Dermatologic Care for LGBTQ+ Patients

Providing adequate and sensitive care to diverse individuals is crucial in every medical specialty, including dermatology. LGBT patients may face certain dermatologic issues that are particularly relevant, and it’s important that providers address any disparities and follow best practices. There are approximately 10 million lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals in the United States.¹ These patients face multiple health care disparities, and awareness of specific issues to this population can help providers practice culturally competent care.²

Health disparities

Such disparities can include lack of appropriate preventative care, higher risk of certain infections, a lack of safe, sensitive providers, and a lack of social services to help them get appropriate care.² These patients may see a dermatologist for specific skin issues, STIs, or skin issues related to gender-affirming surgery or hormone therapy. Providing culturally competent care to this population means following best practices, which involves creating an inclusive model and approach to care.

As a patient, knowing how your dermatologist can provide inclusive care can be empowering and helpful, especially if they open the door for discussion.

Some basics to know

Providing culturally competent dermatologic care for LGBTQ+ patients starts with the basics: getting terminology and pronouns right. It’s a good idea for providers to ask any patient what pronouns they use, regardless of their sexual orientation or gender identity. If there’s any doubt or uncertainty of what terms to use, asking the patient which language they prefer or use is always a good thing. Language and terminology are fluid, and not everyone prefers the same words.¹ Dermatologists and other care providers should also know the basics, like the difference between gender and sex, and what the terms sexual orientation, sexual behavior, gender expression, and gender identity all describe. If you think they might be misunderstanding you, be specific or explain, if you feel comfortable.

Why does sexual orientation or gender identity matter in dermatology?

While on the surface the information may seem irrelevant, it’s not. Men who have sex with men may have a higher risk of getting certain infectious diseases, including methicillin-resistant Staphylococcus aureus infections and non-infectious conditions, including skin cancer.³ Women who have sex with women experience health care disparities in treating STIs, including human papilloma virus (HPV), which can show up on the skin.³

Transgender individuals may experience skin issues during gender affirmation transition from surgery or hormone treatment.³ Knowing a patient’s sexual orientation or gender identity can help dermatologists provide comprehensive, supportive medical care and appropriate referrals, if need be, that are tailored to the patient’s needs. It can also help providers in considering differential diagnoses or risk factors, preventative treatments and guidelines, and in providing sensitive physical exams.¹

Considerations for transgender individuals

During gender affirmation transition or post-surgery, transgender individuals may have an array of issues for which they seek dermatological care, and ensuring that culturally sensitive and appropriate care is given is paramount. Such issues can include hair removal or growth, acne or scar removal, or masculinizing/feminizing of the face, via fillers or surgery.¹ Awareness of the process of transitioning and the various kinds of procedures involved for these patients can help make the process a little easier.

Staying aware of best practices

Disparities in health care exist for the LGBTQ+ population, and it’s important that health care professionals, including dermatologists, be aware of best practices to help treat patients. This includes awareness of terminology, considerations in transitioning, and specific health issues this population may face, including guidelines from the National LGBT Health Education Center.¹ If you feel comfortable with your doctor, talk with them honestly about your sexuality and gender identity – this can help them provide the best care possible for you.