Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities

Publication Date: June 25, 2024
Last Updated: June 25, 2024

Position Statements and Recommendations

The American College of Physicians recommends that gender identity and gender expression, which are independent and fundamentally different from sexual orientation, be included as part of nondiscrimination and antiharassment policies. The College encourages medical schools, hospitals, physicians' offices, other medical facilities, and employers to adopt gender identity and gender expression as part of their nondiscrimination and antiharassment policies.
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The American College of Physicians recommends that public and private health benefit plans include comprehensive gender-affirming care and provide all covered services to transgender and gender-diverse persons as they would all other beneficiaries.
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ACP supports access to evidence-based and clinically indicated gender-affirming care that is provided in line with the medically accepted standard of care using an informed consent model.

a) ACP urges policymakers to uphold access to evidence-based health care services, care, resources, and information. ACP strongly opposes political considerations in determining medical standards of care such as through the use of state medical boards or other politically appointed positions in all levels of government.

b) ACP opposes criminal and civil liability for physicians and other health professionals who provide or assist patients in obtaining evidence-based and clinically indicated gender-affirming care.
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ACP supports additional research and scientific inquiry into gender-affirming care to improve care for transgender and gender-diverse people.
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The American College of Physicians affirms the definition of “family” should be inclusive of those who maintain an ongoing emotional relationship with a person, regardless of their legal or biological relationship.
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The American College of Physicians encourages all hospitals and medical facilities to allow all patients to determine who may visit and who may act on their behalf during their stay, regardless of their sexual orientation, gender identity, or marital status, and to ensure visitation policies are consistent with the Centers for Medicare & Medicaid Services Conditions of Participation and The Joint Commission standards for Medicare-funded hospitals and critical-access hospitals. ACP urges hospitals and medical facilities to adopt policies that ensure all patients regardless of gender identity receive equal and timely access to care, a safe care environment, and the protection of patient privacy.
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The American College of Physicians supports civil marriage rights for same-sex couples. The denial of such rights can have a negative impact on the physical and mental health of these persons and contribute to ongoing stigma and discrimination against LGBTQ+ persons and their families.
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The American College of Physicians supports data collection and research into understanding the demographics of the LGBTQ+ population, historical and contemporary causes of LGBTQ+ health disparities, and best practices in reducing these disparities. ACP urges physicians, health care facilities, hospitals, public health entities, and policymakers institute these best practices once identified.
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The American College of Physicians recommends medical schools, residency programs, and continuing medical education (CME) programs must incorporate LGBTQ+ health into their curricula, policies, and programs, with the goal of improving LGBTQ+ health and health care. Internal medicine physicians should be familiar with gender-affirming care and care standards to help connect patients with the appropriate specialty care.

a) ACP supports full funding for medical education; training; and diversity, equity, and inclusion (DEI) programs that does not impose funding restrictions or exclusions on the basis of their LGBTQ+ health educational and training offerings.

b) ACP asserts institutional undergraduate medical education (UME) and CME funding policies should not restrict physicians in learning, teaching, or otherwise pursuing LGBTQ+ health education, research, and training.

c) The College supports programs that would help recruit LGBTQ+ persons into the practice of medicine and programs that offer support to LGBTQ+ medical students, residents, and practicing physicians.
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The American College of Physicians opposes practices that aim to change an LGBTQ+ person's sexual orientation, gender identity, and/or gender expression (i.e. “gender identity change efforts,” “conversion,” “reorientation,” or “reparative therapy”).
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The American College of Physicians supports continued reviews of blood donation deferral policies and the development of non-discriminatory, evidence-based deferral policies that take into account a comprehensive assessment of the risk level of all individuals seeking to donate, which may result in varying deferral periods or a lengthened or permanent deferral on blood donation. ACP opposes a categorical restriction on blood donation from men who have sex with men (MSM) and other people who have sex with MSM.
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ACP asserts that all people should be able to live openly in a manner consistent with their sexual orientation and/or gender identity without discrimination or harassment. ACP affirms that public policies should protect the civil rights of LGBTQ+ people and uphold one's ability to participate in public life as consistent with one's gender identity, including access to public facilities and activities, government services, and other basic human services and activities.

a) ACP affirms the health benefits of participation in athletics and encourages participation and inclusion of all members of society in sports. ACP acknowledges that determinations for transgender athletes to participate in gender-segregated sports occurs infrequently and that broad policies may create unwarranted instances of discrimination. ACP encourages institutions to examine each case individually, taking into account the unique circumstances. ACP calls for additional quantitative research to better understand transgender athlete participation in gender-segregated athletics, with a focus at the highest competitive levels of each sport to ensure safety and fairness of play.
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ACP opposes explicit restrictions on educational content that includes sexual orientation and gender identity. ACP encourages efforts to incorporate evidence-informed gender identity and sexual orientation education within society.
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities

Authoring Organization

American College of Physicians

Publication Month/Year

June 25, 2024

Last Updated Month/Year

June 26, 2024

Supplemental Implementation Tools

Document Type

Other

Country of Publication

US

Document Objectives

Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient–physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D008913 - Minority Groups, D054525 - Minority Health, D000069576 - Health Equity

Keywords

health disparities, health equity, health disparity, health care equity, LGBTQ+, minority health

Source Citation

Serchen J, Hilden DR, Beachy MW; Health and Public Policy Committee of the American College of Physicians*. Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities: A Position Paper From the American College of Physicians. Ann Intern Med. 2024 Jun 25. doi: 10.7326/M24-0636. Epub ahead of print. PMID: 38914001.