Gender Affirming Care should be driven by evidence-based medicine – not politics

It is time for business leaders to stand up for transgender and nonbinary youth.

Co-authored by Jessica Halem and Colin Quinn. March 21st, 2023

The first gender affirming surgery was done 100 years ago. The American Psychiatric Association resolved that homosexuality was not a mental illness 50 years ago. Both watershed moments happened because patients advocated for themselves and medicine adapted. We’re doing it again today.

Now and for the past seven years, many in healthcare have been working to enforce the intent of the historic ruling in the summer of 2016. That’s when the Office for Civil Rights of the United States Department of Health and Human Services issued Section 1557 of the Affordable Care Act prohibiting discrimination in healthcare settings. The Obama and Biden Administrations have since affirmed that the rule includes sexual orientation and gender identity. 

The intent of Section 1557 is not only to ensure the (passive) absence of discrimination in our industry but also the (active) inclusion of safe, accessible, and appropriate healthcare for all people, including gay, lesbian, bisexual, and transgender patients. But right now best practices in medical care for LGBTQ+ people, specifically those who are transgender and nonbinary are being rolled back in a multi-front, coordinated attack in some locations. We have to see this attack clearly, and fight it soundly.

In total, 315 anti-LGBTQ bills were introduced in state legislatures in the United States in 2022. Of those bills, 29 were signed into law. This year, the numbers are growing and attacks are unrelenting: 420 anti-LGBTQ+ bills have already been proposed this year alone. (Read more in the February 2023 report from Movement Advancement Project (MAP), an independent, nonprofit think tank.) Every time there’s a new headline, concerned and supportive providers, payors, schools, and HR & benefits professionals ask what they can do to ensure quality healthcare is uninterrupted? They want to move forward, not back. 

The promising news is that medical research is on their side. Medically necessary care for adults and youth who are transgender and gender-diverse has been researched and endorsed by the American Academy of Pediatrics, American Psychological Association, and the American Medical Association. These experts – and many more – have spent years putting together a body of work to guide us. We hope everyone will take the time to read from these trusted sources. 

And, as members of the LGBTQ+ community, and as healthcare leaders, we are here to maximize healthcare access for all, support the understanding of the latest clinical guidelines, share best practices for coverage and patient care, and develop services to navigate people to the care they need when they need it. Debate may continue, but three things must happen. 

First, the medical experts and community should guide this conversation. They should lead clinical and policy decisions regarding patient care and overall health and wellness. After all, decisions to be made about medical care involve two people: the medical professional and the patient. There are two seats at the table. We can strengthen the conversation that happens there, making sure it’s informed with data, research, and led by providers who are equipped with appropriate training. But those seats belong to patient and medical professional, not politicians.

Second, transgender medicine must continue to advance, with investment in medical research, data, and clinical training. The medical community reports that providers are woefully underprepared. We have to increase the number of providers in every state who are trained on protocols and best practices like those offered by the The World Professional Association for Transgender Health, to provide high quality, accurate, and affirming care. 

Third, employers, people leaders, and organizations can and should play an active role, so employees feel seen and supported, and have access to the benefits they deserve. How, exactly? Businesses can shore up their LGBTQ+ community, while we continue to make the winning arguments to stop these bills, which are uninformed by medical evidence. (We have precedent on our side: 91% of Anti-LGBTQ+ bills proposed failed in 2022 and 24 pro-equality bills were passed). Some ideas:

• Strengthen or start an LGBTQ+ Employee Resource Group (ERG), and support programming that reaches families with kids who are LGBTQ+.

• Be an Ally. Send a message on March 31st for International Transgender Day of Visibility. A short, positive, company-wide email and social media post, like: “This company stands with our transgender and nonbinary employees, their families, and our customers.”

• Conduct a quick benefits equity assessment to ensure your benefits are inclusive and everyone knows how to use them. Review and revamp Benefits’ Travel Policies so members can take advantage of them as needed, especially now.

• Contact local and state government officials to express your company’s support for LGBTQ+ people of all ages. Remind them to follow the evidence and medical research from trusted sources.

• Do more in your industry. Ask yourself: What can your business and peer businesses uniquely do to champion the rights of all people to express the full range of diversity of gender, families, and relationships?

Bottom line: Every American deserves access to safe, high-quality, affirming healthcare - and a workplace that ensures it. If business leaders respect the wisdom of patients and the expertise of medical professionals, they’ll get it.

