Dear Dr. Eva,

How about a special GLBT health column for Gay Pride?

Reader

Dear Reader,

Here you go. My sources for this column are from the website of GLMA, the Gay and Lesbian Medical Association: glma.org.

Dr. Eva

It is difficult to address the health concerns of GLBT people as a group because the "GLBT" umbrella covers six distinct groups of people: gay men, lesbians, bisexual women, bisexual men, transwomen and transmen.  Still, there are some issues that are important for all six groups. This column will address seven of those issues. Future columns will cover issues specific to transwomen and transmen, issues specific to lesbians, and issues specific to men who have sex with men.

Communicate with your healthcare provider

People's health risks vary according to sexual behavior. Cross-gender hormones also cause specific health risks. To provide you with the best care, your clinician needs to know your sexual orientation and gender identity. Once you inform your provider, he or she should ask you specific questions relating to your orientation or gender identity. A complete sexual history is essential for comprehensive health care. Be honest about your behaviors. If there are some things you are unwilling to disclose, ask yourself why - if you are embarrassed by your behavior, there's a good chance it's dangerous. If your provider does not seem comfortable with your sexual orientation or gender identity, look for another provider.

Tobacco

GLBT people use tobacco at much higher rates. Smoking is guaranteed to damage your health and shorten your life. Long-term tobacco-related health problems include emphysema, lung cancer, throat cancer, bladder cancer, heart disease, strokes, high blood pressure, and many other serious problems. Short term consequences of smoking include bad breath, stained teeth, smoker's cough, and the expense of smoking. Free resources for smoking cessation are available by calling 1-800-quitnow or searching 1-800-quitnow online.

Fitness (Diet and Exercise)

GLBT people, like all Americans, are prone to obesity. Obesity causes high blood pressure, diabetes, and arthritis of the hips and knees. Obesity is also associated with increased rates of heart disease, breast cancer and other cancers, and with premature death.  Regular exercise and a low-fat, low calorie diet are the way to prevent obesity and also the way to cure it. We all find it hard to make time for exercise, but just 20 minutes of brisk exercise three times a week will significantly decrease your risk of heart disease and move you towards a healthier lifestyle. Brisk exercise means your heart rate increases and you are a little out of breath, and not able to carry on a conversation while exercising.

Substance Use/Alcohol

GLBT people use illegal drugs and alcohol more than the general population. Some GLBT people's social lives are largely limited to a small, tightly knit group of friends. When everyone in the group is drinking or drugging, it normalizes the behavior and can serve as an excuse not to change. Regular use of drugs or alcohol eventually leads to problems at work and in relationships. In time, alcohol use leads to nerve damage, brain damage, liver failure and death. Alcohol also increases the risk of heart disease and cancer. Alcohol and drugs cause many deaths through driving while intoxicated and violence against oneself and others. Cocaine can cause abnormal heart rhythms and heart attacks. Amphetamines cause premature aging and gum disease resulting in tooth loss. Twelve-step programs are free and have been effective for many people in stopping and staying off alcohol and drugs. Thee are specific GLBT groups in both Alcoholics Anonymous and Narcotics Anonymous.

Depression/Anxiety

Depression and anxiety affect GLBT people at a higher rate than the general population. This is at least in part due to effects of homophobia and transphobia, and the rejections many GLBT people experience from their families and religions. GLBT people in their teens and twenties have a much higher risk of attempting suicide than straight people of the same age and sex. Young GLBT people with signs of depression need close monitoring; suicide threats should always be taken seriously. When accessing mental health care, it's important to make sure that the counselor or therapist is affirming (not just neutral) towards GLBT people. Depression is easily treatable with effective medications: seek help sooner, not later.

STDs

All sexually active people are at risk for sexually transmitted diseases. STD's occur at a very high rate in gay and bisexual men. A person can be infected with most STD's without any symptoms. People who are infected without symptoms can still infect their partners.  STD's caused by bacteria and lice are curable with medication. These include syphilis, gonorrhea, Chlamydia, trichomonas, and  pubic lice ("crabs")..  STD's caused by viruses are not curable. These include HIV, Hepatitis A, B, and C, Human Papilloma Virus (HPV), and herpes. Vaccines are available to prevent Hepatitis A, Hepatitis B, and HPV. It has been repeatedly shown that the use of condoms (male and female types) and dental dams reduces the risk of sexually transmitted diseases. The more partners a person has in a year, the more often they should be tested for STD's. People are much more likely to become infected with STD's  when they are intoxicated with alcohol or drugs, when they do not know their partner, and when they meet a partner through the internet.

Intimate Partner Violence

GLBT people suffer from violence in intimate relationships at least as often as the general population. Medical providers, emergency room staff and police are less likely to suspect or ask about intimate partner violence when the partners are the same sex. It is especially difficult for GLBT people to get help if they do not acknowledge being in a relationship.