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There has been little medical or behavioral research for the development of a comprehensive lesbian, gay, bisexual, transgender (LGBT) health model. Cultural, economic, racial, age-related, and sexual diversity within the LGBT community dictate a broad range of health needs. Furthermore, the American Psychiatric Association (APA) listed homosexuality as a mental disorder as late as 1973. Currently, the APA defines criteria for gender identity disorder (GID), which is often diagnosed in people who have elective sex reassignment surgery. It was not until the early 1980s, with the publication of the Harry Benjamin Standards of Care for Gender Identity Disorders, that the medical community began to standardize health concerns related to gender issues.

A practical LGBT health model addresses the concerns of the general population as well as the physical and psychological issues that affect the LGBT community. For example, anal cancer affects men regardless of sexual behavior, but men who have sex with men (MSM) are 35 times more likely to develop it than heterosexual men. Additionally, many LGBT people are reluctant to seek care, because they fear insensitivity, dismissal, and discrimination from the medical community. Increased risk for certain diseases combined with inadequate health care puts LGBT people at a disadvantage and jeopardizes their health.

Cultural Factors
Cultural factors that have a psychological impact on the LGBT community and lead to inadequate physical and mental health care include the following:

• Body perception and eating disorders
  • Bulimia and over exercising
  • Obesity
• Concealment of sexual orientation and gender identity from care provider
  • Delayed medical care
  • Incomplete medical history, diagnosis, and care
  • Reluctance to seek preventive care
• Disclosure of sexual orientation and gender identity
  • Causing depression, anxiety, suicide
  • Causing geographic and economic dislocation; relocation
  • Lack of support from family, schools, church, government
• Limited employer insurance coverage for same-sex partners
• Parenting
  • Underdeveloped child-custody laws
  • Insufficient support for same-sex partners using alternative insemination
  • Mental health concerns (e.g., same-sex parenting, alternative insemination)
• Societal prejudice, discrimination, and intolerance
  • Sexism and heterosexism (oppression of nonheterosexual identities)
• Transgender expression in dominant culture
  • Ostracism from family, gay community, and general population
• Violence against LGBT community

• Anal cancer in men who have sex with men (MSM)
• Bacterial vaginosis in women who have sex with women (WSW)
• Depression
• Enteritis (inflammation of the intestine) in MSM
• Hepatitis (viral inflammation of the liver) A, B, and C, particularly in MSM
• HIV and AIDS, especially in MSM
• Human papillomavirus (HPV); (genital warts) in MSM
• Syphilis (multisystemic disease) in MSM
• Women who never bear children (nulliparity) at possible increased risk for breast cancer

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