Author Biographies:

Colin Quinn serves as the President of Included Health Communities at Included Health. As a member of the LGBTQ+ community, he understands firsthand the challenges members of the LGBTQ+ community face navigating the healthcare system. He is passionate about raising care equity for underserved patient populations. He received his undergraduate degree in Finance at Butler University and has an MBA from Stanford’s Graduate School of Business

Jessica Halem, MBA, has worked for over two decades in the LGBTQ+ health equity space as the Executive Director of the Lesbian Community Cancer Project in Chicago; the LGBTQ+ Director at Harvard Medical School; Board of Directors of the Tegan and Sara Foundation; and now as the Senior Director of Eidos, the LGBTQ+ Health Initiative at University of Pennsylvania.

History & Inclusive Language for LGBTQIA+ Patients

When health care organizations partner with Violet, clinicians not only access education to upskill and benchmark cultural competence but also access exclusive webinars presented by thought leaders.

History & Inclusive Language for LGBTQIA+ Patients, presented by Jessica Halem, MBA and Violet educator. Enjoy the discussion and Q&A providing in-depth knowledge about inclusive communication strategies.

Want to learn more about Violet? Visit us at https://www.joinviolet.com.

Abortion Rights made LGBTQ Health Possible

Everything I know about being Queer, I learned from Abortion.

I was a teenager in Ohio during the late 80s obsessed with Abortion. It was all I talked about. I was on the Pill, I went to my first March on Washington, I spent my entire High School Graduation speech talking about “Choice”. I got to college in the early 90s in Westchester County right after their local abortion clinics had been bombed by Operation Rescue. I spent my weekends in the cold rain escorting patients in and out of the Clinic protecting them from the violence of the protesters. I Marched on Washington again. My politics and my identity always started with Abortion.

Abortion was how I could imagine my Queerness.

Living and breathing Abortion possibilities meant everything else was possible, too. In questioning the restrictions and shaming of Abortion, you had to get at what the world imagines for women. And if you get at what the world imagines for women, you have to question your sexuality, too. Questioning the category of woman and everything that was tied to it – heterosexual sex, birth, and marriage – is liberating. The promise of abortion releases women from stereotypes about what it means to be a woman. Abortion being controlled by others is the exact same premise as women being controlled by others. Access to abortion on demand and without apology released me from the constraints of womanhood, including heterosexuality. Fighting for Abortion made me Queer.

It was a natural step to AIDS activism where the well-organized ACT UP movement had so clearly and passionately connected the dots to access and drugs and information about medicine and healthcare. It was clear we had to fight back against any form of shame or stigma for needing lifesaving drugs and information. I knew this because of Abortion. I knew that our bodies were our own to love and save and protect and heal and those who knew more about them must help us – with no judgement about how we got here in the first place. We had to always separate our personal journey around “mistakes” and “risk” and “should have known better” from a medical professional’s ability to provide a fix.

Then there was the Lesbian Feminist Cancer Movement. The women who had worked so hard protecting Abortion and then fighting for AIDS drugs were getting older and getting diagnosed with Cancer. Here they personally met up against the systems they knew all too well from fighting on behalf of everyone else. Doctors that judged them for being gay, or fat, or smoking, or all three at once. Cancers that should have been caught earlier with screenings or prevention. But we had just spent the previous 20 years witnessing medicine’s sexism and homophobia and cold and unjust attitude toward Abortion and HIV. You think I’m gonna voluntarily get a mammogram now?

So we didn’t. We couldn’t. We couldn’t trust any of them. And we started our own clinics and our support groups and our educational campaigns. We healed each other. We buried each other. And we looked around and said enough is enough. We joined with our brothers who started their own AIDS clinics and we became a larger movement that we now call LGBTQ Health. We knit it all together.

The healthcare system was sick – not us. The political system was broken – not us.

We built new worlds together. We played and imagined. We celebrated and partied. We raised our own money. We had our own bars. We kept articulating what it meant to open our body up to possibilities of health and life and demand a system that did, too. That understood us.

In the early 2000s, my then partner came out as transgender. My program director at the Lesbian Community Cancer Project came out as transgender. My queer community was once again changing and growing with the power and promise of personal liberation. Imagining their bodies into existence. New names, pronouns, hormones, surgeries. All another step in our goal of making medicine work FOR us and not AGAINST us. A movement of autonomy and joy and bodies of our choosing. Choice was always our mantra.

