Top Health 

Issues 

for LGBT 

Populations 

Information &

Resource Kit

Top Health Issues for 

LGBT Populations

Information & Resource Kit

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Prevention
ACKNOWLEDGEMENTS

The Top Health Issues for LGBT Populations Information & Resource Kit was prepared by Alexander Camacho, 

Ph.D., CHES, CADC, CPP of the Center for Substance Abuse Prevention (CSAP) at the Substance Abuse and 

Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). 

Nancy Kennedy, Dr.P.H., and Emily Novick, M.P.P., at CSAP, and George Marcelle provided guidance and 

comments during the development and review of this publication.

Editing and graphic designing was prepared by Abt Associates Inc. under contract number HHSS283200700008I/

HHSS28342001T for SAMHSA, HHS. David Wilson at SAMHSA served as Government Project Officer for this task. 

DISCLAIMER

The views, opinions, and content of this publication are those of the author and do not necessarily reflect the 

views, opinions, or policies of SAMHSA or HHS.

PUBLIC DOMAIN NOTICE

All materials appearing in this publication are in the public domain and may be reproduced or copied without 

permission from SAMHSA. Citation of the source is appreciated. The publication may not be reproduced or 

distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA.

ELECTRONIC ACCESS

This publication may be downloaded or ordered at http://store.samhsa.gov/. Or call SAMHSA at 

1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

RECOMMENDED CITATION

Substance Abuse and Mental Health Services Administration, Top Health Issues for LGBT Populations 

Information & Resource Kit. HHS Publication No. (SMA) 12-4684. Rockville, MD: Substance Abuse and Mental 

Health Services Administration, 2012.

ORIGINATING OFFICE

Division of Systems Development, Center for Substance Abuse Prevention, Substance Abuse and Mental Health 

Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. HHS Publication No. (SMA) 12-4684. 

Printed in 2012.
Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Table of Contents

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

Preface ii

Helpful Terms for Prevention Specialists and Healthcare Providers A-1

A Discussion about Gender Identity B-1

Top Health Issues for Lesbians C-1

Top Health Issues for Gay Men D-1

Top Health Issues for Bisexual Men and Women E-1

Top Health Issues for Transgender People F-1

Selected Web-based Resources G-1

PowerPoint Slides: Top Health Issues for LGBT Populations H-1

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Preface

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

“Lesbian, gay, bisexual, and transgender individuals have 

unique health experiences and needs, but as a nation, we do 

not know exactly what these experiences and needs are 

(IOM, 2011).”1

This Top Health Issues for LGBT Populations Information & Resource Kit, provided by 

the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for 

Substance Abuse Prevention (CSAP), presents an overview of current health issues among 

lesbian, gay, bisexual, and transgender (LGBT) populations. While many challenges exist 

with regards to the availability of data, this kit aims to create awareness among prevention 

specialists and healthcare providers of the needs, experiences, and health status of LGBT 

Americans.

SAMHSA is committed to addressing behavioral health disparities among vulnerable populations, such as LGBT 

Americans, and will continue to work toward improving the access, quality, and outcomes of behavioral health 

services nationwide. This resource kit represents an important part of this commitment and directly supports 

SAMHSA’s Strategic Initiatives, as well as the vision and mission of SAMHSA’s Office of Behavioral Health Equity. 

SAMHSA has identified a number of goals and action steps relevant to LGBT populations that include: increasing 

social inclusion and reducing discrimination; preventing suicides and suicide attempts among LGBT youth; 

developing culturally relevant materials related to trauma and military service; and reducing disparities in 

access to—and quality of—behavioral healthcare services, among others.2

This product is designed for a wide-range of organizations and individuals that serve LGBT populations across 

the country. These include prevention specialists working in State, Territorial, and Tribal community-based 

organizations; behavioral healthcare providers; medical and other allied health professionals; health educators; 

technical assistance providers; and LGBT individuals. The tools in this information and resource kit (i.e., fact 

sheets and PowerPoint slides) may be used individually or together to raise awareness of the physical and 

behavioral health status and needs of LGBT populations. 

1 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.

2 The SAMHSA report, Leading Change: A Plan for SAMHSA’s Roles and Actions, contains further information about SAMHSA’s 8 Strategic Initiatives and can be accessed at: 

http://store.samhsa.gov/shin/content//SMA11-4629/01-FullDocument.pdf.

ii

Helpful Terms for Prevention Specialists and Healthcare Providers

Helpful Terms for 

Prevention Specialists 

and Healthcare Providers

A–1 • Helpful Terms for Prevention Specialists and Healthcare Providers

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Helpful Terms for Prevention Specialists and Healthcare Providers

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

As with many other populations, there are terms and definitions that are specific to LGBT populations. Creating

awareness and understanding of these terms is essential to promoting cultural competence among prevention

specialists and healthcare providers, as well as ensuring sensitivity toward LGBT individuals. While not exhaustive,

the following is an overview of terms and related definitions related to gender identity, gender expression, and

sexual orientation that people use to self-identify. When addressing LGBT individuals, prevention specialists and

healthcare providers should always ask clients how they identify and/or wish to be addressed.

Note: Prevention specialists and healthcare providers should be aware that language is dynamic and evolves

over time. Therefore, terms, definitions, and how LGBT individuals identify varies based upon a number of

factors, including geographic region, race/ethnicity, and socioeconomic status, among others.

TERMS AND DEFINITIONS SPECIFIC

TO GENDER IDENTITY

Term Definition

Bigender A person whose gender identity encompasses both male and female genders. 

Some may feel that one identity is stronger, but both are present.

FTM

A person who transitions from female-to-male, meaning a person who was 

assigned the female sex at birth but identifies and lives as a male. 

Note: Also known as a transgender man.

Gender identity A person’s internal sense of being male, female, or something else. Since gender

identity is internal, one’s gender identity is not necessarily visible to others.

Gender nonconforming

A person whose gender expression is different from societal expectations 

related to their perceived gender.

Genderqueer A term used by persons who may not entirely identify as either male or female.

MTF

A person who transitions from male-to-female, meaning a person who was 

assigned the male sex at birth but identifies and lives as a female. 

Note: Also known as a transgender woman.

Transgender

A person whose gender identity and/or expression is different from that typically 

associated with their assigned sex at birth.

