National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

The Health of Lesbian, Gay, Bisexual, and Transgender People

Building a Foundation for Better Understanding

Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. N01-OD-4-2139 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

The health of lesbian, gay, bisexual, and transgender people : building a foundation for better understanding / Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, Board on the Health of Select Populations, Institute of Medicine of the National Academies.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-309-21061-4 (hardcover) — ISBN 978-0-309-21062-1 (pdf)

1. Gays—Medical care—United States. 2. Bisexuals—Medical care—United States. 3. Transgender people—Medical care—United States. I. Institute of Medicine (U.S.). Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities.

[DNLM: 1. Health Status—United States. 2. Minority Health—United States. 3. Bisexuality—United States. 4. Health Services Research—United States. 5. Homosexuality—United States. 6. Transsexualism—United States. WA 300 AA1]

RA564.9.H65H44 2011

362.1086’64—dc23

2011017453

Additional copies of this report are available from the

National Academies Press,

500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2011 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Cover design by LeAnn Locher.

Suggested citation: IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES


Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

COMMITTEE ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH ISSUES AND RESEARCH GAPS AND OPPORTUNITIES

ROBERT GRAHAM (Chair), Professor of Family Medicine and Robert and Myfanwy Smith Chair,

Department of Family Medicine, University of Cincinnati College of Medicine, Ohio

BOBBIE A. BERKOWITZ, Dean and Mary O’Neil Mundinger Professor,

Columbia University School of Nursing;

Senior Vice President,

Columbia University Medical Center, New York, New York

ROBERT BLUM, William H. Gates, Sr. Professor and Chair,

Department of Populations, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

WALTER O. BOCKTING, Associate Professor,

Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis

JUDITH BRADFORD, Co-Chair,

The Fenway Institute;

Director,

Center for Population Research in Lesbian, Gay, Bisexual and Transgender Health, Boston, Massachusetts

BRIAN de VRIES, Professor of Gerontology,

San Francisco State University, California

ROBERT GAROFALO, Associate Professor of Pediatrics,

Northwestern

University’s Feinberg School of Medicine, and

Director,

Adolescent HIV Services, Children’s Memorial Hospital, Chicago, Illinois

GREGORY HEREK, Professor of Psychology,

Department of Psychology, University of California, Davis

ELIZABETH A. HOWELL, Associate Professor,

Departments of Health Evidence and Policy and Obstetrics, Gynecology, and Reproductive Science and Psychiatry, Mount Sinai School of Medicine, New York, New York

DANIEL KASPRZYK, Vice President and Director,

Center for Excellence in Survey Research, National Opinion Research Center at the University of Chicago, Bethesda, Maryland

HARVEY J. MAKADON, Clinical Professor of Medicine,

Harvard Medical School and

Director of Professional Education and Training,

The Fenway Institute, Boston, Massachusetts

CHARLOTTE J. PATTERSON, Professor of Psychology,

Department of Psychology, University of Virginia, Charlottesville

JOHN L. PETERSON, Professor,

Department of Psychology, Georgia State University, Atlanta

CAITLIN C. RYAN, Director,

Family Acceptance Project at the Marian Wright Edelman Institute, San Francisco State University, San Francisco, California

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

MARK A. SCHUSTER, William Berenberg Professor of Pediatrics,

Harvard Medical School, and

Chief,

Division of General Pediatrics, Children’s Hospital, Boston, Massachusetts

LOWELL J. TAYLOR, Professor of Economics,

Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania

RUTH E. ZAMBRANA, Professor of Women’s Studies and Director of the Consortium on Race, Gender and Ethnicity,

University of Maryland, College Park

Study Staff

MONICA N. FEIT, Study Director

JOSHUA JOSEPH, Associate Program Officer

JON Q. SANDERS, Program Associate

KAREN M. ANDERSON, Senior Program Officer

ANDREA COHEN, Financial Associate

FREDERICK (RICK) ERDTMANN, Director,

Board on the Health of Select Populations

SARAH ISQUICK, Christine Mirzayan Science and Technology Policy Graduate Fellow,

Fall 2010

Consultants

RONA BRIERE,

Briere Associates, Inc., Felton, Pennsylvania

JOHN D’EMILIO,

University of Illinois at Chicago

RONALD C. FOX,

Saybrook University, San Francisco, California

CARLOS GODOY,

Rensselaer Polytechnic Institute, Troy, New York

ROBERT BRADLEY SEARS,

The Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy, UCLA School of Law, California