Everything we knew from Abortion, HIV, and Cancer became our movement for Transgender Health. No longer would we have to suffer in bodies or lives prescribed by the world upon our birth.

We could live as we wanted. We could bring our inner most thoughts to the surface to be seen and appreciated by all. If we were to truly shed the dogma of heteronormativity – we must also shed gender, too.

Today’s LGBTQ Health Movement is all of us. The fight for Abortion and HIV medicine. Cancer support. Hormones and surgery. It is our right to control our own bodies. It is our fight to make medicine work for us. It is our bond to work across and with our differences to usher in something better for all. We have built a new world and new conversations that I could have never imagined in the 80s, 90s, 2000s. We know more than ever.

The Abortion fight is our fight. Not because we are women or not; or have a uterus or not; or have sex that could lead to pregnancy or not. This is our fight because they are all our fights. We must bring everything we have learned from Transgender Health and HIV and Cancer and access and shame and stigma to benefit Abortion. Because there is no LGBTQ Health anywhere without Abortion Rights everywhere.

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American Medical Technologists

As frontline workers, allied health professionals are key for creating a welcoming environment for LGBTQ+ patients and workers, which may boost health outcomes and provide greater healthcare resources.

Read the blog here: https://americanmedtech.org/Blog/Blog-Post/a-space-for-everyone.

Tegan and Sara Foundation Share Findings From Survey of LGBTQ+ People and Covid-19 Vaccine Roll-out

Vaccine Hesitancy for LGBTQ+ People Affected by Previous Bad Experiences with Healthcare System

Tegan and Sara, award-winning musicians and founders of the Tegan and Sara Foundation, are sharing the results of their most recent healthcare survey to understand experiences with the COVID-19 vaccine within the LGBTQ+ community. The survey was developed by the Tegan and Sara Foundation in collaboration with health communications firm Entree Health and reviewed by researchers at SurveyMonkey, a leader in agile software solutions for customer experience, market research, and survey feedback, with contributions from physicians and healthcare experts specializing in LGBTQ+ healthcare.

Key findings include:

• The LGBTQ+ population in the US is highly accepting of the COVID-19 vaccine

• More than 2 in 3 respondents are already vaccinated

• 84% of the remainder want to get the COVID-19 vaccine “as soon as possible”

• Gender minority people are more likely to want to get the vaccine as soon as possible, but are less likely to have already been vaccinated

• Wanting to protect others is the most important reason LGBTQ+ people have gotten or will get vaccinated

• Previous bad experiences with the healthcare system is an important driver for LGBTQ+ people who say they will wait to get vaccinated

Tegan and Sara, award-winning musicians and founders of TSF, said:

“We’re passionate about healthcare access for LGBTQ+ people, and always have been. As advocates, we have focused on healthcare because we see how access to quality and affirming care affects our community. Most studies aren’t asking queer people the questions that we need to get better care.”

“That’s why we launched the LGBTQ+ COVID-19 Vaccine Attitudes Study, to better understand the needs and concerns of our community on the pandemic and vaccine efforts. Without these perspectives, healthcare can’t truly be inclusive - which will have repercussions for a long time. We hope the readers of this study can use these results to make meaningful change in their own communities.”

Tegan and Sara and the Foundation encourage all members of the LGBTQ+ community and beyond to review the results of the survey, which can be accessed at the LINK.

Survey Background

COVID-19 has a unique impact on LGBTQ+ people and other marginalized communities (including people of color and rural communities). LGBTQ+ Americans are more likely to live in poverty and lack access to adequate medical care, paid medical leave, and basic necessities - all of these issues have been exacerbated by COVID-19.

The completely-confidential survey, developed with leading LGBTQ+ healthcare experts, was designed to be sensitive to the needs of the community. While current gender was asked in this survey, there was no question asking sex assigned at birth. These questions are often asked insensitively and create unnecessary barriers for gender nonconforming, nonbinary, and transgender people. The survey did include 17 gender and sexual orientation choices, including the option to write-in or choose not to disclose.

To obtain a holistic understanding of the queer community, TSF prioitized survey outreach and distribution to community-level organizations and underserved groups, to make sure that survey response included the diverse voices of the LGBTQ+ community. Key to this outreach was TSF’s Community Grants partners, which reach 39 grassroots organizations across the U.S. and Canada.

