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Closing the Knowledge Gap in Queer Health

Medical schools must include LGBTQ+ health in their curricula

Queer individuals have unique medical needs. More than others, they may need to access hormone replacement therapy (HRT), facial feminization surgery (FFS), mental health services, and reproductive health services. Standard medical curricula inadequately train health care professionals to provide quality, inclusive, and gender-affirming care to queer and trans patients. LGBTQ+ individuals are less likely to have a regular health care provider, are more likely to delay or avoid seeking treatment, and are often reluctant to disclose their sexual orientation to health care professionals. For BIPOC queer and trans people, disparities in health outcomes are often more extreme due to the barriers to health care enforced by racism and transphobia. This is largely due to discrimination and mistreatment by providers. Queer and trans people are left to advocate for themselves, educate their doctors, or move away from mainstream systems of health care in order to reclaim agency over their bodies.  

Medical schools fail to adequately teach the human and social aspect of health that is needed to interact with and treat a diverse group of individuals. Not having received formal training in inclusive and gender-affirming care, many health care professionals are incompetent when it comes to working with people who exist outside heteronormativity and the gender binary. Transphobia and homophobia can result from miseducation and gaps in knowledge. Health care professionals who lack training will often use cisnormative language, propose treatment plans that aren’t sexuality- or gender-affirming, and assume authority over bodies that they know little about. 

In a 2011 survey of 150 medical schools across Canada and the US, nine reported zero hours of LGBTQ+ content taught during preclinical years, and 44 reported zero hours taught during clinical years. The schools that did have LGBTQ+ curricula reported a median of five teaching hours dedicated to this content, and respondents only rated the quality of the curricula as “fair” in 40 per cent of the schools. In a similar survey of LGBTQ+ content in UK medical schools, only five of 19 institutions were found to have “good” or “very good” content on LGBTQ+ topics. 

LGBTQ+ health content in medical curricula is presented primarily in the context of HIV/AIDS, and it lacks coverage of many other queer health topics. According to a study published in the Canadian Journal of Emergency Medicine, the historical failure to train physicians on LGBTQ+  health has resulted in very few providers qualified to treat queer patients, let alone teach the content. 

Overwhelmingly, there is a pervasive cisnormativity and heteronormativity in health education that prevents health professionals from effectively treating queer people. Medicine continues to harm intersex people, for example, by performing medically unnecessary operations on intersex children when they’re too young to know their gender identity. These irreversible procedures, aimed to make the body conform to the gender binary, can result in sterilization, chronic pain, scarring, gender dysphoria, and lifelong psychological trauma. Moreover, in an article in BitchMedia, queer women reported “a lack of medical language around [their] experiences and a dearth of experts who focus on queer women’s reproductive health.” Medical providers often lack knowledge about the experiences of women who have sex with women and the medical implications of this, including the possibility of STIs and other infections. In another instance of medical incompetence, an asexual individual in British Columbia reported that their doctor, misinterpreting their asexuality as low libido, refused to prescribe them medication for their depression because it might reduce libido. 

In The Remedy, an anthology of queer and trans experiences in the Canadian and US health care systems, nursing student Soma Davidson writes, “the medical-industrial complex leaves trans and gender variant bodies yearning for attendance to needs long ignored. […] We live and breathe in defiance of a school of thought based on two genders, eternally rooted in two unchanging bodies.” As an example of gaps in medical knowledge, she speaks on how doctors should consider the hormonal side effects of prescribed drugs; a certain drug should not be prescribed to a person transitioning if the side effects oppose their hormone treatment plan, but these side effects are not considered by all doctors.

A lack of medical training is not the only issue, as there are other barriers for queer and trans people to receive the care they need. Trans people are twice as likely to think about and attempt suicide as other queer people, and access to gender-affirming health care has been shown to reduce this rate. However, coverage for gender-affirming procedures – such as FFS and HRT – is restricted by most Canadian provinces. In Quebec, a diagnosis of gender dysphoria is required to medically transition, subjecting trans individuals to distressing psychological evaluations. Bureaucratic barriers, such as long wait and referral times as well as copious paperwork, also prevent trans people from accessing such care. Yukon’s health care legislation, on the other hand, is considered the “gold standard” by trans advocates. It covers most procedures that can be essential to medically transition, including HRT, FFS, and voice training.

In 2021, an article in the Canadian Medical Association Journal called on Canadian medical schools to implement a national curriculum standard to include queer and trans health training in the licensing and assessment process. The article cited that 2SLGBTQIA+ Canadians experience disproportionately poor health outcomes, with worsened outcomes for BIPOC. The creation of a national standard for queer and trans health care education and physician competency would help bridge this gap. Groups like the Canadian Professional Association for Transgender Health are working toward a country “without barriers to the health, well-being and self-actualization of trans and gender diverse people.” The Centre for Gender Advocacy at Concordia has compiled a crowdsourced map of Montreal clinics that have a history of discriminating against trans people. If you are looking to access gender-affirming care, the Union for Gender Empowerment at McGill and the Centre for Gender Advocacy can point you to appropriate services. BIPOC Women’s Health Network provides anti-oppressive and feminist health care resources for health care providers, medical students, and racialized women in Canadian communities. The Daily calls on the McGill School of Medicine to survey its curriculum and mandate high-quality teaching hours on queer and trans health.