Examining the Health Data Behind L, G, B, T, Q and + Populations

Jun 9, 2024 | Articles, Justice, Equity, Diversity & Inclusion

As we strive for a more inclusive and equitable healthcare system, it is essential to address the unique health needs and challenges faced by the LGBTQ+ community in California. By examining relevant, data-driven health information and incorporating personal narratives from some members of the—Lesbian, Gay, Bisexual, Transgender, Queer, and others (+) community—we aim to shed light on the disparities, barriers, and triumphs within this diverse population. This article not only highlights critical health data but also amplifies the voices of individuals whose experiences underscore the importance of culturally competent and inclusive healthcare practices.

Lesbian (L)

Lesbian individuals often face unique health challenges that are compounded by societal stigma and discrimination. According to a study by the California Health Interview Survey (CHIS), lesbians are more likely to experience higher rates of mental health issues such as anxiety and depression compared to their heterosexual counterparts. Additionally, they may encounter barriers in accessing reproductive health services, as healthcare providers may lack knowledge about their specific needs.

In terms of physical health, lesbians have a higher prevalence of certain risk factors, such as obesity and smoking, which can contribute to chronic conditions like cardiovascular disease. A study published in the American Journal of Public Health found that lesbians are less likely to receive preventive health screenings, including mammograms and Pap smears, due to perceived or experienced discrimination in healthcare settings.

An interview conducted with member of the lesbian community sheds light on how societal stigma and discrimination have impacted her mental health and specific challenges she and her partner faced as they embarked on their journey to parenthood. From encountering prejudice during initial consultations to navigating a system that frequently fails to recognize and respect their family structure, their journey highlights the critical need for more inclusive and equitable healthcare practices. Through their experiences, they hope to advocate for change and inspire others in the LGBTQ+ community to persist in their quest for family and acceptance.

“Societal stigma and discrimination have significantly impacted my mental health. I often feel anxious about holding hands or showing any affection for my partner in public due to the stares and comments we receive. Remarks like, “Are you really a lesbian? You look so feminine; it’s hard to tell,” are particularly distressing. Additionally, I am hesitant to mention my family in my workplace, fearing that colleagues might label me based on my sexuality. This constant vigilance and concern about others’ perceptions create a persistent undercurrent of stress and anxiety, affecting my overall well-being. However, I have been navigating these challenges my entire life and have developed boundaries to protect myself. I’ve also learned to grow from these negative experiences, turning them into opportunities for personal resilience and strength.

I always assumed that accessing healthcare services in Northern California would be straightforward, especially since I never encountered difficulties in Southern California. However, my recent experience contradicted that assumption. My partner and I were seeking to grow our family and scheduled an appointment for fertility services. During the intake process with the scheduling department, my partner requested an appointment for the fertility department. When she provided my name, “Grace,” the associate inquired if I was female. Upon confirming that I was, the associate responded, “Oh, we do not provide fertility services to gay couples; we only offer these services to male and female couples.” My partner was taken aback and looked at me in disbelief, asking if such discrimination was common in Northern California. This incident highlighted a significant and unexpected challenge in accessing healthcare services as a lesbian couple.  My experiences with accessing reproductive health services has been challenging. As I mentioned earlier, we initially faced difficulties obtaining an appointment for fertility services. After escalating the issue to the grievance department, we were finally granted the appointment. The supervisor assured us that the employee involved would receive better training, but we never received any follow-up on the matter.

One particular incident stands out: the fertility department required us to see a Licensed Clinical Social Worker (LCSW) before initiating fertility services, and we were forced to pay out of pocket $350 for this visit. We were informed that if we did not receive an evaluation from the therapist, we could not proceed. This requirement felt discriminatory, as heterosexual couples would not face such an obstacle. The visit with the LCSW lasted only 20 minutes, during which the therapist remarked, “You both seem like a power couple; I don’t see why you needed my permission.” This experience highlighted the lack of understanding and sensitivity towards our specific needs and added unnecessary stress to an already challenging process.

I recommend that healthcare providers take a proactive approach by having both administrative and clinical team members conduct interviews with past patients to identify and understand the obstacles they have faced. Based on these insights, creating a dedicated task force to develop a comprehensive plan of care specifically tailored for LGBTQ+ individuals would be essential. This task force should focus on ensuring equitable access to services, eliminating discriminatory practices, and providing sensitivity training for staff to foster a more inclusive and supportive healthcare environment.”—Grace G, lovely wife and new mother. 

Gay (G)

Gay men face distinct health challenges, particularly in the areas of sexual health and mental health. Data from the Centers for Disease Control and Prevention (CDC) indicates that gay men are disproportionately affected by HIV/AIDS, accounting for a significant percentage of new diagnoses each year. Efforts to reduce this disparity include increasing access to Pre-Exposure Prophylaxis (PrEP) and promoting regular HIV testing.

Mental health is another critical concern, as gay men are more likely to experience depression, anxiety, and suicidal ideation compared to heterosexual men. The Minority Stress Model explains that the chronic stress resulting from societal discrimination and internalized homophobia contributes to these mental health disparities.

Bisexual (B)

Bisexual individuals often face “double discrimination,” experiencing prejudice from both heterosexual and lesbian/gay communities. This unique stressor can lead to significant mental health challenges. According to research from the Bisexual Resource Center, bisexuals report higher rates of depression, anxiety, and substance abuse compared to their lesbian and gay counterparts.