Note: The term transgender has been used to describe a number of gender 

minorities including, but not limited to, transsexuals, cross-dressers, androgynous

people, genderqueers, and gender non-conforming people. “Trans” is shorthand

for “transgender.” 

A–1
A–2 • Helpful Terms for Prevention Specialists and Healthcare Providers

Term Definition

Transgender man A transgender person who currently identifies as a male (see also “FTM”).

Transgender woman A transgender person who currently identifies as a female (see also “MTF”).

Transsexual A person whose gender identity differs from their assigned sex at birth.

Two-Spirit

A contemporary term that references historical multiple-gender traditions in 

many First Nations cultures. Many Native/First Nations people who are lesbian, 

gay, bisexual, transgender, or gender non-conforming identify as Two-Spirit. In 

many Nations, Two-Spirit status carries great respect and leads to additional 

commitments and responsibilities to one’s community.

TERMS AND DEFINITIONS SPECIFIC TO 

GENDER EXPRESSION

Term Definition

Cross-dresser A person who dresses in clothing typically worn by people of the opposite 

gender, but who generally has no intent to live full-time as the other gender.

Drag king A woman who dresses as a man for the purpose of entertaining others at bars, 

clubs, or other events.

Drag queen

A man who dresses as a woman (often celebrity women) for the purpose of 

entertaining others at bars, clubs, or other events.

Note: The term drag queen is also used as slang, sometimes in a derogatory 

manner, to refer to all transgender women.

Gender expression

The manner in which a person represents or expresses their gender identity 

to others.

Note: Gender expression may be conveyed through behavior, clothing, 

hairstyles, voice, and/or body characteristics.

Passing

A term used by transgender people to mean that they are seen as the gender 

with which they self-identify. For example, a transgender man (assigned the 

female sex at birth) who most people see as a man might say that he is passing 

as a man.

Transition

A term used to describe the period during which a transgender person begins to 

express their gender identity. 

Note: During transition, a person may change their name, take hormones, have 

surgery, and/or change legal documents (e.g., driver’s license, Social Security 

record, birth certificate) to reflect their gender identity.
A–3 • Helpful Terms for Prevention Specialists and Healthcare Providers

 TERMS AND DEFINITIONS SPECIFIC TO SEXUAL 

IDENTITY AND SEXUAL ORIENTATION

Term Definition

Bisexual A person who self-identifies as having an emotional, sexual, and/or relational 

attraction to men and women.

Coming out The process through which a person identifies, acknowledges, and decides to 

share information about their sexual orientation and/or gender identity with others.

Gay

A man who self-identifies as having an emotional, sexual, and/or relational 

attraction to other men. 

Note: The term gay may be used by some women who prefer it over the 

term lesbian. 

Lesbian A woman who self-identifies as having an emotional, sexual, and/or relational 

attraction to other women.

MSM

An acronym used to identify men who have sex with men. MSM is a term used 

to identify and describe a behavior among males and is not the same as a 

sexual identity or sexual orientation. 

Outing The act of exposing information about a person’s sexual orientation and/or

 gender identity without their consent.

Queer

A term usually used to refer to specific sexual orientations (e.g., lesbian,

gay, bisexual). 

Note: Some individuals use queer as an alternative to gay in an effort to be 

more inclusive, since the term queer does not convey a sense of gender. 

However, depending on the user, the term can have either a derogatory or 

an affirming connotation.

Sexual orientation

A person’s emotional, sexual, and/or relational attraction to others. Sexual 

orientation is usually classified as heterosexual, bisexual, and homosexual

(i.e., lesbian and gay).

WSW

An acronym used to identify women who have sex with women. WSW is a term 

used to identify and describe a behavior among females and is not the same as 

a sexual identity or sexual orientation. 

A Discussion about Gender Identity

A Discussion About

Gender Identity

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

A Discussion about Gender Identity

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

For many, the acronym LGBT reflects a community of individuals who, in some way, are attracted to members of the same sex. However, many people fail to realize that the “T” in 

the acronym does not relate to sexual attraction at all; rather, it refers to a person’s sense of 

gender (referred to as gender identity). 

There are several schools of thought or theories about how a person develops, accepts, and expresses their 

gender identity. These include, but are not limited to, psychoanalytic theories, gender essentialism, cognitive 

development theories, and gender schema theories, among many others. While not exhaustive, the following 

is a brief overview of some of these perspectives.1,2,3,4

GENDER VS. SEX:

A FUNDAMENTAL SHIFT FROM AN 

 EXCLUSIVE BINARY PARADIGM

Before the 19th century, the terms gender and sex were synonymous, as these were based on an exclusive 

binary paradigm (i.e., male/female). Until then, the only determinant of gender was a person’s assigned sex at 

birth. However, in the mid-1920s, German sexologist Magnus Hirschfeld published an article making the first 

differentiation between the desire for same-sex acts and the desire to live and/or dress as the opposite sex.5,6,7

It wasn’t until the 1950s that the concepts and theories about gender, gender roles, and gender identity were 

introduced and defined in the literature. Psychologists, such as Jerome Kagan and John Money, initially believed 

that gender identity was the extent to which a person felt masculine or feminine. This fundamental feeling, 

coupled with the ability to meet cultural standards for specific gender roles (referred to as sex typing), was 

thought to be necessary for possessing a secure sense of self and overall well-being.8,9,10,11,12

During the mid-1960s to early 1980s, researchers such as Richard Green, Robert Stoller, Harry Benjamin, and 

Sandra Bem furthered the understanding of gender and gender identity. For example, Bem’s research focused on 

the effects of normative behaviors and argued that adhering to gender-related standards could, in fact, promote 

negative rather than positive adjustment. Benjamin, Stoller, and Green believed that incongruence between a 

person’s assigned sex at birth and their gender identity was of a biological, rather than psychological nature and 

went on to pioneer the establishment of gender identity clinics, as well as gender-related medical and surgical 

treatments.13,14,15,16 

The ongoing work of these and other pioneer researchers in the field of gender identity development raised 

awareness that gender is not exclusively determined by an assigned sex at birth, but determined by a person’s 

sense, belief, and ultimate expression of self. 

B–1
B–2 • A Discussion about Gender Identity

GENDER IDENTITY DEVELOPMENT: 

NATURE OR NURTURE?