About Tegan and Sara Foundation

Tegan and Sara Foundation (TSF) was founded in 2016 by Tegan and Sara to address inequalities faced by LGBTQ+ women. TSF’s mission is improving the lives of LGBTQ+ women and girls. This mission is founded on a commitment to feminism and racial, social and gender justice. Learn more about TSF’s work and flagship programming at the OFFICIAL WEBSITE.

About Tegan and Sara

Tegan and Sara have openly identified as queer since the beginning of their career in 1998, and have been outspoken feminist advocates for LGBTQ+ equality and gender justice. The essential message that underpins their worldview and identity is inclusion. The Tegan and Sara Foundation is an extension of their work, identity and longstanding commitment to supporting and building progressive social change.

As musicians, Tegan and Sara have sold more than one million albums, and have received seven Gold certifications, one Double Platinum certification, three Juno Awards, two Polaris Prize nominations, and a Grammy nomination. They have performed on some of the world’s biggest stages, from the 2015 Oscar Telecast to major festivals such as Coachella, Lollapalooza and Glastonbury.

About Entrée Health

Entrée Health is a communications and medical strategy agency serving the life sciences industry and focused on the belief that people deserve access to the healthcare they need. It helps companies secure insurance coverage for their brands, communicate to physicians and patients about the coverage and financial aspects of biopharmaceuticals, and create materials that help overcome coverage hurdles. Entrée Health’s proprietary, integrated data enables them to optimize market access and value strategy and create award-winning communications for drug, device, and diagnostics manufacturers. Reducing the impact of health inequity is a key component of their work; Entree Health has partnered with the Tegan and Sara Foundation since 2018.

Watch the full video of the webinar in collaboration with the National Academies of Sciences, Engineering, and Medicine and the Kaiser Family Foundation to discuss the state of LGBTQ+ Communities in the COVID-19 Pandemic.

American Medical Association LGBTQ & Allies Caucus June 2021 Meeting highlights

Jessica Halem, MBA, award-winning educator, advocate, communicator and consultant on LGBTQ+ issues delivered a keynote address aimed at recentering foundational concepts in LGBTQ health. Ms. Halem explored historic milestones, current demographics, public policy achievements and challenges, and ongoing challenges and opportunities for improving physician awareness and understanding of LGBTQ+ health and well-being and the importance of centering patients in charting the course for the future.

Caucus participants engaged in discussion to assess the impact of the pandemic on LGBTQ+ health, raise awareness of related AMA work and the vital importance of stakeholder alliances. Central to this work is including and elevating the diverse voices and experiences of LGBTQ+ patients, medical students, physicians, and community care and service professionals.

Read more HERE.

Gay to the Bone: LGBTQ Orthopedic Surgeons and Career Success

Recorded on Feb 10, 2021 — a lively panel discussion with LGBTQ Orthopedic Surgeons and trainees as they discuss thriving in a specialty often perceived as the least open to diversity and inclusion.

This special event was co-moderated by Jessica Halem who spent six years at Harvard Medical School as the inaugural LGBTQ Outreach and Engagement Director where she successfully increased recruitment of LGBTQ medical students from 4% to 15% of the class. Her co-moderator was Aliya Feroe, MPH who is and MD Candidate at Harvard Medical School.

Panelists include:

Jaime Bellamy, DO; Adult Reconstruction Orthopaedic Surgeon; Fort Bragg, North Carolina

LTC Jaime Bellamy received her Bachelor of Science in Chemistry (2001) and Masters of Science in Biology (2004) degrees from Missouri State University and her Doctorate of Osteopathy (2008) degree from Kansas City University of Medicine & Biosciences. She joined the Army through the Health Professions Scholarship Program in 2004. After medical school, she completed a Transitional Internship at Brooke Army Medical Center, San Antonio. After Internship, she was a Flight Surgeon and deployed to Iraq in support of Operation Iraqi Freedom in 2009. She did her Orthopaedic Residency at Brooke Army Medical Center from 2010 to 2015 and Fellowship in Adult Reconstruction at Emory University, Atlanta from 2015 to 2016.

She is stationed at Ft. Bragg, NC as an Orthopaedic Surgeon at Womack Army Medical Center where she serves as the Chief of the Orthopaedics Service. LTC Bellamy deployed as an Orthopaedic Surgeon to Afghanistan on a Forward Surgical Team in support of Operation Freedom Sentinel in 2018.

