperm, and even ovarian and testicular tissue may be preserved.
7. Bring a trusted friend if you need emergency care.
Often, when a person needs emergency care, they are stressed, overwhelmed, confused or even unconscious. That’s why, if possible, everyone should have a loved one or an advocate with them when seeking emergency care. This can be especially important for transgender people.
“Emergency medical care can be difficult,” Dr. Lahlou says. “For example, the name or sex listed on legal documents may not match how a person presents.”
Procedures such as catheterization can be uncomfortable physically and emotionally. A friend familiar with your medical needs and preferences may be able to provide essential information that will help providers give you the most effective and affirming care.
Talk to your doctor about all your healthcare concerns, especially those unique to your gender identity. Or find a provider near you.