This post contains discussions of medical trauma, bigotry, denial of gender-affirming care, murder, suicide, depression, AIDS, and death. Please take care of yourself and skip this post if you find any of these topics triggering.
The week of March 18th marks the twenty-second occurrence of National LGBTQ Health Awareness Week—an occasion championed by the National Coalition for LGBTQ Health, which was founded in 2000. This year’s theme is Vital Vibrant Voices, chosen to shine a light on the voices that advocate for and raise awareness about the many unique challenges that gender, sexuality, and relationship diverse (GSRD) people face when it comes to their personal and communal health.
When discussing health of any sort, it is crucial to approach it from a holistic perspective. Any complete picture of a person’s ‘health’ must consider the physical, mental, and emotional aspects of health, three interconnected areas that cannot be viewed in isolation. All three of these areas affect GSRD people in unique ways that are often ‘brushed under the rug,’ so to speak. There are countless issues that demand our attention, but this National LGBTQ Health Awareness Week, we’ll outline some of the most prevalent ones that the community has faced, or is still facing.
Physical health in relation to GSRD people can immediately bring to mind any number of things. The most ‘obvious’ might be the AIDS pandemic, which according to the World Health Organization has killed 40.4 million people across the world to date. AIDS first came into prominence in the 1980s, surfacing primarily in Masculine GSRD communities. Due to this, AIDS was quickly written off as a ‘gay’ disease. Many people in power ignored the crisis at best, and outright called AIDS a ‘divine punishment’ at worst. Either way, little to nothing was done to help as the pandemic spread, and GSRD people had to take helping into their own hands. This explicit and institutionalised homophobia and transphobia was responsible for the deaths of countless GSRD people across decades—and others of all orientations. Recently, with the development of PREP and strides in the creation of an HIV vaccine, things have improved immensely, but access is still an issue. Those who cannot afford such lifesaving treatment or lack access to education on prevention are still suffering and dying—many of them part of marginalised groups and/or living in poor countries.
Another physical health issue that has recently risen to prominence—especially in the United States and the United Kingdom—is the constant restriction of access to gender affirming care for trans, non-binary, and gender diverse people, especially minors. Myths and conspiracies about this lifesaving treatment have spread like wildfire, and have resulted in an ever-growing slate of restrictions being passed into law. To put it briefly; puberty blockers (one of the most common medical interventions for minors) are very safe and reversible, and are life-saving for trans, non-binary, and gender diverse kids. Puberty blockers have been in use since the 1980s, and, although they have not yet been approved for the treatment of gender dysphoria, they were approved by the FDA in 1993 to treat instances of premature puberty. There are, of course, side effects like almost any medication, but that should be a discussion between the patient and their doctor, like almost any other procedure. Other procedures—like various surgeries—are almost exclusively performed on adults, and should be their own personal medical decision.
In addition to these two prevalent challenges, GSRD people face issues in many other areas of physical health. For instance, lack of access to affirming and inclusive sexual health education—proven to improve health across the board—is a massive challenge both in Canada and abroad. In Canada, required teaching varies from province to province, and while guidelines tend to be reasonable and based in science, it’s impossible to be certain they are followed and taught in an empathetic, understanding way. In addition, wait times for gender-affirming surgeries in Canada have skyrocketed thanks to both increased demand and COVID-19, and in 2022 the Ontario Medical Association reported wait times of 12 to 24 months for upper surgery, and up to 65 months for vaginoplasty. Finally, it would be remiss to not mention the horror caused by targeted or random hate crimes, which can lead to trauma, injury or death. These five specific areas of GSRD physical health barely scratch the surface of the inequalities at play, but in the broadest sense, considering them all provides an overview as to the current state of physical health care.
Mental and emotional health—while often regarded as unimportant not just for GSRD people, but every person—are of equal importance of physical health, and are often intrinsically connected. For example, a Canadian Medical Association Journal study in 2022 reported that trans and non-binary people have a risk of suicidal thoughts five times higher than the general population, and are seven point six times more likely to attempt suicide. The Trevor Project—a wonderful organisation based in the US—reported in 2023 that 41% of GSRD youth seriously considered committing suicide in the past year, including roughly half of transgender and non-binary youth. Bi+ folks and people of colour likewise report an increased likelihood of considering or attempting suicide. Taking steps to lower this risk can be simple: for transgender and non-binary people, studies have indicated that puberty blockers, or even something as simple as being accepted and having loved ones use preferred names and pronouns, has a profound effect on reducing the risk of depression and suicide in youth. An accepting home and/or circle of loved ones likewise shows incredible mental health benefits. As draconian policies continue to be proposed and implemented—particularly in some American states—it’s likely that this massive crisis will only continue to worsen.
Other mental health issues likewise show far more prevalence among GSRD people. According to Rainbow Health Ontario, rates of depression, anxiety OCD, phobias, substance abuse, and self-harm are far higher than those of the general public, and GSRD people are additionally twice as likely to develop post-traumatic stress disorder. Stigma, discrimination and bigotry, high rates of homelessness, familial rejection, forcibly changing one’s presentation to reduce risk, sexual abuse, and hate crimes all contribute to these statistics. The most important factor in improving mental and emotional health for GSRD people is having a supportive, loving community, as well as having low internalised homophobia—which is another factor that can lead to issues in mental health. Having a healthy relationship with GSRD culture and having a supportive environment are both key factors in reducing internalised homophobia and thus poor mental health in GSRD youth.
Across all these areas of health, bigotry pervades. Finding an affirming counsellor, GP, or any sort of specialist can be very challenging—especially in rural areas, where access to services can already be limited. Two previous studies in the US reported that 89% of Lesbian and Bi+ women received a negative response when they came out to their doctor. It’s also important to recognize that those with intersectional identities such as First Nations or POC individuals already face significant medical barriers due to racial discrimination, which adds on and intertwines with discrimination on the basis of identity. Economic status—for example, according to the CMHA Ontario, half of gender diverse people live on less than $15 000 a year—also plays a massive role. We must approach the issue of GSRD health by considering all of these factors that play into the inequalities the community faces, and understanding that health is not, and has never, been one size fits all.
If you’re struggling, you can reach out to the Canadian Suicide Crisis Helpline at 9-8-8, or you can contact the folks at the Trevor Project, either on the phone at 1-866-488-7386 or by text at 678-678.
