environment in which there is greater room to explore and define one’s gender within or outside of a binary conceptualization of gender as either man or woman, masculine or feminine, including the adoption of such identity labels as gender variant or gender queer (Bockting, 2008).

No research to date, however, has systematically and empirically studied the natural history of transgender identity development; the clinical management of gender dysphoria under the new paradigm of a greater diversity of gender identities, roles, and expressions; or the outcomes of the interventions of hormone therapy, a change in gender role, and the various surgical options in their own right. Thus while data from a substantial number of follow-up studies show that the vast majority of transgender individuals who complete all three of the latter options are satisfied with the outcome, no studies have examined the current widespread practice of offering each as an option in its own right outside of a linear process of sex reassignment. Research on what predicts satisfaction and psychosocial adjustment in this new landscape of various interventions leading to various outcomes in terms of identity, role, and expression is entirely absent and sorely needed to inform both providers and consumers of transgender-specific health care.

PHYSICAL HEALTH STATUS

While LGBT adults have all of the same health concerns as the general population, there are some areas of physical health that are known to be distinct for sexual and gender minorities.

Sexual/Reproductive Health

Very little research has been conducted on the sexual health of LGBT people, and most of it has focused on sexual dysfunction among gay and bisexual men. Evidence indicates a high rate of sexual dysfunction among all HIV-infected men (homosexual and heterosexual) (Ende et al., 2006; Lallemand et al., 2002). Very limited evidence suggests that gay men experience erectile dysfunction more than heterosexual men. In a study using a convenience sample of self-identified gay men (n = 1,196) and a matched sample of heterosexual men (n = 1,558), none of whom were HIV-positive, Bancroft and colleagues (2005) found that the gay men reported erectile dysfunction more frequently than the heterosexual men. While the authors posit that “erectile dysfunction” may mean different things to gay and heterosexual men, they also suggest that the discrepancy may be associated with anxiety or other factors.

Men who have sex with men and take medication for erectile dysfunction (either through a physician or through other sources) may demonstrate



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