In an update to its 2015 position paper, ACP calls for health benefit plans to include gender-affirming care and for additional research on the topic
July 12, 2024 (ACP) -- The American College of Physicians reaffirmed its support for the lesbian, gay, bisexual, transgender, queer and other sexual or gender minority (LGBTQ+) communities in a new position paper updating guidance to promote equitable access to quality health care and reduce social stigma.
"ACP is extremely concerned about discrimination against LGBTQ+ individuals. Health is a human right that entails an ethical obligation of society to provide access to health care, according to its resources and means, to its members," said Dr. Isaac O. Opole, president of ACP. "It is important that physicians and other health professionals are aware of the complex social and health issues that uniquely and disproportionately affect LGBTQ+ populations in order to provide the highest level of patient care."
The position paper, titled "Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities: A Position Paper from the American College of Physicians," was published June 25 in the Annals of Internal Medicine.
As noted in the paper, an estimated 7.6 percent of the U.S. population now identifies as being part of the LGBTQ+ community, and 1.7 percent have an intersex trait. "As this number grows," the authors state, "it is increasingly important that physicians and other health professionals be aware of the complex social and health issues that uniquely and disproportionately affect these populations in order to provide the highest level of patient care."
Since the publication of a 2015 ACP paper on the topic, the rights of the LGBTQ+ community have expanded. The Supreme Court made same-sex marriage legal, and the U.S. Food and Drug Administration has lifted the strictest restrictions on blood donation by gay and bisexual men.
At the same time, many disparities in health care continue to exist.
"There has been a distressing rise in individual, political and legal attacks on our LGBTQ+ communities, ranging from restrictions on gender-affirming care to bans on books and speech that acknowledge the full spectrum of sexual orientation and gender identity," said Dr. Haidn Foster, a resident physician at Penn State Milton S. Hershey Medical Center in Pennsylvania and a member of the ACP Health and Public Policy Committee, which wrote the paper. "A comprehensive update to College policy was necessary to allow ACP to better advocate on behalf of our LGBTQ+ patients in the current medical and legal environment."
The position paper authors recommend that "public and private health benefit plans include comprehensive gender-affirming care and provide all covered services to transgender and gender-diverse persons as they would all other beneficiaries." ACP also opposes criminal and civil liability for physicians who provide this care.
"ACP represents internal medicine physicians and our adult patients, so we do not make specific recommendations on the care of children in this position paper," Foster noted.
He highlighted three new policies in the paper. "First, we now support additional research into gender-affirming care to improve the state of transgender heath care," he said. "This is an important step to not only affirm the importance of gender-affirming care, but to demonstrate our commitment to pushing the field forward on behalf of our transgender patients."
ACP has played an important advocacy role in transgender health by joining numerous amicus briefs in cases challenging discriminatory state laws targeting transgender people. "Now, thanks to our updated policy, ACP will be empowered to take even more decisive action on behalf of our transgender patients," Foster said.
On another front, "ACP also declares that all people -- regardless of sexual orientation or gender identity -- should be able to live free from discrimination or harassment," Foster said. "Consistent with this recommendation, we now support narrow, case-by-case determinations on the participation of transgender athletes in sex-segregated sports to reduce the likelihood of discrimination from overly broad participation policies."
Finally, "we oppose restriction of educational content that includes discussion of sexual orientation and gender identity and encourage incorporating evidence-informed education on these topics within society," he said. "This puts ACP policy on the right side of history and stands in stark relief to some state bans on the discussion of LGBTQ+ topics."
In the big picture, Foster said, the "take-home message of ACP's new guidance on LGBTQ+ health disparities is the College's unwavering affirmation of the dignity and personhood of all lesbian, gay, bisexual, transgender and queer people. LGBTQ+ people deserve to fully and unapologetically participate in society and are entitled to evidence-based care that affirms their sexual orientation and gender identity."
More Information
The position paper, "Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities," is available on the Annals of Internal Medicine website.
Back to the July 12, 2024 issue of ACP Advocate