When I made an appointment for my first physical as a bona fide, unsupervised 18-year-old, I never thought I’d leave feeling more anxious about my health—and doctors in general—than when I went in.
I found the physician by calling the number on the back of my insurance card, figuring it was my best shot at developing a relationship with a provider I could trust. As I sat in the waiting room filling out forms, everything seemed okay. A nurse led me to an exam room to check my weight and vitals, and then the doctor emerged. She asked me a few questions, including some about my period.
When I admitted it wasn’t exactly regular, she said she wanted to do blood work, including a pregnancy test. I laughed and told her there was no way I was pregnant. “I only have sex with girls,” I explained. She gave me a once-over and set her mouth into a thin line. “You never know,” she said. “People say that and then things happen.”
It suddenly felt like the fluorescent lights were beating down on my skin. Was she suggesting I wasn’t really a lesbian? Back then, I was newly out and still learning how to express that part of my identity, so I stayed quiet for the rest of the appointment and never went back.
That was the first time I felt rejected by a person who took an oath to treat patients to the best of their ability, but it wasn’t the last. I’ve had birth control pushed on me (“just in case!”) and more pregnancy tests (ditto) and received skeptical looks from doctors after “coming out” to them. So it’s no surprise that I haven’t had a primary care physician in almost a decade and went to the gyno for the first time ever this year. Or that 15 percent of LGBTQ+ Americans push off necessary doctor visits to avoid discrimination, according to a 2020 survey by the Center for American Progress.
Unfortunately, my doctors’ microaggressions were relatively tame compared to the kind of prejudice intensifying nationwide as states like Arkansas pass laws that allow transphobic or homophobic doctors to refuse to treat certain patients (one new law even threatens fines or jail time for providers who *do* try to help). And as usual, the situation is even worse for LGBTQ+ people who are also BIPOC or disabled, since our health care system favors white hetero patients over everyone else.
Okay, deep breaths, and we’ll get to what you can do about all this soon. First, it’s crucial to understand the biggest hurdles we’re up against just to stay healthy rn.
“If you were to call three medical schools and ask them how many hours of training are devoted to this community, I think zero would be the most common answer,” says A.G. Breitenstein, founder and CEO of FOLX Health, an online LGBTQ+ health clinic. Because LGBTQ+ care is not prioritized in most medical schools, finding a doc who gets you (especially if you don’t live in a city) can feel impossible.
And when a physician knows basically nothing about your health needs, you wind up, at best, spending most of the appointment educating them on things like why you need an STI test even if you’re not in a heterosexual relationship. At worst, you face misgendering, interrogation of your identity, or harmful treatment.
Like some medical professionals, insurers often don’t account for the needs of different gender identities—and in the 28 states that don’t protect LGBTQ+ residents from health insurance discrimination, companies don’t even need to try.
This is super important to be aware of because these companies are the ones that dictate what treatments and procedures get covered for which patients. Some men in the trans community may need pap smears, while some women may need prostate exams—but both groups may be forced to pay in full (or battle with their insurers) just to get these basic services.
Raymond Forbes
Depending on which state you live in, pharmacists can legally decline to fill your prescription for hormone therapy or antiretroviral drugs like PrEP. A therapist can stop working with you after learning about your sexuality. A doctor’s office can make it impossible for you to book an appointment once they find out you’re non-binary.
It’s awful. And it has big ramifications, says Kameryn Lee, MD, vice president of medical affairs at FOLX Health. The LGBTQ+ community is more likely to rate their health as poor, more likely to use the emergency room, and, again, more likely to delay getting care. If you have the time and money, you can try to fight this discrimination in court (it’s possible a judge may decide these laws are unconstitutional). But right now, anyone can call their elected representatives and urge them to support laws that protect LGBTQ+ people (the Equality Act, for one, is currently awaiting a Senate vote). And you can follow the steps at right to get better health care ASAP. —TDH
WHAT NOW? If you feel safe, say something like, “my name is, and I shouldn’t be referred to by any other name.” you could also try, “my pronouns are, and I shouldn’t be referred to by any others.”
WHAT NEXT? Some states consider misgendering a patient on purpose a form of harassment, so (again, if you feel comfortable) you can file a complaint against the facility where it happened or with your state medical board. The latter can determine whether or not the doctor should face fines, probation, or even suspension.
WHAT NOW? Ask others in your community for recs. Then check out the lists of LGBTQ+ friendly primary care docs, dentists, and specialists near you on sites like GLMA, OutCareHealth, and the Human Rights Campaign. A local LGBTQ+ center may even offer care or be able to connect you to it.
WHAT NEXT? When the “nearest provider” is actually really far away, consider telehealth services from Plume, Fenway Health, Planned Parenthood, or FOLX Health (some take insurance, some don’t). Since the pandemic-times CARES Act was passed, you should be able to work with doctors who practice outside of your state for the foreseeable future.
WHAT NOW? It’s okay to remind them if you feel alright doing so, that birth control can help people dealing with issues that have nothing to do with pregnancy prevention—things like PCOS, acne, and severe cramping.
WHAT NEXT? Whether or not you get the prescription, look for an inclusive gyno by using the ob-gyn filter on OutCareHealth. If you’re in a hurry and you’ve got a primary care doc you like, ask if they can write the script for you or help you find a new gyno. Not possible? Services like Nurx, The Pill Club, and Planned Parenthood Direct can deliver the pill to your door.
WHAT NOW? Get right to the point and say, “This was prescribed by a medical professional. It is my right and a necessity to have this prescription filled without discrimination. I would like to speak with your manager now.”
WHAT NEXT? Consider taking your business elsewhere for good. Pharmacy chains like Walgreens and CVS have adopted LGBTQ+ inclusive policies and training to prevent scenarios like this from happening. Plus, you can get gender-affirming meds from FOLX Health and Queer Doc by mail or via an in-house pharmacy at some LGBTQ+ centers. Head to LGBTCenters.org to find one close to you.
WHAT NOW? If you are feeling suicidal and you’re under 25, reach out to the Trevor Project crisis hotline at 866-488-7386 or text “START” to 678-678. If you’re 26 or older, call the LGBT National Hotline at 888-843-4564. Trained volunteers are available at both numbers 24/7.
WHAT NEXT? If you can wait a couple of weeks, check out PsychologyToday.com and filter therapists by their interest in helping LGBTQ+ patients (you can also filter for insurance coverage). Many offer telehealth sessions, so you can find someone who suits you quickly no matter where you live. Keep in mind that a therapist can be a resource for other types of care as well.
WHAT NOW? Rule out a coding mistake by getting your insurer’s customer service on the phone to figure out what’s going on. It might be an easy fix.
WHAT NEXT? If you were denied because of a discriminatory policy, reach out to Lambda Legal and/or the National Center for Lesbian Rights for free legal advice. Although some states do let insurance companies discriminate on the basis of gender identity or sexuality, these groups can help clarify your rights. —OW
SOURCES: Ruth Dawson, Senior Policy Manager at the Guttmacher Institute; Jan Oosting Kaminsky, Ph.D., Founder of Rainbow Health Consulting and Assistant Professor of Nursing at the Cuny School of Professional Studies; Alex Keuroghlian, MD, Associate Professor of Psychiatry at Harvard Medical School and Director of the National LGBTQIA+ Health Education Center at The Fenway Institute.