Healthcare utilization patterns among bisexual individuals reveal gaps in preventive care. A study in the Journal of Bisexuality found that bisexuals are less likely to disclose their sexual orientation to healthcare providers, which can hinder the delivery of appropriate care. This nondisclosure is often due to fears of stigma or misunderstanding.

Transgender (T)

Transgender individuals face some of the most profound healthcare disparities. According to the 2015 U.S. Transgender Survey, nearly one-third of transgender people have had negative experiences with healthcare providers, including verbal harassment and refusal of treatment. This discrimination contributes to significant barriers in accessing both routine and specialized medical care.

Transgender people also face high rates of mental health issues, with nearly 40% reporting suicidal ideation. Access to gender-affirming care, such as hormone therapy and surgical interventions, has been shown to significantly improve mental health outcomes. However, these services are often limited by insurance exclusions and a lack of knowledgeable providers.

To gain a comprehensive understanding of the experiences faced by the transgender community in accessing gender-affirming care, two insightful interviews were conducted. One interview provided the perspective of a transgender individual, who shared their personal experiences and challenges encountered within the healthcare system. The other interview offered a unique viewpoint from the mother of a transgender child, detailing her experience navigating the healthcare landscape to support her son’s journey. These narratives highlight the systemic obstacles, emotional struggles, and the crucial need for improved healthcare accessibility and sensitivity towards transgender individuals and their families.

“My experience navigating the healthcare system as a transgender individual began last year. Initially, I noticed some positive reinforcements, such as my new care team addressing me by my preferred pronouns and carefully walking me through the process. However, this was not always the case when I encountered other staff in clinics or hospitals. Some refused to use my preferred pronouns until I legally changed them, while others were outright rude, making assumptions about the procedures and dysphoria I was facing. Many staff members assumed I would want reassignment surgery, even though I was not dysphoric about my sexual organs. Their jargon and tone often made me feel as if I needed surgery. When I explained to a clinical assistant that I only felt dysphoric about my chest and was considering top surgery, she said verbatim, “I have seen a lot of patients who receive top surgery who have been non-binary or even straight, and feeling dysphoric about your chest doesn’t mean you are transgender. Most transgenders are insecure about their sex organs and want bottom surgery.” I was taken aback by her attempt to diagnose my feelings, which hindered my progress for a long time. Thankfully, I have since found my permanent care team, who have been nothing but supportive and have assisted me in moving forward in my journey.”—A human being trying to live freely and happily.

“My child has suffered from depression & crippling anxiety since they first started thinking they might be transgender. Once they came out and received complete love and support from my husband and myself and saw we supported/advocated for them during all the obstacles and hate they received we saw his personality and light come back a bit. A strong and loving support system, therapy & the gender clinic at SMCH have been the saving grace in our child’s mental health.

Being able to receive care at SMCH Gender clinic has been a missing piece to seeing my son be more comfortable in his own skin, improved his confidence and social anxieties. He still has hard days a couple days a week due to the hate he endures- but surrounding him with love, support, gender clinic, therapy and open communication he is now able to talk through these issues, processes and releases to ensure he doesn’t carry the weight of others’ opinions. He has told us frequently that our unwavering support, advocacy and ability to communicate freely with us makes him feel safe and supported.”—Melissa B, mother of a transgender child. 

Queer (Q)

The term “queer” is often used by individuals who do not subscribe to traditional categories of sexual orientation and gender identity. Queer individuals may face unique health challenges due to the fluid and nonconforming nature of their identities. This fluidity can result in healthcare providers being uncertain about how to address their needs, leading to potential gaps in care.

Research indicates that queer individuals, like other LGBTQ+ groups, experience higher rates of mental health issues and substance abuse. A study by the National LGBTQ Task Force found that queer individuals often feel marginalized within both mainstream healthcare settings and within the broader LGBTQ+ community.

Plus (+)

The “+” in LGBTQ+ encompasses a wide range of identities, including but not limited to nonbinary, asexual, and intersex individuals. Each of these groups faces distinct health challenges and barriers to care. For instance, nonbinary individuals often struggle with a lack of recognition and appropriate medical forms that respect their gender identity. Asexual individuals may encounter misconceptions about their sexual health needs, leading to inadequate care.

Intersex individuals, who are born with physical sex characteristics that do not fit typical binary notions of male or female bodies, often face invasive and non-consensual medical procedures. Advocacy for informed consent and bodily autonomy is crucial for this community.


As we reflect on the diverse experiences within the LGBTQ+ community in California, it becomes clear that inclusive and culturally competent healthcare is not just a goal but a necessity. By understanding and addressing the unique health needs of each subgroup, we can move towards a more equitable healthcare system that honors and respects all individuals. Through data-driven insights and personal narratives, this article aims to foster greater awareness and advocacy for the health and well-being of the LGBTQ+ community.

Charisse Fuller, MS-HCA, is Ambulatory Site Manager for Stanford Medicine Children’s Health, where she leads the strategic planning, implementation, and evaluation of ambulatory health delivery systems for seven Perinatal Diagnostic Center offices, serving 3,000 patients each month. She serves on the CAHL Justice, Equity, Diversity and Inclusion (JEDI) Committee.
Jeremy Hough, FACHE, is Director, Ancillary & Safety Services, John Muir Health, where he is responsible for nutrition services, workplace safety, security, emergency management, and guest services. He chairs the CAHL Justice, Equity, Diversity, and Inclusion (JEDI) Committee.