LGBT Wellness Guide

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 doctor 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 LGBT community tends to avoid primary care because they feel stigmatized and don’t want to have uncomfortable conversations. The providers at North Memorial Health are culturally competent and routinely care for the LGBT population. In fact, there are several open LGBT providers who welcome all customers and specialize in Lesbian, Gay, Bisexual, and Transgender health.

With higher rates of diabetes, heart disease, smoking, high blood pressure, and obesity, the LGBT 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 both men and women 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 LGBT population; anabolic steroids, hormones and club drugs can also increase the risk of heart disease.

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

Colon Heath: Begin screening at age 50 and continuing until age 75.

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

Cervical Cancer: Cisgender women and transgender men who have a cervix should undergo a pelvic exam and pap smear every three years in their 20s and pap smear with human papillomavirus (HPV) test every five years from age 30 to 65.

Breast Health: Women age 50 to 75 should have a mammogram every two years. Those over 75 should talk with their provider about the frequency that is right for them. A breast exam should occur every three years in your 20s and 30s and every year for women 40 and older. All women should know how their breasts normally look and feel and report ANY breast change promptly to their doctor.

Prostate Health: Most prostate cancers grow slowly and don’t cause health problems. The digital rectal exam is used to screen for prostate cancer. Most transgender women still have a prostate and still need routine screening for prostate cancer. Talk to your doctor about the best screening approach for you.

Tobacco use is the leading cause of avoidable death in the US with nearly double the prevalence of tobacco use in the LGBT population. We all know smoking is bad for you but quitting is not easy.

 

Additional LGBT health guidelines:

Men who have sex with men (MSM) 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. Men who receive high-risk, receptive anal intercourse with multiple sexual partners have 80 times greater risk for anal cancer, a rate comparable to cervical cancer for women. Your risk is elevated when immunosuppressed by treatments for HIV as well as steroids. In addition, HPV has been linked to anal cancer.

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

Women who have sex with women (WSW): Your overall risk for many issues is still based upon lifetime number of male sexual partners. It’s important to discuss past sexual behaviors, prior to “coming out,” as most WSW have had male sexual partners.

HPV can be transmitted skin to skin.

It’s important to clean sex toys using soap and water as well as bleach.

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

The World Professional Association of Transgender Health (WPATH) sets the standards of care today for transgender individuals. North Memorial Health Clinic providers in Brooklyn Center and Maple Grove follow WPATH standards of care with transgender health issues related to hormones, surgery, lifestyle, and more.

Transgender men taking exogenous testosterone are more likely to have high levels of cholesterol, hypertension and coronary artery disease so routine screening is important.

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.

Transgender men have a high incidence of polycystic ovary syndrome which is a risk factor for ovarian cancer and other metabolic issues. Exogenous testosterone can also increase your risk for ovarian and endometrial cancers, further underscoring the need for routine pelvic exams.

Transgender women commonly take estrogen and spironolactone. There is not good data on the long-term effects of exogenous estrogen but the general guideline is to decrease estrogen supplementation as transgender women age. Estrogen use increases your risk of cardiovascular disease and high cholesterol so routine screening is key.

Your risk for breast cancer increases with age and the longer you take estrogen; it also increases if you were older when you had your first child 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.

Your prostate is easy to forget after sex reassignment surgery and low levels of testosterone inhibit the growth of prostate cancer. Routine digital rectal exams are important.

 

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 LGBT community feels welcomed and can receive quality care along with other members of their 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.