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  • Jun 28, 2017

New Study Led by CHA Resident Explores Unmet Health Needs of LGBTQI Patients

LGBTQI patients want better communication with doctors about their health need

CAMBRIDGE, Mass. — A study published online today by the Journal of Homosexuality found that LGBTQI patients want doctors to make it easier for transgender patients to access hormone therapy.

Traditionally, providers have required that patients attend psychotherapy or dress in a manner consistent with their gender identity before hormone therapy or surgeries are provided. Focus group participants in this study suggested this strategy of "gate-keeping" might exclude patients from decisions about their own health care. "Hormone therapy gives a person a way to have a body that reflects their sense of their own gender," explained Dr. Alison Alpert, lead author and an Internal Medicine resident at Cambridge Health Alliance who began this research as a medical student at the University of Vermont Larner College of Medicine. "Doctors should remove any obstacles to receiving this therapy."

Patients also described experiences during which doctors were unwilling or unable to talk about behaviors which are often looked down on, such as sex work, intravenous drug use or silicone injection, a dangerous practice by which silicone is directly injected into lips, hips, buttocks and chests in order to create curves for transgender women and others. A willingness to discuss these behaviors may lead to more open dialogue and opportunities for reducing harm.

The study's investigators held focus groups comprised of 48 LGBTQI patients in 4 U.S. cities. Participants were asked to describe experiences with doctors and barriers they face to receiving effective, compassionate care.

In 2014, the American Association of Medical Colleges (AAMC) created a list of provider competencies to address providing appropriate care to LGBTQI patients. However, this study's findings contrast with the AAMC's recommendations. For example, the AAMC competencies only parenthetically mention hormone therapy and do not address providers' role in deciding whether a particular patient should receive hormones. Moreover, the AAMC does not mention silicone injection, sex work, or other experiences of LGBTQI people.

The study suggests that current guidelines developed by national organizations may not be in line with what LGBTQI patients need.

This may in part because of differences in demographics of national organizations compared to community members. Eileen CichoskiKelly, PhD, a paper co-author and Director of Educational Instruction and Associate Professor of Family Medicine at the University of Vermont Larner College of Medicine, noted, "A strength of the study was that it included a diverse group of LGBTQI patients: one-half of the participants were people of color and two-thirds were transgender or genderqueer, not fully identifying as male or female." These demographics, may differ considerably from those of national bodies overseeing groups of providers, like the AAMC.

"Performing research that involves directly talking to patients, particularly marginalized patients, is the best way to create standards of care that truly address their needs," said Dr. Aaron Fox, co-author and Associate Professor of Medicine and a Clinician-Investigator in the Division of General Internal Medicine at Albert Einstein College of Medicine/Montefiore Medical Center. "We hope that this paper will be the beginning of a trend toward including patients' input into provider competencies."

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"What Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Patients Say Doctors Should Know and Do: A Qualitative Study." Alison Alpert, MD, MFA, Eileen CichoskiKelly, PhD, and Aaron Fox, MD, MS. Journal of Homosexuality. Vol. 64, issue 10. Published online on June 28, 2017.

For a copy of the study and/or to schedule an interview, please contact David Cecere at 617-591-4044 or dcecere@challiance.org.

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