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Thomas J. Coates, David Geffen School of Medicine, University of California, Los Angeles

Anthony R. D’Augelli, Pennsylvania State University

Lisa M. Diamond, University of Utah

Angela Diaz, Mount Sinai School of Medicine

Jamie Feldman, Program in Human Sexuality, University of Minnesota

Karen Fredriksen-Goldsen, University of Washington School of Social Work

Gary Gates, The Williams Institute, University of California, Los Angeles School of Law

Susan R. Johnson, University of Iowa

David E. Kanouse, The RAND Corporation

David J. Malebranche, Emory University School of Medicine

Vickie M. Mays, University of California, Los Angeles

Patricia Robertson, University of California, San Francisco

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

Ronald Stall, University of Pittsburgh

Alan M. Zaslavsky, Harvard Medical School

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Kristine M. Gebbie, City University of New York, and Bradford H. Gray, The Urban Institute. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

Preface

In 1999 the Institute of Medicine (IOM) released the report Lesbian Health—the first IOM report that focused on the health of a sexual-minority population. In addition to presenting what was known about the health status of lesbians, the report highlighted the challenges inherent in conducting research on the health needs and risks of this population. The report created an awareness about the health of lesbians and the importance of research in improving their health.

Society has experienced many changes during the ensuing 12 years, yet much remains unknown about the health status of sexual and gender minorities. Moreover, many of the research challenges identified in Lesbian Health persist today. At the request of the National Institutes of Health (NIH), in 2010 the IOM convened a committee to assess the current state of knowledge about the health of lesbian, gay, bisexual, and transgender people, as well as to identify research gaps and formulate a research agenda that could guide NIH in enhancing and focusing its research in this area.

The task before the committee was broad and complex. In considering the health of sexual and gender minorities, the committee recognized that not only are lesbians, gay men, bisexual men and women, and transgender people all separate groups, but each of these groups encompasses subpopulations with their own unique health needs. This report presents a wealth of information that has, for the first time, been compiled and organized in a comprehensive fashion. It is the product of more than a year of information gathering, review, and deliberation. The committee benefited from three open meetings (two in Washington, DC, and one in San Francisco) where not only invited presenters but also members of the public generously gave

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

of their time, shared their knowledge, and responded to questions from the committee. These sessions, along with materials submitted from various sources, were invaluable in furthering the committee’s understanding of the topic.

On behalf of the committee, in addition to the presenters, reviewers, consultants, and members of the public who assisted in the creation of this report, I extend our deepest thanks to the project staff: Monica Feit, study director; Joshua Joseph, associate program officer; Jon Sanders, program associate; Karen Anderson, senior program officer; Sarah Isquick, Christine Mirzayan Science and Technology Policy Graduate Fellow, fall 2010; and Rick Erdtmann, board director. The committee could not have done its work without the outstanding support and guidance provided by these individuals.

It is the committee’s hope that this report will not only assist NIH in its goal of promoting the nation’s health through research, but also advance the public’s understanding about the health of lesbian, gay, bisexual, and transgender people.


Robert Graham, Chair

Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

3

 

CONDUCTING RESEARCH ON THE HEALTH STATUS OF LGBT POPULATIONS

 

89

   

 Research Challenges,

 

89

   

 Research Methods,

 

96

   

 Data Sources,

 

122

   

 Best-Practices Principles Associated with Sample Survey and Research Studies,

 

123

   

 Summary of Key Findings and Research Opportunities,

 

129

   

 References,

 

132

4

 

CHILDHOOD/ADOLESCENCE

 

141

   

 Development of Sexual Orientation and Gender Identity,

 

142

   

 Mental Health Status,

 

146

   

 Physical Health Status,

 

153

   

 Risk and Protective Factors,

 

157

   

 Health Services,

 

166

   

 Contextual Influences,

 

167

   

 Summary of Key Findings and Research Opportunities,

 

170

   

 References,

 

173

5

 

EARLY/MIDDLE ADULTHOOD

 

185

   

 Development of Sexual Orientation and Gender Identity,

 

186

   

 Mental Health Status,

 

189

   

 Physical Health Status,

 

202

   

 Risk and Protective Factors,

 

211

   

 Health Services,

 

222

   

 Contextual Influences,

 