DEVELOPMENTAL PERSPECTIVE: NATURE

In the 1990s, psychologist and researcher Diane Ruble suggested that gender identity is developed in three 

stages: construction (ages 0–5), consolidation (ages 5–7), and integration (ages 7 and up).17

During construction, children seek information about gender and do not necessarily react strongly to norm 

violations (e.g., a boy may play with a Barbie doll). In the consolidation phase, children have well-developed 

gender stereotypes and show rigidity about their gender beliefs (e.g., a boy may avoid or refuse to touch a Barbie 

doll). Lastly, in the integration phase, children may show more flexibility and individual differences in how they 

think about gender (e.g., a boy may choose to play with certain types of dolls).

ENVIRONMENTAL PERSPECTIVE: NURTURE

Contemporary perspectives on human development challenge the notion that the process of identity development 

is intrinsic to an individual or that one construct can explain such a dynamic process. Many researchers believe 

that identities develop as a result of complex interactions between an individual and their environment.18,19,20,21

For example, some research suggests that three external factors may influence how a person develops 

and ultimately expresses their gender identity: centrality, evaluation, and felt pressure. Centrality refers to how 

important gender is to a person’s overall identity; evaluation refers to how a person views his or her gender in 

terms of cultural standards, beliefs, and norms; and felt pressure refers to a person’s feelings about the need to 

conform to these cultural standards, beliefs, and norms.22

GENDER IDENTITY DISORDER: 

A MEDICAL PERSPECTIVE

Though many people, including clinicians, do not consider transgender people to have a disorder, the medical 

community developed a specific diagnosis now known as Gender Identity Disorder (GID), for children and adults 

whose gender identity and gender expression are not aligned with their assigned sex at birth.23

Diagnoses related to gender identity first appeared in the third version of the Diagnostic and Statistical Manual of 

Mental Disorders (DSM-III) published in 1980 and included Gender Identity Disorder for Children, Transsexualism 

(for adolescents and adults), and gender identity disorder of adolescence and adulthood, nontranssexual type 

(added in the DSM III-R in 1987).24,25

With the release of the DSM IV in 1994, the three gender identity-related diagnoses were collapsed into one, known 

as Gender Identity Disorder, with different criteria for children and adults that included a persistent discomfort with 

the assigned sex at birth; a persistent discomfort with the role typically associated with their assigned sex at birth; 

and significant discomfort or impairment at work, social situations, or other major life areas.26
B–3 • A Discussion about Gender Identity

There are no comprehensive studies of the prevalence of GID among children, adolescents, or adults.27

Nonetheless, there is stark contrast in the literature about the estimated prevalence of GID. According to 

researchers who use estimates from a government-subsidized gender identity clinic in the Netherlands as 

a benchmark, the prevalence rate of GID among men is approximately 1 in 11,900 and among women is 

approximately 1 in 30,400. However, it is important to note that this and other prior estimates are based solely 

on the transsexual minority of transgender people (i.e., those who present for a diagnosis of GID and referral for 

treatment for medical transition to the opposite gender). It is likely that many more transgender people do not 

present for such treatment and have not been included in these estimates. 

TRANSGENDER

Nowadays, the term transgender is an umbrella term for people whose gender identity, expression and/or 

behavior is different from those typically associated with their assigned sex at birth. Since the 1990s, the term has 

often been used to describe groups of gender minorities including but not limited to transsexuals, cross-dressers, 

androgynous people, genderqueers, and gender non-conforming people.28

To clarify gender differences among transgender individuals, transgender men had or have female body parts; 

however, they may identify and/or express themselves as male. Conversely, transgender women had or have 

male body parts; however, they may identify and/or express themselves as female.

RELATIONSHIP TO SEXUAL ORIENTATION

Research shows that gender identity, in many cases, is independent of sexual orientation. For example, 

transgender men may be attracted to men, women or both, and transgender women may be attracted to men, 

women or both.29 Transgender men may also partner with other transgender men and transgender women, and 

transgender women may also partner with other transgender women and transgender men.30

Prevention specialists and healthcare providers should be aware that beliefs around gender can, and often 

do, touch upon many aspects of life. These beliefs can manifest in a number of areas ranging from reactions 

toward clothing individuals wear to the pronouns used during clinical assessments. It is important for providers to 

demonstrate sensitivity to all clients, regardless of perceived gender, when communicating to and/or about clients.
B–4 • A Discussion about Gender Identity

This publication lists non-Federal resources to provide additional information. The views and content in these 

resources have not been formally approved by the U.S. Department of Health and Human Services (HHS). Listing 

of the resources is not an endorsement by HHS or its operating divisions.

REFERENCES

1 Freud, S. (1905). Three essays on the theory of sexuality. Standard Edition. London: Hogarth.

2 Cosmides, L., Tooby, J. (1994). Origins of domain specificity: The evolution of functional organization. In: Hirschfeld LA, Gelman SA, 

editors. Mapping the Mind: Domain Specificity in Cognition and Culture. New York: Cambridge University, 85-116.

3 Liben, L.S. (2008). Cognitive approaches to gender development. In: Blakemore JEO, Berenbaum SA, Liben LS, editors. Gender 

Development. New York: Taylor & Francis, 197-226.

4 Martin, C.L., Halverson, C.F. (1981). A schematic processing model of sex typing and stereotyping in children. Child Development, 52, 

1119-1134.

5 Di Ceglie, D. (2010). Gender identity and sexuality: What’s in a name? Diversity in Health and Care, 7, 83–86.

6 Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and 

statistical manual. Archives of Sexual Behavior, 39, 427–460.

7 Hirschfeld, M. Die Transvestiten; ein Untersuchung uber den erotischen Verkleidungstrieb: mit umfangreichem casuistischen und 

historischen Material. Berlin: Pulvermacher, vi, 562 pp1910. English translation by Michael A Lombardi-Nash. Tranvestites: The Erotic 

Urge to Cross-dress. Buffalo: Prometheus Books. 424 pp 1991.

8 Kagan, J. (1964) A cognitive-developmental analysis of children’s sex-role concepts and attitudes. In M. L. Hoffman & L. W. Hoffman 

(Eds.), Review of Child Development Research (Vol. 1, 137–167). New York: Russell Sage Foundation.

