Why LGBTQ Youth Face Heightened Health Risks

Recent news that queer youth may be at a much higher risk for developing diabetes than their straight peers (data for transgender youth was not available) has been widely covered. For those of us who work with lesbian, gay, bisexual, and transgender people of all ages, the news was not surprising. A story I recently heard about a middle school student's experience with coming out explains why.

The student lives in Massachusetts. She has two moms and two siblings. She attends school in a district where support for LGBTQ kids is routine and evidenced by administrative support for queer-straight alliances and LGBTQ-themed posters and signs in classrooms and hallways throughout the district. The student, a 13-year-old girl, was out as queer to her close circle of friends. A boy she had become friends with outside of that circle asked her out on a date. When she told him she wasn't interested because she liked girls, the boy threatened to out her to the entire school if she did not date him at least once. She tried for weeks to deal with the situation on her own. By the time she sought help from her parents, she had become anxious and depressed and no longer wanted to attend school.

What this 13-year-old experienced, coming out in 2018 with supportive parents in a school district that proactively reaches out to LGBTQ students to ensure that they feel safe, was as damaging as anything experienced by either of her parents, who came out in the 1980s. Unfortunately, stories like this play out every day in every state in the country, many of which have much weaker community-based systems of support for LGBTQ youth than does Massachusetts, which formed the country's first Governor's Commission to study the needs of LGBTQ youth and how to best address them in 1992.

Clinicians see the health impacts of this trauma, born of stigma and prejudice, every day. Gay men, especially black and Latinx gay men, are at higher risk for HIV and other sexually transmitted infections. Lesbian- and bisexual-identified women are less likely to receive preventative cancer screening. Transgender people have a high prevalence of violence victimization. LGBTQ people in general have disproportionately high prevalence of nicotine, alcohol, and other substance use disorders. These disparities have been painstakingly documented in Healthy People 2020, a national health promotion and disease prevention initiative of the U.S. Department of Health and Human Services issued in 2010, and The Health of Lesbian, Gay, Bisexual, and Transgender People, a 2011 report by the Institute of Medicine. In every year since, new studies, such as the one published in the journal Pediatrics Diabetes last month, confirm and build on these findings.

What we are learning is that although our youth are coming out into a society with unprecedented acceptance and integration of LGBTQ people, they are at serious and significant risk of harm and poorer health simply for being who they are. A recent report on the demographics of Massachusetts's LGBTQ population found that LGBTQ young people age 18-24 in Massachusetts were more than twice as likely as their non-LGBTQ peers to have experienced symptoms of depression. Nearly half reported that they have considered attempting suicide, 35 percent have made a plan, and 25 percent said they had attempted suicide, which is five times the prevalence reported by their non-LGBTQ peers. And nearly all (88 percent) LGBTQ youth of color reported that they had experienced discrimination based on sexual orientation or gender identity.

This reality is distressing. The lack of a quick fix is frustrating. But we can find hope in what's working, and Massachusetts has systems in place that are making a positive difference. We have a statewide network of peer support and social groups administered by BAGLY (Boston Alliance of Gay and Lesbian Youth). The state's decades-long work at making schools safer for LGBTQ youth resulted this year in an LGBTQ-inclusive history, English, and health curriculum for all schools. Most hopeful of all is that our young LGBTQ people are resilient. They are prominent and effective activists. As adults, we can help by advocating for the resources and providing the care that our young people need to come out safely and live authentically.

ALEX KEUROGHLIAN, MD, MPH, is director of education and training programs at the Fenway Institute of Fenway Health.