LTC Bellamy is Board Certified by the American Board of Orthopaedic Surgeons. She is an Emerging Leader of the American Orthopaedic Association and Fellow of the American Association of Hip and Knee Surgeons and American Academy of Orthopaedic Surgeons (AAOS). In the AAOS, she serves on the Diversity Advisory Board committee. LTC Bellamy is on the Editorial Board and an Elite Reviewer for the Journal of Arthroplasty. She is a social media ambassador for the AAOS, Society of Military Orthopaedic Surgeons, and Women in Arthroplasty and the Social Media Editor for Arthroplasty Today.

She has been married to her wife Kalah since 2014 after the repeal of DADT and DOMA. They have a hobby farm with various rescued animals.

FIND LTC BELLAMY ON TWITTER HERE: https://twitter.com/jaimelbellamyDO.

Chloe EH Scott, MD MSc FRCSEd; Consultant Hip & Knee Surgeon; Royal Infirmary of Edinburgh

Chloe Scott is a consultant hip, knee and trauma surgeon and an NHS Scotland Research Fellow working at the Royal Infirmary of Edinburgh, United Kingdom. She is the 2020 recipient of the Hunter-Doig medal from the Royal College of Surgeons of Edinburgh. She completed medical training and an MD in unicompartmental knee biomechanics at the University of Edinburgh in addition to a master’s degree in orthopaedic engineering from Cardiff University. Her current research interests include arthroplasty outcomes, periprosthetic fractures, post-traumatic osteoarthritis, finite element analysis and knee biomechanics. She serves on the executive committee of the British Association for Surgery of the Knee and on the editorial boards of the Bone and Joint Journal and Bone and Joint Research where she is also an associate editor for hip and knee papers. She has been involved in projects to increase visibility and diversity in orthopaedics in both the UK and the US and is active on Twitter.

FIND DR. SCOTT ON TWITTER HERE: https://twitter.com/EdinburghKnee.

Steven B. Orr, MD; Clinical Assistant Professor in the Department of Orthopaedic Surgery; NYU Grossman School of Medicine

Dr. Steven Orr is a Clinical Assistant Professor in the Department of Orthopaedic Surgery at the NYU Grossman School of Medicine. He is a fully trained orthopaedic surgeon and a fellowship trained hand and upper extremity surgeon, specializing in conditions of the hand, wrist, forearm, and elbow.

A native of Atlanta, GA, Dr. Orr graduated magna cum laude from Vanderbilt University. He completed his medical school training at Duke University School of Medicine, where he was awarded the Anthony V. Seaber Student Fellowship from the Piedmont Orthopaedic Foundation for his research in the field of tendon engineering.

Dr. Orr moved to New York to complete his orthopaedic residency training at Hospital for Special Surgery. While at HSS, Dr. Orr’s research focused on optimizing imaging techniques of the complex joints of the hand and wrist, and he received grants from both the American Foundation for Surgery of the Hand and the Orthopaedic Research and Education Foundation for this work. He was also instrumental in the development and adoption of a patient safety and quality improvement initiative promoting early detection of and rapid intervention for new post-operative nerve complications in joint replacement patients.

During his hand and upper extremity surgery fellowship at NYU Langone, Dr. Orr’s training encompassed the full spectrum of hand surgery, including microsurgical and arthroscopic techniques. While in fellowship, Dr. Orr turned his research efforts to identifying and addressing implicit bias as it pertains to hand surgery. Dr. Orr is thrilled to retain an affiliation with NYU Langone and to continue serving as an educator to residents and fellows.

Beyond his clinical, research, and educational endeavors, Dr. Orr is a member of GLMA: Health Professionals Advancing LGBTQ Equality (previously known as the Gay & Lesbian Medical Association) and a member of the NYU Langone Orthopaedic Diversity and Inclusion Committee. In these roles, Dr. Orr works to promote healthcare equality and representation for LGBTQ patients and providers.

Outside of his work in healthcare, Dr. Orr enjoys singing, writing songs on his Yamaha keyboard, staying fit, spending time with friends and family, eating great food, and traveling the world with his husband.

FIND DR. ORR ON INSTAGRAM HERE: https://www.instagram.com/stevenborrmd/.

Navigating Your Rainbow Path: Being Queer in Academia

University of Texas PRIDE Health Pop-Up Research Institute 2020

This panel, moderated by Jessica Halem, explored the barriers and facilitators encountered by successful LGB-identified academic clinicians and educators. This conversation is meant to be broadly applicable and audience Q&A will follow.