9 Money, J., Hampson, J.G., & Hampson, J.L. (1955a). Hermaphroditism: Recommendations concerning assignment of sex, change of 

sex, and psychological management. Bulletin of Johns Hopkins Hospital, 97, 284–300.

10 Money, J., Hampson, J.G., & Hampson, J.L. (1955b). Examination of some basic sexual concepts: Evidence of human 

hermaphroditism. Bulletin of Johns Hopkins Hospital, 97, 301–319.

11 Di Ceglie, D. (2010). Gender identity and sexuality: What’s in a name? Diversity in Health and Care, 7, 83–86.

12 Lurye, L.E., Zosuls, K.M., & Ruble, D.N. (2008). Gender identity and adjustment: Understanding the impact of individual and normative 

differences in sex typing. In M. Azmitia, M. Syed, & K. Radmacher (Eds.), The Intersections of Personal and Social Identities: New 

Directions for Child and Adolescent Development, 120, 31–46.

13 Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and 

statistical manual. Archives of Sexual Behavior, 39, 427–460.

14 Lurye, L.E., Zosuls, K.M., & Ruble, D.N. (2008). Gender identity and adjustment: Understanding the impact of individual and normative 

differences in sex typing. In M. Azmitia, M. Syed, & K. Radmacher (Eds.), The Intersections of Personal and Social Identities: New 

Directions for Child and Adolescent Development, 120, 31–46.

15 Bem, S.L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88, 354–364.

16 Bem, S.L., & Lenney, E. (1976). Sex typing and the avoidance of cross-sex behavior. Journal of Personality and Social Psychology, 

33, 48–54.

17 Lurye, L.E., Zosuls, K.M., & Ruble, D.N. (2008). Gender identity and adjustment: Understanding the impact of individual and normative 

differences in sex typing. In M. Azmitia, M. Syed, & K. Radmacher (Eds.), The Intersections of Personal and Social Identities: New 

Directions for Child and Adolescent Development, 120, 31–46.

18 Ashmore, R.D., Deaux, K., & McLaughlin-Volpe, T. (2004). An organizing framework for collective identity: Articulation and significance 

of multidimensionality. Psychological Bulletin, 130, 80–114.

19 Egan, S.K., & Perry, D.G. (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. 

Developmental Psychology, 37, 451–463.

20 Bandura, A. (1991b). Social cognitive theory of moral thought and action. In W. M. Kurtines & J. L. Gewirtz (Eds.), Handbook of Moral 

Behavior and Development (Vol. 1, pp. 45–103). Hillsdale, NJ: Erlbaum.

21 Martin, C.L., Ruble, D.N., & Szkrybalo, J. (2002). Cognitive theories of early gender development. Psychological Bulletin, 128, 

903–933.
B–5 • A Discussion about Gender Identity

22 Lurye, L.E., Zosuls, K.M., & Ruble, D.N. (2008). Gender identity and adjustment: Understanding the impact of individual and normative 

differences in sex typing. In M. Azmitia, M. Syed, & K. Radmacher (Eds.), The Intersections of Personal and Social Identities: New 

Directions for Child and Adolescent Development, 120, 31–46.

23 American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.

24 Shechner, T. (2010). Gender identity disorder: A literature review from a developmental perspective. Israel Journal of Psychiatry & 

Related Sciences, 47, 42–47.

25 Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and 

statistical manual. Archives of Sexual Behavior, 39, 427–460.

26 American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.

27 Shechner, T. (2010). Gender identity disorder: A literature review from a developmental perspective. Israel Journal of Psychiatry & 

Related Sciences, 47, 42–47.

28 National Center for Transgender Equality. (2009). Terminology. From http://transequality.org (accessed May 31, 2011).

29 Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and 

statistical manual. Archives of Sexual Behavior, 39, 427–460.

30 Xavier, J., Honnold, J., Bradford, J. (2007). The health, health-related needs, and lifecourse experiences of transgender 

Virginians. Richmond, VA: Virginia HIV Community Planning Committee and Virginia Department of Health. Available from 

http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf.

Top Health Issues for Lesbians

Top Health Issues

for Lesbians

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Top Health Issues for Lesbians

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

PHYSICAL HEALTH

HEART DISEASE

The more risk factors a woman has, the greater the chance that she will develop heart disease. Factors that raise 

women’s risk for heart disease include physical inactivity, obesity, and smoking—all of which have been found to 

be more prevalent among lesbians than other women.1

CANCERS

Lesbians are at significantly higher risk for developing breast cancer than heterosexual women. Risk factors for 

breast cancer among lesbians include fewer full-term pregnancies, fewer mammograms and/or clinical breast 

exams, and being overweight.

Traditionally, lesbians and bisexual women have been less likely to bear children and, as a result, may not fully 

benefit from hormones released during pregnancy and breastfeeding. These hormones are believed to protect 

women against different types of cancers.2,3

Lesbians have also been less likely to visit a doctor or nurse for routine screenings than heterosexual women. 

Routine screenings, such as Pap tests and mammograms, are critical to the prevention or early detection of 

breast, cervical, and other cancers among all women.4,5,6

FITNESS

Some research has indicated that adult lesbians are not sufficiently physically active. In a recent study, lesbian 

participants identified barriers to participating in exercise, such as being too tired, not having a physical activity 

partner, finding a lack of lesbian-focused physical activity groups, and lacking same-sex family memberships to 

fitness facilities. Interventions developed for the general population of women are likely to be less effective in 

assisting lesbians to include exercise as part of their daily or weekly routine.7,8

Providers should be aware of an additional important factor: lesbians tend to possess somewhat different attitudes 

about beauty than do heterosexual women.9

 As a result, lesbians’ current weight, and perceptions of being 

overweight, may not necessarily contribute to their likelihood of engaging in frequent exercise.10

OBESITY

Some groups of lesbian women are more likely to be overweight and obese than females of other sexual 

orientations. Specifically, higher prevalence rates of obesity have been found among lesbians who are: AfricanAmerican; live in rural or urban areas; have lower levels of education; and are from a low socioeconomic 

status. Providers should encourage all women to seek routine health assessments to determine their weight 

status.11,12,13,14

C–1
C–2 • Top Health Issues for Lesbians

INJURY/VIOLENCE

Studies have shown that lesbian women and gay men report experiencing harassment or physical violence from 

family members due to their sexual orientation.15 In addition, when compared with straight adults (17.5 percent), 

a significantly higher percentage of lesbian or gay adults (56.4 percent) and bisexual adults (47.4 percent) report 

experiencing intimate partner violence.16 Providers should routinely assess women for a history of domestic 

violence and/or victimization.

