Top Ten Health Issues for Lesbians: Following are the health issues GLMA’s healthcare providers have identified

as most commonly of concern for lesbians. While not all of these items apply to everyone, it’s wise to be aware of these issues.

1. Breast Cancer
Lesbians have the richest concentration of risk factors for breast cancer than any subset of women in the world. Combine

this with the fact that many lesbians over 40 do not get routine mammograms, do breast self-exams, or have a clinical

breast exam, and this cancer may elude early diagnosis, when it is most curable.

2. Depression/Anxiety
Lesbians have been shown to experience chronic stress from homophobic discrimination. This stress is compounded by

the need that some still have to hide their orientation from family and colleagues at work, and by the fact that many

lesbians have lost the important emotional support most others get from their families due to alienation stemming from

their sexual orientation.

3. Heart Health
Smoking and obesity are the most prevalent risk factors for heart disease among lesbians; but all lesbians need to also

get an annual clinical exam because this is when blood pressure is checked, cholesterol is measured, diabetes is

diagnosed, and exercise is discussed. Preventing heart disease, which kills 45 percent of women, should be paramount

to every clinical visit.

4. Gynecological Cancer
Lesbians have higher risks for many of the gynecologic cancers. What they may not know is that having a yearly exam

by a gynecologist can significantly facilitate early diagnosis and a better chance of cure.

5. Fitness
Research confirms that lesbians have higher body mass than heterosexual women. Obesity is associated with higher

rates of heart disease, cancers, and premature death. What lesbians need is competent and supportive advice about

healthy living and healthy eating, as well as healthy exercise.

6. Tobacco
Research also indicates that lesbians may use tobacco and smoking products more often than heterosexual women use

them. Whether smoking is used as a tension reducer or for social interactions, addiction frequently follows and is

associated with higher rates of cancers, heart disease, and emphysema — the three major causes of death among all women.

7. Alcohol
Alcohol use and abuse may be higher among lesbians. While one drink daily may be good for the heart, more than that

can be a risk factor for cancer or osteoporosis.

8. Substance Use
Research indicates that lesbians may use illicit drugs more often than heterosexual women. This may be due to added

stressors in lesbian lives from discrimination. Lesbians need support from each other and from health care providers to

find healthy releases, quality recreation, stress reduction, and coping techniques.

9. Domestic Violence
Domestic violence is reported to occur in about 11 percent of lesbian homes, about half the rate of 20 percent reported by

heterosexual women. But the question is where do lesbians go when they are battered? Shelters need to welcome and

include battered lesbians, and offer counseling to the offending partners.

10. Osteoporosis
The rates and risks of osteoporosis among lesbians have not been well characterized yet. Calcium and weight-bearing

exercise as well as the avoidance of tobacco and alcohol are the mainstays of prevention. It is also important to get bone

density tests every few years to see if medication is needed to prevent fracture.

*Information has been provided by the Gay and Lesbian Medical Association.

Top Ten Health Issues for Gay Men: Following are the health issues GLMA’s healthcare providers have identified

as most commonly of concern for gay men. While not all of these items apply to everyone, it’s wise to be aware of these issues.

1. HIV/AIDS, Safe Sex
That men who have sex with men are at an increased risk of HIV infection is well known, but the effectiveness of safe sex

in reducing the rate of HIV infection is one of the gay community’s great success stories. However, the last few years

have seen the return of many unsafe sex practices. While effective HIV treatments may be on the horizon, there is no

substitute for preventing infection. Safe sex is proven to reduce the risk of receiving or transmitting HIV. All health care

professionals should be aware of how to counsel and support maintenance of safe sex practices.

2. Substance Use
Gay men use substances at a higher rate than the general population, and not just in larger communities such as New

York, San Francisco, and Los Angeles. These include a number of substances ranging from amyl nitrate ("poppers"), to

marijuana, Ecstasy, and amphetamines. The long-term effects of many of these substances are unknown; however

current wisdom suggests potentially serious consequences as we age.

3. Depression/Anxiety
Depression and anxiety appear to affect gay men at a higher rate than in the general population. The likelihood of

depression or anxiety may be greater, and the problem may be more severe for those men who remain in the closet or

who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide

because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more

effective in the prevention, early detection, and treatment of these conditions.

4. Hepatitis Immunization
Men who have sex with men are at an increased risk of sexually transmitted infection with the viruses that cause the

serious condition of the liver known as hepatitis. These infections can be potentially fatal, and can lead to very serious

long-term issues such as cirrhosis and liver cancer. Fortunately, immunizations are available to prevent two of the three

most serious viruses. Universal immunization for Hepatitis A Virus and Hepatitis B Virus is recommended for all men who

have sex with men. Safe sex is effective at reducing the risk of viral hepatitis, and is currently the only means of

prevention for the very serious Hepatitis C Virus.