Speakers:

• Jessica Halem, MBA, LGBTQ Diversity, Equity, and Inclusion Expert and Consultant

• Chase Anderson, MD, Child Psychiatry Fellow, UCSF

• Robin Reister, MD, Internal Medicine Primary Care Program Director, Dell Medical School

• René Salazar, MD, Assistant Dean for Diversity and Professor of Internal Medicine and Medical Education, Dell Medical School

U.S. medical schools boost LGBTQ students, doctor training

Exact numbers of LGBTQ medical students and doctors are unknown. In 2018, the AMA added sexual orientation and gender identity as an option for members to include in demographic profiles the group compiles. Of the 15,000 doctors and students who have volunteered that information so far, about 4% identify as LGBTQ. That’s similar to Gallup estimates for the general U.S. population, although LGBTQ advocates believe the numbers are higher and rising as more people are willing to “out” themselves.

This past fall, Harvard’s entering class of medical students was 15% LGBTQ, a milestone that is no accident.

Associated Press, U.S. medical schools boost LGBTQ students, doctor training, By Lindsey Tanner, February 20, 2020

LGBTQ&A: Building a Foundation for Understanding and Care

June is LGBTQ Pride Month, a good time to better understand the health and wellness concerns of the lesbian, gay, bisexual, transgender and queer community. A panel of experts from Harvard Medical School will share research and experiences with LGBTQ patients, answer questions about health disparities, and discuss the importance of social supports and how to foster an inclusive environment that is welcoming to all.

The 'Pronoun Go 'Round': Our Changing Language Around Gender

How we define gender is shifting, and so is the way we talk about it. Most notably, the way we use gender pronouns. For example, he/him for a man, she/her for a woman or they/them for someone who doesn’t identify with either gender. It’s a change that has come easy for some, but for many people it’s an adjustment that can be anxiety-inducing as they worry about saying the wrong thing. And then there are still others who simply don’t get why there is a need for a change.

Under the Radar with Callie Crossley, November 13, 2018

Who Gets to be the Authority on LGBTQ Medical Terms?

[Reposted from the blog Paging Dr. Rainbow]

"Hello! I have a question for the experts: Do any medical organizations have established guidelines against the usage of the term "homosexual"? I know GLAAD, The Associated Press, the NYT and many media sources and universities advise against usage of the term, but do we still use it in a medical setting? I had a lecturer today say that MSM, MSW, WSW, WSWM, etc. are incorrect and to use the terms, "heterosexual, homosexual, and bisexual" when giving a case presentation. I challenged the idea and was told they are "medical terms" and we always use the "medical terms." So, help a student out!"

-PA in training seeking better answers

Dear PA in training seeking better answers:

First off, let me say how pleased I am to hear that you have cases with LGBTQ patients in your education. It wasn’t that long ago that cases like this weren’t available, discussed, or appreciated as an important part of patient care. We have come a long way.

Language that describes the LGBTQ community has changed and will continue to change. But language is just a tool to use to describe what we observe, learn, or hear from our patients. So, everyone will have to be a bit flexible as we continue to listen better and illicit more information from patients. In fact, at the turn of the last century in the US, the “medical term” was “invert” which represented the conflation of gender and sexual orientation and then the word “homosexual” became more widely used. Both were terms used more with derision and judgement than care from the medical community. So, there’s that history.

Today, we know “nonbinary” is a widely used word to describe a gender identity or expression that some would have called “androgynous” just a few years ago. And of course, transsexual was a word we used to use as well, but now use the word transgender. I am sure there are cases and textbooks that haven’t been updated accordingly.

So, finding an authority on “medical terms” seems to be the issue with your lecturer. I can say with authority -- we do not use the word “homosexual” to describe patients anymore. It actually isn’t a word that people use to describe themselves or does a good job of describing behavior that needs to be discussed.

What is key here is appreciating two distinct differences in discussing sexual orientation – first, language that describes the SEXUAL BEHAVIOR of our patients and secondly, language that patients use to describe themselves. What we still like about MSM is that it describes sexual behavior and doesn’t assume identity. We know plenty of men have sex with other men and are married to women. We also know plenty of women describe themselves as lesbians but have had or will have sex with men.

