Coming Around: Parenting Lesbian, Gay, Bisexual, and Transgender Kids (19 page)

Don’t ask your child to “straighten up” for another member of the family by withdrawing from events, leaving his partner out of certain family gatherings or refraining from such actions as holding his partner’s hand or dancing with his partner at a wedding. Imagine that you disapproved of your heterosexual son’s partner, not because the girl was disrespectful or abusive, but just because you didn’t like her. Can you imagine asking your child to leave his girlfriend behind when he comes to family events? Can you imagine saying to him, “Can’t you just pretend to be friends with her? Do you have to introduce her as
your girlfriend?” When applied to heterosexual relationships, these requests seem rude and offensive. They are equally offensive when asked of gays.

You cannot single-handedly change the system, but you can accept your child and create a welcoming home. That alone will result in positive health effects. In addition, you can advocate for anti-bullying legislation, partner benefits (health insurance) and an end to state and federal laws that discriminate against LGBs. You can help put an end to the oppression that leads to LGB health disparities.

W
hen one segment of the population displays a greater tendency for certain health problems as compared to the general population, that group suffers from
health disparities.
When a group is identified as suffering from health disparities, the medical community tries to find out why. As discussed in previous chapters, LGBTQs suffer from a number of health disparities, e.g., they experience certain medical problems at a higher rate than the general population.

Another problem that affects LGBTQs is diminished
access to care.
There are many problems that limit access to care, such as being in a rural location or speaking a language different from that of most providers. In the case of LGBTQs, access to care has been negatively affected by lack of health insurance and the perception that healthcare providers are biased. For example, according to the Bureau of Labor Statistics, only about one-third of US employers offer same-sex partner benefits, such as health insurance. In accordance with this bias, LGBs have a greater number of unmet medical needs than their heterosexual counterparts. Lesbians are less likely than heterosexual women to receive preventive screenings such as breast exams, pap smears and mammograms. Gay men are at risk for delaying preventive screening that results in late cancer diagnosis and treatment.

While the American Medical Association recognizes that health disparities exist for LGBTQs, many medical schools and residencies still fail to provide adequate training about LGBTQ health-related concerns. In addition, many physicians feel inadequately prepared to ask their patients about sexual orientation, sexual attraction and gender orientation when taking a sexual history.
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The lack of training affects care. Not asking about sexual and gender orientation can result in failure to screen for LGBTQ health risks, such as suicidal thinking.
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Many otherwise excellent physicians have not explored their internalized homophobia. Doctors who are not self-aware in this area can, by their silence or by their advice, do harm to your gay or transgender child. Because the medical interview is designed for heterosexuals, it takes special training to hear and properly respond to the needs of sexual minorities. In my experience as a health psychologist who trains physicians, only those doctors who have had this training and who have consciously explored homophobia avoid making mistakes with gay adolescents. An early bad experience with a physician can make for a later distrust of doctors and a tendency to put off health care. Studies show that gays and lesbians terminate patient-physician relationships due to perceived bias on the part of the provider.
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Ensure that your child gets off to a good start by finding the right doctor early on.

How do you locate a gay-friendly, gay-knowledgeable physician? The Gay and Lesbian Medical Association’s Web site (
glma.org
) has a provider directory that you can use to search for a gay-friendly physician and/or therapist. Otherwise, you can screen potential providers by asking questions such as, “Have you received any training in providing care to LGBTQs? Do you know about LGBTQ risk factors? How would they impact your management of my child’s health?” If your child’s physician displays an appreciation and enthusiasm for learning about LGBTQ patients, that’s a good start.

Once you’ve found a healthcare provider, how do you know that s/he is doing a good job with your child? A physician treating LGBTQs should screen vigilantly for alcohol and drug abuse, smoking, depression and suicide. S/he should ask about bullying and be aware of the local attitudes toward gays, particularly in the school system your child attends. The physician should be able to converse comfortably about sexual orientation and sexual behavior. S/he should be able to refer you and your child to local chapters of support groups for gay youths.
Most important, your child’s physician should display unconditional positive regard toward your gay child. If your child is unsure of his or her sexual orientation, the physician should maintain a neutral “wait-and-see” attitude, i.e., no push toward or against homosexuality. This neutrality is important to allow adolescents to explore their sexual thoughts and feelings freely without having to worry about being judged or prematurely labeled. If your child is transgender, the physician should also be knowledgeable about hormone reassignment or be comfortable referring your child to a specialist in sex reassignment if your child desires it.

Physicians who treat LGBTQs should also be aware of the special vulnerabilities their patients may experience during particular examinations. LGBTQs who’ve encountered harassment, especially in the form of physical or sexual abuse, may be afraid to expose themselves to examinations in which they are physically vulnerable, especially those examinations or procedures involving genitals or erogenous parts of the body. For lesbians and bisexual women, this includes breast and gynecological examinations; for gay and bisexual men, rectal exams and colonoscopies; for transgender individuals, those parts of the body which they hope to minimize or remove.

In addition to fear of rough treatment, LGBTQs may also feel shame during these physical exams due to internalized homophobia or, in the case of transgender people, gender dysphoria. It is not enough for physicians to treat LGBTQs the way they would anybody else during similar examinations. Physicians should carefully explore any hesitancy, offer reassurance and make their positive regard overt. These additional actions are necessary to offset the common expectation of physician bias and the increased rate of victimization in the LGBTQ population.

