It can be tough, so here’s some help.
Once, at a medical appointment, I saw a nurse who seemed unable to wrap his head around the fact that I was sexually active but not on birth control. I wasn’t sleeping with cisgender men at the time; I didn’t need pregnancy protection. Even though I explained this, he prodded me with more questions about my sexual orientation than needles to draw my blood.
I’m a queer, white, cis woman with access to money, transportation, insurance, and other resources that allow me immense privilege. I’ve still had trouble finding doctors and other medical professionals who act as LGBTQ+ allies. To me, a medical LGBTQ+ ally is well-versed in the correct language to describe my sexuality, doesn’t automatically assume I’m straight just because I’m femme, doesn’t say or do offensive things when I correct them, is committed to understanding how my sexuality might influence my health, and generally treats me with respect.
The National Institute on Minority Health and Health Disparities has identified the LGBTQ+ community as a “health disparity population” due, in part, to our lowered health care access. Unfortunately, some of this comes down to LGBTQ+ patients avoiding medical treatment due to past discrimination and fear of stigma. When LGBTQ+ people belong to other marginalized groups, such as being a person of color or having a disability, it only becomes more difficult to find accessible, non-biased care.
It shouldn’t be this hard. Not only because access to affordable, quality health care should be a human right, but also because LGBTQ+ people are at greater risk for a variety of health threats. These include depression, suicide, substance abuse, breast cancer, heart disease, and HIV/AIDS, depending on the specific community in question.
Unfortunately, even the health care we do get sometimes falls miles short of the compassionate, dignified sort we should receive.
Finding decent and affordable health care in America is a challenge for many people, regardless of their gender identity or sexual orientation. Being LGBTQ+ can just make it harder.
Outdated misconceptions about gender identity and sexual orientation have no place in medicine, but they can run rampant. Liz M., 33, a queer, disabled, and non-binary person, tells SELF of “the nurse practitioner who asked ‘how I became a lesbian’ while her hands were inside my intimate parts.”
Even with the best of intentions, medical professionals can make assumptions that lead to mistakes. Leah J., 21, is a non-binary LGBTQ+ speaker and activist with polycystic ovary syndrome (PCOS), a hormonal disorder that is traditionally seen as a condition that only affects women. “Navigating [seeing] an ob/gyn as a non-binary person is very difficult,” Leah tells SELF, explaining that people in doctor’s offices have misgendered them. Leah also has yet to see an intake form that offers “non-binary” as a gender option (or provides space to write in an answer), they add. Then there’s the thorny matter of how medical professionals talk about Leah’s condition, which causes the body to make an excess of testosterone. “I’ll grow extra hair on my face. My voice might be lower. [Doctors have assumed] it’s something I want to fix, that I want to change,” Leah says.
Sometimes it simply comes down to medical professionals’ lack of familiarity with the specific health issues at play for their LGBTQ+ patients. After a dental procedure left me with bloody gums, I asked my dentist and ob/gyn if there was an increased risk of STI transmission during oral sex on people with vaginas. Both doctors fumbled over their words, leaving me without a clear answer.
So, how does the LGBTQ+ community find a safe space to seek medical treatment free from judgment, assumption, and in the worst cases, harassment and even assault?
There are various resources out there for LGBTQ+ people to find supportive primary, sexual, and mental health care.
Here are a few places to start:
- The Human Rights Campaign’s 2018 Healthcare Equality Index (HEI) surveyed 626 medical facilities across the nation to see which provide patient-oriented care for LGBTQ+ people. (The survey evaluated areas such as staff training in LGBTQ+ services, domestic partner benefits, and patient/employment non-discrimination.)
- The HEI designated 418 of those facilities as “LGBTQ Healthcare Equality Leaders” because they scored 100 points, indicating that they’ve made a concerted effort to publicly fight for and provide inclusive care. An additional 95 facilities got “Top Performer” because they received 80 to 95 points.
- You can look through the full report to learn about the survey and see how various health centers and hospitals performed. The Human Rights Campaign also has a searchable database of 1,656 facilities they’ve scored (including those from past years and some that have never participated at all). Here’s a map laying out where those facilities are, too.