5. STDs
Sexually transmitted diseases (STDs) occur in sexually active gay men at a high rate. This includes STD infections for

which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others), and for which no cure is

available (HIV, Hepatitis A, B, or C virus, Human Papilloma Virus, etc.). There is absolutely no doubt that safe sex

reduces the risk of sexually transmitted diseases, and prevention of these infections through safe sex is key.

6. Prostate, Testicular, and Colon Cancer
Gay men may be at risk for death by prostate, testicular, or colon cancer. Screening for these cancers occurs at different

times across the life cycle, and access to screening services may be negatively impacted because of issues and

challenges in receiving culturally sensitive care for gay men. All gay men should undergo these screenings routinely as

recommended for the general population.

7. Alcohol
Although more recent studies have improved our understanding of alcohol use in the gay community, it is still thought

that gay men have higher rates of alcohol dependence and abuse than straight men. One drink daily may not adversely

affect health, however alcohol-related illnesses can occur with low levels of consumption. Culturally sensitive services

targeted to gay men are important in successful prevention and treatment programs.

8. Tobacco
Recent studies seem to support the notion that gay men use tobacco at much higher rates than straight men, reaching

nearly 50 percent in several studies. Tobacco-related health problems include lung disease and lung cancer, heart

disease, high blood pressure, and a whole host of other serious problems. All gay men should be screened for and

offered culturally sensitive prevention and cessation programs for tobacco use.

9. Fitness (Diet and Exercise)
Problems with body image are more common among gay men than their straight counterparts, and gay men are much

more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for

cardiovascular health and in other areas, too much of a good thing can be harmful. The use of substances such as

anabolic steroids and certain supplements can adversely affect health. At the opposite end of the spectrum, overweight

and obesity are problems that also affect a large subset of the gay community. This can cause a number of health

problems, including diabetes, high blood pressure, and heart disease.

10. Anal Papilloma
Of all the sexually transmitted infections gay men are at risk for, human papilloma virus —which cause anal and genital

warts — is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in

the increased rates of anal cancers in gay men. Some health professionals now recommend routine screening with anal

Pap Smears, similar to the test done for women to detect early cancers. Safe sex should be emphasized. Treatments for

HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between

partners is very high.

*Information has been provided by the Gay and Lesbian Medical Association.

Top Ten Health Issues for Transgendered Persons: Following are the health issues GLMA’s healthcare providers have

identified as most commonly of concern for transgender persons. While not all of these items apply to everyone, it’s wise

to be aware of these issues.

1. Access to Health Care
Transgender persons are often reluctant to seek medical care through a traditional provider-patient relationship. Some are

even turned away by providers. A doctor who refuses to treat a trans person may be acting out of fear and transphobia, or

may have a religious bias against GLBT patients. It’s also possible that the doctor simply doesn’t have the knowledge or

experience he needs. Furthermore, health care related to transgender issues is usually not covered by insurance, so it is

more expensive. Whatever the reasons, transgender people have sometimes become very ill because they were afraid to

visit their providers.

2. Health History
Trans persons may hide important details of their health history from their doctors. Perhaps they fear being denied care if

their history is known. Even many years after surgery, they may omit the history of their transition when seeing a new

provider. Patients should see their provider as an equal partner in their health care, not as a gatekeeper or an obstacle to be overcome.

3. Hormones
Cross-gender hormone therapy gives desirable feminizing (or masculinizing) effects, but carries its own unique risks.

Estrogen has the potential to increase the risk of blood clotting, high blood pressure, elevated blood sugar and water

retention. Anti-androgens such as spironolactone can produce dehydration, low blood pressure, and electrolyte

disturbances. Testosterone, especially when given orally or in high doses, carries the risk of liver damage. Hormone use

should be appropriately monitored by the patient and provider. Some trans people tend to obtain hormones and other

treatment through indirect means, bypassing the health care system. Taking hormones without supervision can result in

doses too high or too low, with undesired results.

4. Cardiovascular Health
Trans persons may be at increased risk for heart attack or stroke, not only from hormone use but from cigarette smoking,

obesity, hypertension, and failure to monitor cardiovascular risks. Trans women may fear that a provider who finds them

at risk for cardiovascular disease will instruct them to stop their hormones, and so they do not seek medical attention

even when they have early warning signs of heart disease or stroke.

5. Cancer
Hormone-related cancer (breast in trans women, liver in women or men) is very rare but should be included in health

screening. A greater worry is cancer of the reproductive organs. Trans men who have not had removal of the uterus,

ovaries, or breasts are still at risk to develop cancer of these organs. Trans women remain at risk, although low, for

cancer of the prostate. Furthermore, some providers are uncomfortable with treating such cancers in trans people. Some

cases have been reported in which persons delay seeking treatment, or are refused treatment, until the cancer has spread.

6. STDs and Safe Sex
Trans people, especially youth, may be rejected by their families and find themselves homeless. They may be forced into

sex work to make a living, and therefore at high risk for STDs including HIV. Other trans people may practice unsafe sex

when they are beginning to experience sexuality in their desired gender. Safe sex is still possible even in transgender relationships.

