It’s not uncommon for people to put off seeking medical care. The process can be stressful, especially if you feel your health care provider doesn’t really understand you and your special concerns. That can be even more true for some patients, such as those in the LGBTQ+ community.
In this Q&A, Barbara Warren, PsyD, Senior Director for LGBT Programs and Policies in Mount Sinai’s Office for Diversity and Inclusion, explains how to find a provider with specific experience in LGBTQ+ health issues, how that can help alleviate stress and improve health outcomes, and details Mount Sinai’s approach to offering compassionate care. Dr. Warren, who leads Mount Sinai’s implementation of lesbian, gay, bisexual, transgender and gender diverse (LGB/TGD) culturally and clinically competent health care, is also an Assistant Professor of Medical Education at the Icahn School of Medicine at Mount Sinai.
What are some of the biggest health challenges for the LGBTQ community?
One of the biggest challenges for LGB/TGD consumers is finding a provider and finding a health system that is both LGB/TGD clinically and culturally competent, and being able to go anywhere in that system, to any provider, to any setting, and feel safe, to feel that you are being treated both effectively and with compassion. This is something that we have taken lots of strides to make possible throughout the Mount Sinai Health System.
Why is it important to find a provider who has experience with LGB/TGD health issues? What can they offer?
One of the things that LGB and TGD patients should look for is a provider who understands their needs. Being lesbian, gay, bisexual, transgender and gender diverse isn’t a health problem in itself. But many LGB/TGD people have health issues that are related to something we call “minority stress.” Minority stress is any kind of stress that people can undergo that affects us both psychologically and physiologically—when we either have experienced or anticipate experiencing discrimination, bullying, or even violence. This is something that many people in the LGB/TGD community live with. Even if they themselves have had not had personal experiences, they know that there is a possibility of discrimination, and of misunderstanding by health care providers. This can create anxiety. When sustained over time, this anxiety can create health problems, not just psychological or health behavior issues.
“It is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects,” says Barbara Warren, PsyD.
Can You Give an Example?
Sometimes if we are experiencing many stressors, we may overeat, or drink more alcoholic beverages, or not get enough rest or sleep. Increased and sustained anxiety in response to stressors can interfere with decision-making, memory, and effective functioning. Sustained stressors create a physiological response that leads to increased levels of cortisol in our bodies. Cortisol is known as the body’s stress hormone. It governs key body functions but too much cortisol can lead to a number of health problems, for example increased cardiovascular risk. It is important to note that stressors may be personal or interpersonal in our lives in terms of our current life circumstances like the loss of a loved one, or loss of a job or housing.
Recent threats to LGB/TGD safety and equity across many states in the form of legislation to deny gender-affirming care, banning books and public education inclusive of both racial and LGB/TGD history and representation, banning drag or any other behaviors that don’t conform to rigid and outdated binary gender stereotypes, have all been recent sources of what we are calling “minority stressors.” They have had the effect of increasing rates of depression, anxiety, and suicidality, especially among LGB/TGD young people. So it is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects.
How do you find a provider who has this experience?
At the Mount Sinai Health System, we have a number of ways. First we have web pages that give you information and resources, including our LGBT web page. There are a number of other organizations that can help, including the Gay and Lesbian Medical Association and the World Professional Association for Transgender Health. You can email us at LGBTinfo@mountsinai.org, and we will answer your email and make a direct referral to providers around the Mount Sinai Health System that have special expertise.
In addition, we have a number of programs and a number of practitioners specializing in certain aspects of LGBT health. For example, our Institute for Advanced Medicine, which started as our HIV/AIDS program to serve the large gay and bisexual population, specializes in some of the health care issues that are facing LGB/TGD people. There are five locations throughout the city. Our Center for Transgender Medicine and Surgery is a national model for services to support undergoing a gender transition and TGD affirmative primary care. We take LGB/TGD health very seriously at Mount Sinai and offer ongoing training for all of our providers, our front-line workers—everybody from our security guards to our surgeons to create a safe and welcoming environment for our LGB/TGD patients, families, visitors, and employees.