Heteronormative bias can make a physician visit an unpleasant experience and discourage the formation of a good patient-physician bond. Heteronormative bias is first encountered in the waiting room. Intake forms often ask whether one is “married, single or divorced.” Those in gay relationships, even those with life-long partners, must check “single” or alter the form. The lack of recognition of gay relationships often continues throughout the medical interview. Physicians will automatically ask whether patients want their spouses, if they have accompanied them, present during important medical conversations. Likewise, they involve the spouse in discussions related to diet,
physical activity and the patient’s general function. The life partners of LGBTQs are often left out of these important conversations.

Many times lesbians have told me that, after telling their physicians about their sexual orientation, the physicians asked them if they needed birth control. Actually, physicians are trained to ask every female patient about safe sex and birth control, regardless of expressed sexual orientation, because many patients who identify as lesbian may still have sex with men. However, there are right and wrong ways to bring this up with lesbians. Ideally, the physician will say something like, “Many women who identify as lesbians still sometimes have sex with men. Is this true for you or do you exclusively have sex with women? I’m asking you this to ascertain whether there is any need to talk about birth control. Knowing about your sexual activity will also tell me if certain screenings are necessary or not.”

Let’s summarize the key issues that your gay, lesbian or transgender child should discuss with his or her physician. The Gay and Lesbian Medical Association’s (GLMA) Web site offers lists of the things to discuss with healthcare providers for lesbians, gay men and transgender persons.
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The information here borrows from these lists with some adaptations and additions.

LGBTQS AND THE PATIENT-PHYSICIAN RELATIONSHIP

Due to oppression and stigmatization, LGBTQs are at increased risk for developing mood and anxiety disorders. Despair can lead to suicide, even in adolescents who do not appear to be suffering from depression, especially in the early stages of coming out when internalized homophobia is not yet fully vetted. Rejection and bullying, if they occur, can make life seem unbearable. Your child needs to feel at ease talking with his or her physician, about being gay and about people’s reactions when s/he discloses his or her sexual orientation. If the provider is empathic, your child will be more likely to disclose thoughts, feelings and behaviors suggestive of depression, anxiety and suicide. If needed, your physician should be able to refer your child to a culturally sensitive therapist who can offer support and help to monitor symptoms. Sometimes medications may be suggested as well.

Cancers, heart disease, cerebral vascular accident (stroke) and emphysema are just four of the many potentially life-threatening consequences of smoking. Lesbians, gay men and transgender individuals are more likely to smoke than their heterosexual counterparts. Parents of gay youths should do what they can to intervene. If your child takes up smoking, explore smoking cessation options with his or her pediatrician/physician. Do this as early as possible. Smoking cessation is easier when it’s addressed when the problem begins.

Why are LGBTQs so prone to smoking? There are many reasons. People often smoke as a way of managing stress and gay children, due to discrimination, experience added stress. Also, smoking is sometimes used as a means of self-medicating. Some people need a cigarette before getting out of bed each morning. Smoking can also help people self-sooth. These are the folks who smoke when something upsets them. If underlying mood and anxiety disorders are detected and treated, it may reduce reliance on tobacco. Additionally, parents should work to move their LGBTQ children away from loitering in parking lots and bars and toward school-supervised activities. Parents can help by advocating for the provision of non-smoking activities that are welcoming, safe and appealing to LGBTQ youths.

Just as LGBTQs are prone to smoke to deal with stress, they are also more inclined to use drugs and alcohol than their heterosexual peers. Moderate drinking (as established by the National Institute on Alcohol Abuse and Alcoholism) for healthy women is no more than three drinks per occasion and no more than a total of seven drinks per week. For healthy men, moderate drinking is no more than four drinks per occasion and no more than fourteen drinks per week. (The amount for men and women differs because gender affects how alcohol is metabolized.)

I recommend that you discourage your child from early use of alcohol, prior to the legal drinking age. This is especially important if your child has the added risk factor of having an alcoholic parent or grandparent, because genetics play a role in developing this disease. Talk to your child about alcohol before it becomes a problem and request your child’s pediatrician to ask your child about alcohol use.

Much the same can be said for substance abuse and substance abuse screening. When screening for substance abuse, physicians should ask about all the common drugs such as marijuana, cocaine, heroin and methamphetamine. In addition, s/he should ask about drugs especially popular with youths, including Ecstasy (synthetic amphetamine), whippets (compressed nitrous oxide), poppers (amyl nitrite) and certain prescription drugs like narcotic pain medications.

LGBTQ youths need access to social venues that allow for dating and companionship while still offering adult supervision. LGBTQ youth groups can also provide opportunities to talk about the stress associated with being a sexual minority, which may help support self-esteem and imbue the desire for self-care. Perhaps most importantly, it is essential to keep your child in school and living at home. Once on the street, drugs and alcohol can seem the only comfort.

Your child’s pediatrician/provider should initiate discussion about your child’s school environment and ask your child directly if s/he is experiencing any verbal or physical harassment. If these things are happening, the physician should work with you to intervene on your child’s behalf. If the environment proves recalcitrant to change, additional steps may be needed, such as contacting child protection services in your state.

Obesity is associated with increased risk for many serious disorders such as heart disease, cancers and diabetes. It is critical that issues related to poor diet and lack of exercise be addressed as early as possible. While some gay men struggle with obesity, others suffer from eating disorders (bulimia and anorexia nervosa). An unhealthy preoccupation with appearance can lead to the use of steroids and health supplements that can affect health adversely. Lesbians tend to have a higher body mass index than heterosexual women. As a parent, you can help your LGBTQ child develop a healthy body image by exposing him or her to healthy gay role models and a healthy, balanced lifestyle. Problems with eating disorders, which may surface in adolescence, should be addressed by a culturally competent therapist.