In terms of who else is an authority on medical terms for the LGBTQ community – the NIH now uses the phrase “sexual and gender minorities” and the hospitals you will work with have electronic health records that probably already have SOGI (sexual orientation and gender identity) data collection in place and use words like “gay” and “cisgender”.

Medical terms are only authoritative if they are helpful in understanding, valuing, and supporting the patients you are being trained to care for in the future.

If this analysis doesn’t work, attached here are guidelines from Harvard Medical School here.

-Jessica Halem, MBA, LGBT Program Director, Harvard Medical School

Thank you Jessica for your awesome contribution to our blog! What an amazing conversation starter you have been!

Today Is the Day: A Call to Action for Providers During LGBTQ Pride Month

The LGBTQ community needs health care providers to open their eyes and commit to our health, well-being, and healing. We need them to be aware of our history and the reasons why so many of us don't trust that doctors and nurses will treat us with respect. We need them to refuse to go along with historic or religiously based attitudes that belie our humanity. We need them to embrace their role as a positive, powerful force in mitigating the discrimination and shame felt by patients. Seeing and healing this foundational pain is the first step to our health and wellness today.

The BodyPro for the HIV/AIDS Workforce. HIV Case Management and Social Work. Viewpoints. June 12, 2018

The Future of Lesbian Health

"Strong Women," Curve Magazine, April/May 2017

By Jessica Halem

Since 2001, I have been an LGBT health advocate. I learned the most about this type of advocacy from my five years as the executive director of the Lesbian Community Cancer Project in Chicago. It was there that I met lesbians like Peggy, who died of ovarian cancer. She was without her partner at the end because her homophobic parents flew in and seized control of her care. And then there was Shannon, who died of breast cancer. She was an artist, didn’t have health insurance, and had never had a mammogram—until it was too late. My dear friend Lisa died of lung cancer. She ignored the signs for months because she was busy organizing our support groups, taking care of her partner and everyone but herself.

Lesbian health is about all of this—homophobia, access to health insurance, and the challenge of putting ourselves first in a busy, stressful world. But to hear most doctors talk, you would think tackling our BMI (Body Mass Index) would magically solve all these problems. Obesity is often the first thing out of their mouths when it comes to lesbian health—but it shouldn’t be.

What we really should be talking about is strength. How are we building strength in our bodies, our muscles, our bones? How are we building strong hearts, relationships, and communities? In what ways are we already strong, and where do we need to get stronger?

Me? I'm 44 years old and keep suffering from lower back pain. As soon as my doctor described how core strength would support my back, it all made sense. Suddenly, it wasn’t a conversation about weight but about strength. Many of us avoid going to the doctor because we don’t want to talk about our weight—especially with a straight doctor. Prioritizing a strong back and core was exactly what I needed to motivate my feminist lesbian soul. 

I propose centering lesbian health—our health—on strength and resilience. Lesbians building muscles. Lesbians with strong hearts. Lesbians whose backs can bear the weight of it all. Resilience is the ability to bounce back or quickly adjust to change. As lesbians, we should see this as a crucial and powerful goal. Resilience is built on strength.

I now work at Harvard Medical School, where I get to influence the next generation of doctors. I asked a woman on our faculty to tell me what she thought about the idea that strength is a powerful key to health. Dr. Jennifer Potter is an associate professor of Medicine at Harvard Medical School, the director of Women’s Health at Fenway Health, and an out lesbian. Dr. Potter says, “Building physical strength helps build psychological resilience and a sense of empowerment,” affirming that there is a strong connection between the mind and body.

I asked her directly how we could shift the focus away from weight with our doctors. Her advice was to say something like this at your next appointment: “I am aware that my body size is outside the ‘ideal body weight’ range for my height. I’m looking for a provider who can help me focus on wellness by helping me increase my strength or endurance, rather than focusing on diet or calories, which I’ve never found helpful. Is that something you think you can do?”

Imagine if our health care providers asked us to describe how we take care of our bodies and minds in a world that makes doing so a challenge—or if doctors communicated that they understood how homophobia directly impacts our health. Dr. Potter wishes you would tell your doctor more, like what brings you joy and what challenges you to go forward. Imagine you and your doctor talking about strategies for building physical and emotional strength, brainstorming together about potential solutions to life’s challenges.

Remember, self-care is an act of resistance. We are lesbians, we are strong—we got this.

Rebecca Fox pictured above. Photo Credit: Bayla Bryski

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