7. Alcohol and Tobacco
Alcohol abuse is common in transgender people who experience family and social rejection, and the depression which

accompanies such rejection. Alcohol combined with sex hormone administration increases the risk of liver damage.

Tobacco use is high among all trans persons, especially those who use tobacco to maintain weight loss. Risks of heart

attack and stroke are increased in persons who smoke tobacco and take estrogen or testosterone.

8. Depression/Anxiety
For many reasons, trans people are particularly prone to depression and anxiety. In addition to loss of family and friends,

they face job stress and the risk of unemployment. Trans people who have not transitioned and remain in their birth

gender are very prone to depression and anxiety. Suicide is a risk, both prior to transition and afterward. One of the most

important aspects of the transgender therapy relationship is management of depression and/or anxiety.

9. Injectable Silicone
Some trans women want physical feminization without having to wait for the effects of estrogen. They expect injectable

silicone to give them “instant curves.” The silicone, often administered at “pumping parties” by non-medical persons, may

migrate in the tissues and cause disfigurement years later. It is usually not medical grade, may contain many

contaminants, and is often injected using a shared needle. Hepatitis may be spread through use of such needles.

10. Fitness (Diet & Exercise)
Many trans people are sedentary and overweight. Exercise is not a priority, and they may be working long hours to

support their transitions. A healthy diet and a frequent exercise routine are just as important for trans persons as for the

public. Exercise prior to sex reassignment surgery will reduce a person’s operative risk and promote faster recovery.

*Information has been provided by the Gay and Lesbian Medical Association.

LGBT communities are among the populations most severely impacted by tobacco use.  
•    LGBT are almost 35 to almost 200% more likely to smoke than non-LGBT.
•    In the largest and most scientific study to date, LGBT people smoke at rates almost 50% to 200% higher than the

rest of the population.
•    This is one of the highest smoking rates even of all the disproportionately affected sub-populations.
•    LGBT adolescents are taking up smoking at an alarming rate, in a national study 45% of females and 35% of males

reporting same-sex attraction or behavior smoked.  In comparison, only 29% of the rest of the youth smoked. 
•    American Cancer Society estimates that over 30,000 LGBT people die each year of tobacco-related diseases.

The 1-2-3 of Stopping Smoking
1. Quitting smoking is HARD but millions have QUIT!
•   Tobacco is one of the most highly addictive substances around us.  In the words of one LGBT health researcher,

“This is much harder to kick than heroin.”
•    Don’t underestimate the challenge!  It’s better to slow down and prepare a quit attempt than race ahead.

2. Cold turkey is rarely a good choice.
•    Yes, it works for some... but only about one in ten who try.  You can double or triple your chances of staying quit by

combining strategies. Read on to learn about the best recipe for success.

3. Slow down and learn about how to do it more successfully. Practice leads to success!

*Information provided by the National LGBT Tobacco Control Network

What is Crystal? (AKA: Tina, crank, crissy, speed, meth, tweek)

Crystal is an amphetamine — a synthetic stimulant that excites the brain and the central nervous system.

Crystal increases the release of dopamine in your body — the chemical that sends pleasure messages to the brain.

Crystal is most often found as an odorless off-white or white powder but can also be found in pill, capsule, or crystal form.

Why so Popular?

People express different reasons for using crystal. Some of the more common ones are:

• The desire to have lots of sex for a long time with multiple partners.
• The ability to dance for hours on end.
• To accomplish dull tasks; for example, users report feeling more energetic and having more fun cleaning their house.
• To get higher on less; for example, crystal provides a high that lasts much longer than cocaine, so users get "more for the money."
• To lose sexual inhibitions; for example, to have sex with men if you normally don't, to have aggressive or submissive sex, to bottom.

People may use crystal for other reasons that are not so apparent:

• Loneliness: Some gay men may feel isolated; crystal is often a social experience.
• The desire to connect with others: Some gay men say it's easier to meet or feel close with other men when on crystal.
• Body image: Some gay men say that crystal makes you feel good about your body (i.e. dick size, build, weight, etc.).
• Loss of energy: Some gay men say crystal gives you energy to do it all. Some HIV men say crystal makes up

for weakness associated with taking HIV medications.

• Self-esteem: Some gay men say crystal reduces insecurities, giving them confidence.
• Depression: Feeling sad, empty or incomplete inside is a big reason a person might turn to crystal, or any

substance, to change how he is feeling. Gay men are sometimes un-aware that depression is impacting their use of crystal.

Health Concerns to Remember

• Crystal is highly addictive. Use may change from snorting to smoking or slamming — or from using socially to using alone.
• Binging postpones the end of the party but will make the crash worse.
• Tolerance develops quickly. You will need more and more crystal to get high.
• Crystal will decrease your desire for food.
• Crystal will impact your perceived need for sleep.
• Crystal can cause exhaustion and dehydration.
• It can lead to depression and cause temporary psychosis.
• Agitation and anxiety are common when using crystal.
• Overdose is a very real and present danger.

* Information provided by the Gay Men's Health Crisis.