BEHAVIORAL HEALTH

MENTAL HEALTH

Many factors affect the mental and emotional health of lesbian women. For example, a research study found 

that adverse, punitive, and traumatic reactions from parents and caregivers in response to their children’s sexual 

orientation were closely correlated with poor mental health and an increase in substance use.17

Among adults, a study that examined the risk of psychiatric disorders among individuals with same-sex partners 

found that, during the previous 12 months, women with same-sex partners experienced more mental health 

disorders—such as major depression, phobia, and post-traumatic stress disorder—than did women with oppositesex partners.18

Studies have found that lesbian and bisexual women consult general practitioners for emotional reasons more 

often than heterosexuals if their primary care physician is aware of their sexual orientation. However, not all 

lesbian and bisexual women want to disclose their sexual orientation. Building positive rapport with clients and 

creating a safe environment for the sharing of sensitive information, such as sexual orientation and/or sexual 

behaviors, could lead to more opportunities for the screening and monitoring of critical behavioral health indicators 

such as smoking status, alcohol use, and mental health.19

SUICIDE

Results from an anonymous survey administered in 33 healthcare sites across the United States showed 

that sexual orientation was associated with higher levels of emotional stress and other types of mental health 

disorders. 

Specifically, the study found that lesbian and bisexual women who were “out” experienced more emotional 

stress as teenagers and were 2 to 2.5 times more likely to experience suicidal ideation in the past 12 months 

than heterosexual women. Meanwhile, lesbian and bisexual women who were not “out” were more likely to have 

attempted suicide than heterosexual women.20

It is critical for providers to discuss with clients their coming out experience and/or plans to come out to friends 

and family. Many times, clients will need resources and support for this critical milestone. 
C–3 • Top Health Issues for Lesbians

SUBSTANCE ABUSE

Studies have found that lesbians are between 1.5 and 2 times more likely to smoke than heterosexual women. 

Among lesbians, younger women are more likely to smoke than older women, while “butch” lesbians are much 

more likely to smoke and use marijuana than young “femme” lesbians. Experiences of gay-related stressful 

events, internalized homophobia, and emotional distress were found to account for most of the butch/femme 

differences in tobacco and marijuana use. The difference between the two age groups may be explained, in part, 

by younger women being more likely to socialize in bar settings.21

A number of studies have also suggested that lesbians are significantly more likely to drink heavily than 

heterosexual women. Specifically, exclusively heterosexual women tend to have lower drinking rates than all other 

women, while bisexual women report more hazardous drinking than heterosexual or lesbian women.22,23

These findings suggest that prevention and treatment programs aimed at addressing substance use among 

lesbian and bisexual women must also address experiences of gay-related stress and emotional distress.24

This publication lists non-Federal resources to provide additional information. The views and content in these 

resources have not been formally approved by the U.S. Department of Health and Human Services (HHS). Listing 

of the resources is not an endorsement by HHS or its operating divisions.

REFERENCES

1,2,3,4 National Women’s Health Information Center. (n.d.) Lesbian and bisexual health. From http://womenshealth.gov/faq/lesbian-health.cfm

(accessed May 31, 2011).

5 Dibble, S.L., Roberts, S.A., & Nussey, B. (2004). Comparing breast cancer risk between lesbians and their heterosexual sisters. 

Women’s Health Issues, 14(2), 60–68. 

6 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA. 

7 Brittain, D.R., Baillargeon, T., McElroy, M., Aaron, D.J., & Gyurcsik, N.C. (2006). Barriers to moderate physical activity in adult lesbians. 

Women Health, 43(1), 75–92.

8 Bowen, D.J., Balsam, K.F., Diergaarde, B., Russo, M., & Escamilla, G.M. (2006). Healthy eating, exercise, and weight: Impressions of 

sexual minority women. Women’s Health, 44(1), 79–93.

9 Haines, M.E., Erchull, M.J., Liss, M., Turner, D.L., & Nelson, J.A. (2008). Predictors and effects of self-objectification in lesbians. 

Psychology of Women Quarterly, 32(2), 282–287.

10 Yancey, A.K., Cochran, S.D., Corliss, H.L., & Mays, V.M. (2003). Correlates of overweight and obesity among lesbian and bisexual 

women. Prevention Medicine, 36, 676–683.

11 Struble, C.B., Lindley, L.L., Montgomery, K., Hardin, J., & Burcin, M. (2010). Overweight and obesity in lesbian and bisexual college 

women. Journal of the American College of Health, 59(1), 51–56.

12 Boehmer, U., Bowen, D.J., & Bauer, G.R. (2007). Overweight and obesity in sexual-minority women: evidence from population-based 

data. American Journal of Public Health, 97(6), 1134–1140.

13 Cochran, S.D., Mays, V.M., Bowen, D., Gage, S., Bybee, D., Roberts, S.J., et al. (2001). Cancer-related risk indicators and preventative 

screening behaviors among lesbian and bisexual women. American Journal of Public Health, 91, 591–597.

14 Smith, N., Markovic, N., Danielson, M. et al. (2010). Sexual abuse, sexual orientation, and obesity in women. Journal of Women’s 

Health 19(8), 1525-1532.

15 Gross, L., Aurand, S., & Addessa, R. (2000). The 1999–2000 study of discrimination and violence against lesbian and gay 

men in Philadelphia and the commonwealth of Pennsylvania. Philadelphia: Philadelphia Gay and Lesbian Task Force. From 

http://www.plgtf.org/cr2kstudy.pdf (accessed June 1, 2011).
C–4 • Top Health Issues for Lesbians

16 VanKim, N.A., & Padilla, J.L. (2010). New Mexico’s progress in collecting lesbian, gay, bisexual, and transgender health data and its 

implications for addressing health disparities. Albuquerque, NM: New Mexico Department of Health, Chronic Disease Prevention and 

Control Bureau. From http://nmhealth.org/erd/healthdata/pdf/2010_LGBT_Report.pdf (accessed May 31, 2011).