227

   

 Summary of Key Findings and Research Opportunities,

 

231

   

 References,

 

236

6

 

LATER ADULTHOOD

 

251

   

 Development of Sexual Orientation and Gender Identity,

 

253

   

 Mental Health Status,

 

256

   

 Physical Health Status,

 

259

   

 Risk and Protective Factors,

 

268

   

 Health Services,

 

273

   

 Contextual Influences,

 

276

   

 Summary of Key Findings and Research Opportunities,

 

281

   

 References,

 

284

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Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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Tables, Figures, and Boxes

TABLES

2-1

 

Estimated Percentage of People by Sexual Orientation and Behavior from Selected Sample Surveys,

 

55

3-1

 

Sources of Nonsampling Error in Survey Research,

 

112

3-2

 

Recurring Federally Funded Surveys That Include LGB Measures,

 

124

7-1

 

Research Opportunities for Studying Lesbian, Gay, Bisexual, and Transgender Health Across the Life Course,

 

300

FIGURES

S-1

 

Research agenda,

 

6

2-1

 

Discretionary funding for HIV/AIDS by the Department of Health and Human Services in thousands of dollars,

 

72

2-2

 

Estimated number of new HIV infections by race/ethnicity among men who have sex with men,

 

73

3-1

 

Publications in LGBT health indexed in PubMed,

 

127

7-1

 

Research agenda,

 

294

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

BOXES

1-1

 

Statement of Task,

 

17

1-2

 

A Note on Terminology,

 

18

3-1

 

Examples of Probability Sample Studies with Sexual Orientation Measures,

 

100

3-2

 

Examples of State-Level Probability Sample Studies with LGBT Measures,

 

102

3-3

 

Drawing an Inference from Census Data,

 

103

3-4

 

Examples of the Use of Nonprobability Sample Surveys to Address Transgender Health,

 

110

3-5

 

Examples of Longitudinal Cohort Studies,

 

118

4-1

 

Criteria for Diagnosis of Childhood Gender Identity Disorder,

 

152

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

Acronyms and Abbreviations

AAPOR American Association for Public Opinion Research

ACASI audio computer-assisted self-interview

AIDS acquired immune deficiency syndrome

BMI body mass index

BRFSS Behavioral Risk Factor Surveillance System

CDC Centers for Disease Control and Prevention

CHIS California Health Interview Survey

DEBI Diffusion of Effective Behavioral Interventions

DOMA Defense of Marriage Act

DSM Diagnostic and Statistical Manual of Mental Disorders

FBI Federal Bureau of Investigation

FDA U.S. Food and Drug Administration

GIDC gender identity disorder of childhood

GLMA Gay and Lesbian Medical Association

GnRH gonadotropin-releasing hormone

GSI General Severity Index

GSS General Social Survey

GUTS Growing Up Today Study

HIV human immunodeficiency virus

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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HPV human papillomavirus

HRT hormone replacement therapy

IOM Institute of Medicine

LGB lesbian, gay, and bisexual

LGBT lesbian, gay, bisexual, and transgender

MA BRFSS Massachusetts Behavioral Risk Factor Surveillance System

MIDUS Midlife Development in the United States

NAS National Academy of Sciences

NCAVP National Coalition of Anti-Violence Programs

NCS National Comorbidity Survey

NESARC National Epidemiologic Survey on Alcohol and Related Conditions

NHANES National Health and Nutrition Examination Survey

NHBS National HIV Behavioral Survey

NHIS National Health Interview Survey

NHS Nurses’ Health Study

NHSDA National Household Survey of Drug Abuse

NHSLS National Health and Social Life Survey

NIH National Institutes of Health

NLHCS National Lesbian Health Care Survey

NNHS National Nurses Health Survey

NORC National Opinion Research Center

NSFG National Survey of Family Growth

NSHAP National Social Life, Health, and Aging Project

NSSHB National Survey of Sexual Health and Behavior

NTDS National Transgender Discrimination Survey

RCT randomized controlled trial

STD sexually transmitted disease

STI sexually transmitted infection

THIS Transgender Health Initiative Survey

VDH Virginia Department of Health

WPATH World Professional Association for Transgender Health

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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Next: Summary »
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Get This Book
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At a time when lesbian, gay, bisexual, and transgender individuals--often referred to under the umbrella acronym LGBT--are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs.

The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research.

The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.

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