LGBTQIA+ Wellness Guide

Erik Haugland, MD
Family Medicine, Gender Care, Geriatrics at:
North Memorial Health Clinic - Brooklyn Center
June 30, 2023
2 females holding LGBT rainbow flag

Healthy habits and preventive care are the keys to good health. Along with daily routines to eat healthy, exercise, manage stress, and get good sleep, annual physicals are critical. Seeing your provider once a year for an overall health assessment and routine screenings can help you avoid illness and detect problems early when treatment and a cure are most successful, and most preventive services are covered by health insurance.

The LGBTQIA+ community may tend to avoid primary care because they feel stigmatized and may have had negative interactions with health care professionals in the past. North Memorial Health includes a number of open LGBTQIA+ providers as well as many allies who welcome LGBTQIA+ patients and specialize in Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual health.

Social stigmatization often manifests into physical issues. With higher rates of diabetes, heart disease, smoking, high blood pressure, and obesity, the LGBTQIA+ population has even greater reason to stay up to date on their prevention and early detection.

Preventive health guidelines for people at average risk

Heart Disease is the leading cause of death for everyone in the US. Know your blood pressure and cholesterol numbers and monitor them routinely to minimize your risk. There’s a higher prevalence of hypertension, high cholesterol, and coronary artery disease in the LGBTQIA+ population.

Transgender and Gender Diverse (TGD) individuals taking exogenous hormones may be more likely to have high levels of cholesterol, hypertension, and coronary artery disease, so routine screening is important.

Diabetes is a national epidemic, with rates increasing along with obesity. TGD individuals may be at a higher risk with exogenous hormones. Know your glucose numbers and recheck every three years after age 45, especially if you are overweight.

Colon Heath: Begin screening at age 45 and continuing until age 75.

Bone Health: People with low hormone levels such as postmenopausal cisgender women or gender diverse patients in certain circumstances should begin screening for osteoporosis at age 65, or younger if your fracture risk is high.

Cervical Cancer: Individuals who have a cervix should undergo a pelvic exam and pap smear with human papillomavirus (HPV) test every five years from age 21 to 65.

Breast Health: Recommendations for frequency of mammograms vary. Those over 75 should talk with their provider about the frequency that is right for them. All people with breasts should know how their breasts normally look and feel and report ANY breast change promptly to their provider.

There is conflicting evidence about what impact exogenous testosterone has on your risk for breast cancer. The need for breast cancer screening is based upon the amount of breast tissue you have and your lifetime exposure to higher estrogen levels.

There is not good data on the long-term effects of exogenous estrogen, but the general practice is to decrease estrogen supplementation as transwomen and transfeminine individuals age. Your risk for breast cancer increases with age, the longer you take estrogen, and if you have a family history of breast cancer. Begin breast cancer screening at age 50 if you have at least five years of exogenous hormone therapy. If there is a strong family history, you may consider starting screening earlier and undergoing genetic testing. There is no evidence of an increase in breast cancer due to implants, but implants may impair mammogram accuracy.

Prostate Health: Most prostate cancers grow slowly and do not cause health problems. The digital rectal exam and PSA screening are used to screen for prostate cancer. TGD people who have a prostate still need routine screening for prostate cancer, even though low levels of testosterone are generally thought to inhibit the growth of prostate cancer. Routine prostate health discussions are important. Talk to your doctor about the best screening approach for you.

Sexually Transmitted Infections: STI’s can be spread many different ways. It is important to clean sex toys using soap and water as well as bleach. Your provider may recommend base screening rates for HIV, Hepatitis C and Syphilis depending upon your sexual history and potential risks.

The Hepatitis B vaccination is now recommended for all adults.

HPV infections can be transmitted skin to skin and are thought to be a common contributing factor to anal and cervical cancers. The HPV vaccine is available to everyone up to age 45. Vaccination can help to lower risks of cervical, anal, and head/neck/throat cancers.

Individuals who receive anal sex from people assigned male at birth (AMAB) should have routine anal pap smears every one to three years to screen for anal cancer along with an open discussion with their provider about sexual practices. Your risk is elevated when immunosuppressed by treatments for HIV as well as steroids.

TGD individuals: Your screening recommendations are based on your sexual history and body parts, along with your social, family, and hormonal history.

The World Professional Association of Transgender Health (WPATH) is one of the organizations which helps to set the standards of care today for TGD individuals. North Memorial Health Clinic providers in Brooklyn Center follow current WPATH standards of care with TGD health issues related to hormones, surgery, screening recommendations, and more.

Tobacco use is the leading cause of avoidable death in the US with nearly double the prevalence of tobacco use in the LGBTQIA+ population. We all know smoking is bad for you, but quitting is not easy. You and your provider can discuss tools to help you quit.

Primary care is key

Together with your doctor, you can determine what screenings and prevention plans are right for you. North Memorial Health has created an environment where the LGBTQIA+ community feels welcomed and can receive quality care along with other members of their family, however you define family. You can be confident that routine screenings will be provided by a medical team who will treat you and your family with respect and empathy.

To make an appointment, call 763-581-CARE or schedule online.

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