17 Ryan, C., Huebner, D., Diaz, R.M., Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino 

lesbian, gay, and bisexual young adults. Pediatrics, 23(1), 346–352.

18 Gilman, S.E., Cochran, S.D., Mays, V.M., Hughes, M., Ostrow, D., & Kessler, R.C. (2001). Risk of psychiatric disorders among 

individuals reporting same-sex sexual partners in the national comorbidity survey. American Journal of Public Health, 91, 933–939.

19 King, M., & Nazareth, I. (2006). The health of people classified as lesbian, gay, and bisexual attending family practitioners in London: A 

controlled study. BMC Public Health, 6, 127.

20 Koh, A.S., & Ross, L.K. (2006). Mental health issues: A comparison of lesbian, bisexual and heterosexual women. Journal of 

Homosexuality, 51(1), 33–57.

21 Nyitray, A., Corran, R., Altman, K., Chikani, V., & Negrón, E.V. (2006). Tobacco use and interventions among Arizona lesbian, gay, 

bisexual and transgender people. Phoenix, AZ: Arizona Department of Health Services. From 

http://www.lgbttobacco.org/files/Arizona_smoking_lgbt_report.pdf (accessed May 31, 2011).

22 Diamant, A.L., Wold, C., Spritzer, K., & Gelberg, L. (2000). Health behaviors, health status, and access to and use of health care: A 

population-based study of lesbian, bisexual, and heterosexual women. Archives of Family Medicine, 9(10), 1043–1051.

23 Wilsnack, C.V., Hughes, T.J., Johnson, T.P., Bostick, W.B., Szalacha, L.A., Benson, P., et al. (2008). Drinking and drinking-related 

problems among heterosexual and sexual minority women. Journal of Studies on Alcohol and Drugs, 69(2), 129–130.

24 Rosario, M., Schrimshaw, E.W., & Hunter, J. (2008). Butch/femme differences in substance use and abuse among young lesbian and 

bisexual women: Examination and potential explanations. Substance Use and Misuse, 43(8–9), 1002–1015.
Top Health Issues for Gay Men

Top Health Issues

for Gay Men

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Top Health Issues for Gay Men

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

D–1

PHYSICAL HEALTH

HEART DISEASE

Heart disease remains a significant concern for men of all sexual orientations. Major risk factors for heart disease 

among men include tobacco use and alcohol use—behaviors prevalent among gay men.1,2,3,4,5,6,7,8,9,10,11

CANCER

In some cases, gay men are at increased risk for several types of cancer—including prostate, testicular, and colon 

cancers. In addition, gay men, as well as anyone who has receptive anal sex, are at higher risk for anal cancer 

due to an increased risk of becoming infected with human papillomavirus (HPV), the virus that causes genital 

and anal warts. However, access to screening services may be severely limited due to issues and challenges in 

receiving culturally sensitive care.12,13,14,15,16,17

INJURY AND VIOLENCE

Data show that gay men generally experience two types of violent victimization: criminal violence based on their 

sexual minority status, and violence from an intimate male partner. As a result, providers should routinely assess 

their male clients for a history of domestic violence and/or victimization.18,19,20

FITNESS

Problems with body image are more common among gay men than among their straight counterparts. In addition, 

gay men are much more likely to experience an eating disorder such as bulimia or anorexia nervosa.21,22,23 

Therefore, providers should be able to recognize the signs and symptoms of eating disorders and supply their 

male clients with the necessary referrals for behavioral health services.

BEHAVIORAL HEALTH

MENTAL HEALTH

Multiple studies have shown that depression and anxiety affect gay men at a higher rate than the general 

population, and are often more severe for men who remain “in the closet.” Culturally sensitive mental health 

services that specifically target gay men have been shown to be more effective in the prevention, early detection, 

and treatment of these conditions.24,25,26,27,28

SUICIDE

Factors such as verbal and physical harassment, negative experiences related to “coming out” (including 

level of family acceptance), substance use, and isolation all contribute to higher rates of suicidal attempts and 

completions among gay men and youth than among other populations.29,30,31,32,33
D–2 • Top Health Issues for Gay Men

SUBSTANCE ABUSE

Recent studies have improved our understanding of substance use in the gay community. Specifically, some 

studies show that gay men use substances, including alcohol and illicit drugs, at a higher rate than the general 

population—not just in larger communities such as New York, San Francisco, and Los Angeles.34,35

Many studies also indicate that gay men use tobacco at much higher rates than straight men—reaching nearly a 

50 percent difference in some cases.36,37,38,39,40,41,42,43

It is important for providers to understand that alcohol and illicit drug use among gay men is significantly affected 

by factors such as age, affiliation with gay culture, level of stress, and how “out” an individual is, among others. 

Therefore, culturally sensitive and accessible prevention and treatment programs are critical for addressing 

substance use among gay men.44

SEXUAL HEALTH

SEXUALLY TRANSMITTED DISEASES: HIV/AIDS

The fact that men who have sex with men (MSM) are at an increased risk of HIV infection has been well 

documented. In 2006, MSM accounted for 48 percent of the more than 1 million people living with HIV in the 

United States and accounted for 53 percent of all newly diagnosed HIV infections in the United States. 

While the Centers for Disease Control and Prevention (CDC) estimates that MSM account for just 4 percent of the 

U.S. male population ages 13 and older, the rate of new HIV diagnoses among MSM in the United States is more 

than 44 times that of other men (range: 522–989 per 100,000 MSM vs. 12 per 100,000 other men). 

Of young MSM, African-American MSM bear the greatest HIV/AIDS burden. More than twice as many AfricanAmerican MSM ages 13–24 were diagnosed with HIV infection or AIDS in 2006 as their White or Hispanic 

counterparts. In addition, African-American and Hispanic MSM were more likely to become infected with HIV at 

a younger age (13–29 years), whereas White MSM were more likely to become infected when they were older 

(30–39 years).45

The effectiveness of safer sex practices for reducing the rate of HIV infection is one of the gay community’s great 

success stories. Safer sex has been shown to be effective in reducing the risk of receiving and transmitting HIV. 