- Another great resource is the GLMA (Gay and Lesbian Medical Association) provider directory, Bruce Olmscheid, M.D., a primary care provider at One Medical, tells SELF. The providers in the directory have agreed to certain affirmations listed on GLMA’s website, such as: “I welcome lesbian, gay, bisexual, and transgender individuals and families into my practice and offer all health services to patients on an equal basis, regardless of sexual orientation, gender identity, marital status, and other non-medically relevant factors.”
- Planned Parenthood has long been fighting the battle to provide affordable sexual and reproductive health care for all. On their LGBT Services page, they explicitly state their commitment to delivering quality care no matter a person’s gender identity or sexual orientation. Of course, while this policy is excellent, Planned Parenthood has many health centers. The level at which staff reflects the written policy can vary from location to location. With that in mind, you can find a local center here.
- GBLT Near Me has a database of local resources for LGBTQ+ people, including health-related ones.
- This great Twitter thread serendipitously went viral as I was writing this story. The person behind the account, Dill Werner, notes that you might be able to find therapy services through your local LGBTQ+ center, your state’s Pride website, or by specifically Googling your location and the words “gender clinic.”
- One Medical of New York City put me in touch with an LGBTQ+ general practitioner with quickness and ease. One Medical is a primary care brand that offers services in eight metropolitan regions: Boston, Chicago, Los Angeles, New York, Phoenix, San Francisco, Seattle, and Washington, D.C. Enter your location here to find nearby offices.
- You can use the website to find One Medical doctors who specialize in LGBTQ+ care,” a One Medical representative tells SELF via email. If you click “Primary Care Team” at the top of the site, you’ll see a dropdown labeled “Interests” with an “LGBT Care” option. (One thing to note: One Medical is a concierge service with a membership of $199 a year, although the fee is not mandatory, so you can ask your local office about waiving it.)
- If you’re in New York City, Manhattan Alternative is a network of sex-positive health care providers committed to affirming the experiences of LGBTQ+ people, along with those in gender non-conforming, kink, poly, and consensually non-monogamous communities. If you’re not in NYC, try searching for a few of those keywords and your city, like “sex-positive therapist in Washington, D.C.”
- You can also try Googling “gay doctor” or “LGBTQ+ doctor” in your area, Dr. Olmscheid says.
- This isn’t specifically about doctors, but we’d be remiss to leave it out: If you or someone you know is LGBTQ+ and having a mental health emergency, organizations like The Trevor Project offer crisis intervention and suicide prevention specifically for LGBTQ+ people. You can reach their 24/7 hotline at 866-488-7386. They also have a texting service (text TREVOR to 202-304-1200) and an online counseling system. (The texting is available Monday through Friday from 3 P.M. to 10 P.M. ET; the online counseling is available every day of the week at the same times.)
- Trans Lifeline is another incredibly valuable hotline. It’s run by transgender operators in the United States (877-565-8860) and Canada (877-330-6366) who are there to listen to and support transgender or questioning callers in crisis. While the hotline is technically open 24/7, operators are specifically guaranteed to be on call from 10 A.M. to 4 A.M. ET every day. (Many are also there to talk off-hours, so don’t let that keep you from calling.)
- “Leverage your community. Ask friends or colleagues if they’ve had positive experiences with their doctors. It’s important to keep the conversation going,” Dr. Olmscheid says.
Of course, all of this might lead you to a list of doctors who don’t accept your insurance, possibly driving up the cost of your care. In that case, Liz has a strategy for working backwards. “If none of my friends know someone good, I start by going into my insurance page and [seeing] who’s in-network,” Liz says. “Are they publicly or visibly identifiable as someone with at least one marginalized identity? Then they might understand that prejudice, even in medicine, is a thing.”
You might feel all set once you’ve found a doctor. But if you’re still not feeling comfortable, you can try calling the front desk with questions.
“I don’t always feel people who advertise as LGBTQ+-competent [actually] are,” Kelly J. Wise, Ph.D., an NYC-based therapist specializing in sexuality and gender who is trans himself, tells SELF. Doing a bit more digging may help ease your mind.
