Review

Best practices in LGBT care: A guide for primary care physicians

Megan C. McNamara, MD, MSc and Henry Ng, MD, MPH
Cleveland Clinic Journal of Medicine July 2016, 83 (7) 531-541; DOI: https://doi.org/10.3949/ccjm.83a.15148

Article Figures & Data

Tables

  • TABLE 1

    Suggested questions for obtaining a sexual history

    Consider questions inclusive of nonbinary identities—instead of asking whether the patient identifies as a man or a woman or as gay or straight, ask about anatomy and behavior, eg:

    • Are you sexually active? (Explore what sexual activity means for the patient)

    • With whom do you have sex? Men, women, or both?

    • What parts of your body do you use when having sex with your partner(s)?

    • Do you practice safer sex? (Explore what safer sex means for the patient)

      With primary partners?

      With casual partners?

    • How do your partners identify their gender or sexual orientation?

  • TABLE 2

    Gender identity terms and definitions

    Sex—refers to the physical genotype and phenotype, without regard to the sense of self
    Cisgender—relating to a person whose gender identity and biological sex correspond
    Gender identity—inherent sense of being male or female regardless of genotypic, phenotypic, or biochemical sex; also referred to as affirmed gender
    Genderqueer—one who defies or does not accept stereotypical gender roles and may choose to live out-side expected gender norms. Genderqueer people may or may not avail themselves of hormonal or surgical treatments.
    Sexual orientation—how a person identifies their physical and emotional attraction to others
    Transgender—an umbrella term used to describe the discordance between a person’s gender identity and expression and the cultural expectations based on the sex assigned at birth
    Transsexual—an older term that originated in the medical and psychological communities and is typically ascribed to adults committed to making their bodies congruent with their gender identity. This term is still preferred by some people who have permanently changed or seek to change their body through medical interventions (including but not limited to hormone therapy and surgery).

    • Adapted from references 10, 11, 29, and 32

  • TABLE 3

    Creating a welcoming environment for LGBT patients

    What to doWhy
    Establish gender-neutral bath-rooms and avoid restroom signage that specifically designates one gender or anotherTransgender individuals should feel comfortable using a rest-room that corresponds to their gender identity and expression
    Avoid clinic names and signs that seem welcoming to only one gender (eg, Men’s Health Center, Women’s Health Center)Gender-specific clinic names or centers may not appeal to or affirm gender-nonconforming people
    Create initial patient intake forms that collect information on the patient’s preferred name, pronoun, gender identity, sex as- signed at birth, partner, and other family membersThis information will help providers and staff address the patient correctly, both by name and pronoun
    Create electronic health record forms that allow for collection of gender identity and natal sex that also include an anatomic inventoryThis information will help providers address individuals’ specific healthcare needs according to their natal sex and current anatomy
  • TABLE 4

    Screening and immunizations for sexual minority and transgender individuals

    Screening service or immunizationMen who have sex with menWomen who have sex with womenTransgender men aTransgender women a
    Annual screening for gonorrhea, Chlamydia, syphilis
    (every 6 months if high risk)    		YesChlamydia screening for all women age < 25
    Consider based on exposure and risk    		Consider based on exposure and riskConsider based on exposure and risk
    Annual screening for HIV
    (every 6 months if high risk)    		YesConsider based on exposure and riskConsider based on exposure and riskConsider based on exposure and risk
    Offer HPV vaccination
    (up to age 26)    		YesYesYesYes
    Give meningococcal vaccine (if additional risk factor is present)YesConsider based on exposure and riskConsider based on exposure and riskConsider based on exposure and risk
    Assess for immunity to hepatitis A and B,
    immunize if not immune    		YesConsider based on exposure and riskConsider based on exposure and riskConsider based on exposure and risk
    Screen for anxiety, depression, and other mental health disordersYesYesYesYes
    Assess for substance use disorders
    (tobacco, alcohol, drug use)    		YesYesYesYes
    Assess risk factors for breast cancer, offer mammographyNot applicableYesPerform chest wall examination after chest surgery; other- wise mammography as recommended for cisgender womenConsider if previously or currently treated with hormone therapy and having additional risk factors (family his- tory, obesity, estrogen and progestin use greater than 5 years)
    Screen for cervical cancer at appropriate intervals
    (if no hysterectomy)    		Not applicableYesYesNot applicable
    Assess risk factors for osteoporosisNot applicableBone density testing starting at age 65 or earlier based on risk factorsBone density at age 60 or earlier based on risk factors
    Consider in those not compliant with hormone therapy    		Bone density at age 60 or earlier based on risk factors
    Consider in those not compliant with hormone therapy

    • ↵a Transgender men are people with the XX genotype who identify as male; transgender women are people with the XY genotype who identify as female.

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