However, studies over the last few years have demonstrated the return of many unsafe sex practices. Providers 

should be aware of how to counsel their patients to support the maintenance of safer sex practices.46,47

SEXUALLY TRANSMITTED DISEASES: OTHER INFECTIONS

Sexually transmitted diseases (STDs) occur at a high rate among sexually active gay men. This includes 

STD infections for which effective treatment is available (e.g., syphilis, gonorrhea, chlamydia, pubic lice, anal 

papilloma) and for which no cure is currently available (e.g., HIV; hepatitis A, B, or C virus; human papillomavirus). 
D–3 • Top Health Issues for Gay Men

SYPHILIS

Over the past several years, an increase in syphilis among MSM has been reported in various cities and areas—

including outbreaks in Chicago, Seattle, San Francisco, Southern California, Miami, and New York City. These 

areas have experienced high rates of syphilis and HIV co-infection, ranging from 20 to 70 percent. 

The health problems caused by syphilis can be serious. Additionally, it is now known that contracting syphilis also 

makes one more likely to transmit or acquire HIV infection sexually.48

HPV

The human papillomavirus (HPV), which causes anal and genital warts, is often downplayed as an unsightly 

inconvenience. However, HPV infections may play a role in the increased rates of anal cancers among gay men. 

Gay and bisexual men are estimated to be 17 times more likely to develop anal cancer than heterosexual men. 

While treatments for HPV do exist, recurrences of the warts and the rate at which the infection can be spread 

between partners are very high. Certain populations (including gay and bisexual men, people with weak immune 

systems, and people with HIV/AIDS) are also at higher risk for some HPV-related health problems. There is no 

doubt that safer sex reduces the risk of STDs; prevention of these infections through safer sex is key.49,50,51,52,53

HEPATITIS

MSM are at increased risk of acquiring sexually transmitted infections carrying viruses that cause the serious liver 

condition known as hepatitis. In the United States, cases of hepatitis among MSM are primarily caused by one or 

more of the following viruses:54

Hepatitis A virus (HAV) is primarily transmitted by the fecal-oral route, through either person-to-person contact or 

consumption of contaminated food or water. 

Hepatitis B virus (HBV) is transmitted through percutaneous (puncture through the skin) or mucosal contact with 

infectious blood or body fluids. HBV can cause acute illness and/or lead to chronic or lifelong infection, cirrhosis 

(scarring) of the liver, liver cancer, liver failure, and death. 

Hepatitis C virus (HCV) is spread by sexual contact and/or contact with the blood of an infected person, and can 

cause a liver disease that sometimes results in an acute illness, but more often becomes a silent, chronic infection 

that can lead to cirrhosis (scarring), liver failure, liver cancer, and death. 

While some infections can be fatal, especially among MSM with other chronic conditions (e.g., HIV),55

immunizations are available to prevent two of the three hepatitis viruses. Universal immunization for HAV and 

HBV is recommended for all MSM. Data furthermore show that safer sex is effective at reducing the risk of viral 

hepatitis and is currently the only means of prevention for HCV.56,57
D–4 • Top Health Issues for Gay Men

This publication lists non-Federal resources to provide additional information. The views and content in these 

resources have not been formally approved by the U.S. Department of Health and Human Services (HHS). Listing 

of the resources is not an endorsement by HHS or its operating divisions.

REFERENCES

1 World Heart Federation. (2012). Cardiovascular disease risk factors. From 

http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/

2 Ostrow, D.G., & Stall, R. (2008). Alcohol, tobacco, and drug use among gay and bisexual men. In Wolitski, R. J., Stall, R., & Valdiserri, R. O., 

(Ed.) Unequal opportunity: Health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press.

3 Centers for Disease Control and Prevention. (2010). CDC fact sheet, substance abuse among gay and bisexual men. Atlanta: Author.

4 Irwin, T.W., Morgenstern, H., Parsons, J.T., et al. (2006). Alcohol and sexual HIV risk behavior among problem drinking men who have 

sex with men: An event level analysis of timeline follow-back data. AIDS and Behavior, 10(3), 299–307.

5 Wong, C.F., Kipke, M.D., Weiss, G. (2008). Risk factors for alcohol use, frequent use, and binge drinking among young men who have 

sex with men. Addictive Behaviors, 33(8), 1012–1020. 

6 Stall, R., Paul, J.P., et al. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban 

Men’s Health Study. Addiction, 96(11), 589–601. 

7 Padilla, Y., Crisp, C., & Rew, D.L. (2010). Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: 

Results from a national survey. Social Work, 55(3), 265–275. 

8 Halkitis, P.N., Mukherjee, P.P., & Palamar, J.J. (2009). Longitudinal modeling of methamphetamine use and sexual risk behaviors in 

gay and bisexual men. AIDS and Behavior, 13(4), 783–791. 

9 Lee, J.G., Griffin, G.K., et al. (2009). Tobacco use among sexual minorities in the USA, 1987 to May 2007: A systematic review. 

Tobacco Control, 18(4), 275–282. From http://tobaccocontrol.bmj.com/content/18/4/275.long (accessed June 1, 2011). 

10 Gruskin, E.P., Greenwood, G.L., Matevia, M., Pollack, L.M., & Bye, L.L. (2007). Disparities in smoking between the lesbian, gay, and 

bisexual population and the general population in California. American Journal of Public Health, 97(8), 1496–1502. 

11 Greenwood, G.L., Paul, J.P., et al. (2005). Tobacco use and cessation among a household-based sample of U.S. urban men who have 

sex with men. American Journal of Public Health, 95(1), 145–151. From 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449276/pdf/0950929.pdf (accessed June 1, 2011).

12 Asencio, M., Blank, T., & Descartes, L. (2009). The prospect of prostate cancer: A challenge for gay men’s sexualities as they age. 

Sexuality Research & Social Policy, 6(4), 38–51.

13 Mayo Clinic. (2010). Testicular cancer. Retrieved from www.mayoclinic.com. 

14 Bowen, D.J., & Boehmer, U. (2007). The lack of cancer surveillance data on sexual minorities and strategies for change. Cancer 

Causes and Control, 18(4), 343–349.

15 Heslin, K.C., Gore, J.L., King, W.D., & Fox, S. (2008). Sexual orientation and testing for prostate and colorectal cancers among men in 

California. Med Care, 46(12), 1240–1248. 

16 Chin-Hong, P.V., Vittinghoff, E., Cranston, R.S., Browne, L., Buchbinder, S., Colfax, G. et al. (2005). Age-related prevalence of anal 

cancer precursors in homosexual men: The EXPLORE study. Oxford Journals, 97(12), 896–905. 