Leah Torres, M.D., an ob/gyn based in Salt Lake City, advises calling the office to ask questions before booking an appointment. You can try asking if the office sees or attends to LGBTQ+ people, Dr. Torres tells SELF. (Dr. Torres is a SELF columnist.) You can also ask more specifically about their experience with people of your identity if you like. If the receptionist doesn’t have an immediate answer for you and doesn’t seem concerned about getting one (or does, but no one follows up with you), that might tell you something about the care the office provides. (Although sometimes the doctor is great with LGBTQ+ issues, and the staff isn’t as familiar. “One of [medicine’s] pitfalls is that the office staff isn’t always trained,” Dr. Torres says. “Having a staff that’s able to set aside their own assumption and bias is important.”)
You can also look through the office’s reviews on resources such as Yelp and ZocDoc. Even if there aren’t any pertaining to LGBTQ+ people in particular, you may get a better feel for how they treat people in the potentially vulnerable spot of trying to look after their health. Finally, consider looking into what sorts of community events the office has participated in, the charitable contributions they’ve made, and the social media presences of the office and the specific provider you might see.
Once you’re face to face with your doctor, their allyship (or lack thereof) might become clear pretty quickly.
Your doctor’s office should be a safe space to explain anything they need to know in order to take excellent care of you, including various aspects of your identity. When they ask what brought you in to see them, that’s a great time to lead with something like, “I have sex with other women, and I’m here for STI testing,” or “I’m dealing with some stress because I’m non-binary, and the people in my office refuse to use my proper pronouns.”
But remember that the onus is really on the doctor to navigate the situation properly, not you, Wise says. Here are some signs they’re committed to doing so:
- They ask what your pronouns are, or if you tell them before they ask, they use the correct ones.
- If they mess up your pronouns, they apologize.
- They ask assumption-free questions such as, “Are you in a relationship?” rather than, “Do you have a husband?”
- They also don’t assume things after you express your identity, such as thinking you’re there for STI testing just because you are bisexual.
- If their body language and/or facial expression change when you mention your identity, it’s only in affirming ways, such as nodding and smiling.
- They admit when they don’t have the answers. “You don’t want the person who is like, ‘I know everything’. You want someone who knows when they have to ask a colleague,” Dr. Torres says. As an example, Dr. Torres, who doesn’t have many transgender patients, tells those undergoing hormone therapy that she will discuss their care with an endocrinologist.
What if a doctor screws up and doesn’t apologize or otherwise doesn’t offer compassionate, comprehensive care?
“Our medical system hasn’t caught up with how evolved our gender and sexual identities are,” Leah says. “A lot of people just aren’t educated.”
If your medical provider does do something that makes you uncomfortable, you might freeze up and not know how to respond. That’s OK. However, if you feel safe enough, try to advocate for yourself in that moment, Wise says. You can try correcting them by saying something like, “I actually don’t date men” or, “As I mentioned, my pronouns are ‘they/them.’” Depending on how comfortable you feel being direct, you can also straight up say something like, “That was extremely unprofessional.”
If you don’t feel you’re in a position to speak up but you want to leave, do or say what you need to in order to get out of there. Maybe it’s exiting the room instead of changing into a dressing gown and proceeding with an exam, or even pretending you got a text and need to attend to work immediately. Whatever you need to do is valid
However you respond in the moment, writing a Yelp and/or Zocdoc review after your appointment or sharing your experience on social media is really up to you. You might feel compelled to warn other LGBTQ+ patients, Wise says, but only do this if you really feel OK with it—it’s not a requirement. (Especially if you’re concerned it might out you before you’re ready.) Dr. Torres also notes that you can file a complaint with the office or hospital’s human resources department. Another option: Get in touch with your state’s medical board to report the episode.
As you can see, there are plenty of options at your disposal if you want to spread the word about a medical professional who isn’t an LGBTQ+ ally. But if all you want to do is move on and find a provider who treats you with the care you deserve, that’s perfectly fine, too.
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