Lesbian, gay, bisexual and transgender people may face barriers to health care, especially if they live in rural areas, according to new research from West Virginia University.

A study published in the Journal of Gay and Lesbian Social Services by Zachary Ramsey, a WVU doctoral candidate, found that LGBT patients may face health issues and complications because of their sexual or gender orientation. Health care providers were asked open-ended questions such as “what does LGBT mean to you?”

The study included researchers who study the LGBTQ population at universities in California, Michigan, Pennsylvania and Texas as well as doctors in Pennsylvania, Virginia and West Virginia.

About 20% of Americans live in rural areas, but according to the Association of American Medical Colleges, only 11% of physicians practice there. So with few doctors serving rural communities, the LGBTQ population in those areas may not have many options for health care.

The study “was looking at LGBTQ health, from the perspective of researchers and health care providers,” said Ramsey. “Their understanding really leaned into the discussion of health care and the barriers to getting health care and everything that entails.”

Ramsey said that health care providers often assume their patients are straight and identify with the sex given at birth.

“One of the biggest barriers is the idea that physicians will go in with this heteronormative mindset that their patient is cisgender and heterosexual,” he said. “It puts a lot of burden and stress on the patient, to have to open up.”

Ramsey used the example of a lesbian patient. Many providers ask female patients if they are pregnant. However, Ramsey pointed out that many lesbians are not in partnerships that could lead to pregnancy. Some patient may fear “outing” their sexual orientation in a potentially dangerous environment. Instead, he suggests providers ask open-ended questions to build trust and remove all bias.

He said that knowing a patient’s sexual orientation segues into important conversations about their sexual health, mental health and social aspects of their life. In the case of a transgender patient who was born female, identifies as male, but has not undergone gender-affirmation surgery, an open question could help a doctor realize that the patient is due for health screenings such as mammograms or pap smears.

Michael Trujillo, an assistant professor in the psychology department at Carnegie Mellon University, who has studied bias in the LGBT population but was not involved in this research, agreed with the premise of the study and the health barriers LGBT members face.

“It's important to recognize that we even have to think about how people who come from a diversity of genders have very different experiences,” he said. He suggested that a way to provide open ended conversations with patients is by asking about the sexual health history of every new patient.

Ramsey found that LGBT people face barriers from health insurance companies as well as from health care providers. Some insurance companies refuse to provide medication or cover certain procedures due to gender, his research found, which can cause health issues with hormones and mental stress.

Despite these findings, Ramsey seemed hopeful about new medical providers. He said there is already a shift in ethics in medical schools.

His advice to medical professionals is to be receptive and open to patients, without making assumptions: “Let them talk to you and be receptive to what you hear. Don't assume that you understand their social life. Just let them speak to you and learn from them that way.”

Alecia Taylor: ataylor@post-gazette.com.

First Published: July 24, 2022, 10:00 a.m.