17 McRee, A.L., Reiter, P.L., Chantala, K., et al. (2010). Does framing human papillomavirus vaccine as preventing cancer in men increase 

vaccine acceptability? Cancer Epidemiology Biomarkers and Prevention, 19(9), 1937. 

18 Herek, G.M. (2009). Hate crimes and stigma-related experiences among sexual minority adults in the United States: Prevalence 

estimates from a national probability sample. Journal of Interpersonal Violence, 24(1), 54–74. 

19 Willis, D G. (2004). Hate crimes against gay males: An overview. Issues in Mental Health Nursing, 25(2), 115–132. 

20 Houston, E., & McKirman, D.J. (2007). Intimate partner abuse among gay and bisexual men: Risk correlates and health outcomes. 

Journal of Urban Health, 84(5), 681–690.

21 Siconolfi, D., Halkitis, P.N., & Allomong, T.W. (2009). Body dissatisfaction and eating disorders in a sample of gay and bisexual men. 

International Journal of Men’s Health, 8(3), 254–264. 

22 Donald, R., McCreary, T.B., Hildebrandt, L.J., Heinberg, M.B., & and Thompson, J.K. (2007). A review of body image influences on 

men’s fitness goals and supplement use. American Journal of Men’s Health, 1(4), 307–316. 
D–5 • Top Health Issues for Gay Men

23 Deputy, N.P., & Boehmer, U. (2010). Determinants of body weight among men of different sexual orientation. Preventive Medicine, 

51(2), 129–131.

24 Cochran, S D., Mays, V.M., et al. (2007). Mental health and substance use disorders among Latino and Asian American lesbian, gay, 

and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5), 785–794. 

25 Gilman, S.E., Cochran, S.D., et al. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the 

National Comorbidity Survey. American Journal of Public Health, 91(6), 933–939. 

26 Berg, M.B., Mimiaga, M.J., & Safren, S.A. (2008). Mental health concerns of gay and bisexual men seeking mental health services. 

Journal of Homosexuality, 54(3), 293–306. 

27 Burgess, D., Tran, A., Lee, R., & Van Ryn, M. (2008). Effects of perceived discrimination on mental health and mental health services 

utilization among gay, lesbian, bisexual and transgender persons. Journal of LGBT Health Research, 4(1), 43. 

28 Bostwick, W.B., Boyd, C.J., et al. (2009). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the 

United States. American Journal of Public Health, 100(3), 468–475. From 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820045/?tool=pubmed (accessed June 1, 2011).

29 Cochran, S D., Mays, V.M., et al. (2007). Mental health and substance use disorders among Latino and Asian American lesbian, gay, 

and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5), 785–794.

30 Gilman, S.E., Cochran, S.D., et al. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the 

National Comorbidity Survey. American Journal of Public Health, 91(6), 933–939.

31 Berg, M.B., Mimiaga, M.J., & Safren, S.A. (2008). Mental health concerns of gay and bisexual men seeking mental health services. 

Journal of Homosexuality, 54(3), 293–306.

32 Burgess, D., Tran, A., Lee, R., & Van Ryn, M. (2008). Effects of perceived discrimination on mental health and mental health services 

utilization among gay, lesbian, bisexual and transgender persons. Journal of LGBT Health Research, 4(1), 43.

33 Bostwick, W.B., Boyd, C.J., et al. (2009). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the 

United States. American Journal of Public Health, 100(3), 468–475. From 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820045/?tool=pubmed (accessed June 1, 2011).

34 Ostrow, D.G., & Stall, R. (2008). Alcohol, tobacco, and drug use among gay and bisexual men. In Wolitski, R. J., Stall, R., & Valdiserri, R. O., 

(Ed.) Unequal opportunity: Health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press.

35 Centers for Disease Control and Prevention. (2010). CDC fact sheet, substance abuse among gay and bisexual men. Atlanta: Author.

36 Irwin, T.W., Morgenstern, H., Parsons, J.T., et al. (2006). Alcohol and sexual HIV risk behavior among problem drinking men who have 

sex with men: An event level analysis of timeline follow-back data. AIDS and Behavior, 10(3), 299–307.

37 Wong, C.F., Kipke, M.D., Weiss, G. (2008). Risk factors for alcohol use, frequent use, and binge drinking among young men who have 

sex with men. Addictive Behaviors, 33(8), 1012–1020. 

38 Stall, R., Paul, J.P., et al. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban 

Men’s Health Study. Addiction, 96(11), 589–601. 

39 Padilla, Y., Crisp, C., & Rew, D.L. (2010). Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: 

Results from a national survey. Social Work, 55(3), 265–275. 

40 Halkitis, P.N., Mukherjee, P.P., & Palamar, J.J. (2009). Longitudinal modeling of methamphetamine use and sexual risk behaviors in 

gay and bisexual men. AIDS and Behavior, 13(4), 783–791. 

41 Lee, J.G., Griffin, G.K., et al. (2009). Tobacco use among sexual minorities in the USA, 1987 to May 2007: A systematic review. 

Tobacco Control, 18(4), 275–282. From http://tobaccocontrol.bmj.com/content/18/4/275.long (accessed June 1, 2011). 

42 Gruskin, E.P., Greenwood, G.L., Matevia, M., Pollack, L.M., & Bye, L.L. (2007). Disparities in smoking between the lesbian, gay, and 

bisexual population and the general population in California. American Journal of Public Health, 97(8), 1496–1502. 

43 Greenwood, G.L., Paul, J.P., et al. (2005). Tobacco use and cessation among a household-based sample of U.S. urban men who have 

sex with men. American Journal of Public Health, 95(1), 145–151. From 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449276/pdf/0950929.pdf (accessed June 1, 2011).

44 Green, K.E., & Feinstein, B.A. (2011, November 7). Substance Use in Lesbian, Gay, and Bisexual Populations: An Update on Empirical 

Research and Implications for Treatment. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0025424

45 Centers for Disease Control and Prevention. (2010). CDC fact sheet, substance abuse among gay and bisexual men. Atlanta: Author.

46 Hall, H.I., Song, R., Rhodes, P., Prejean, J., An, Q., Lee, L.M., Karon, J., Brookmeyer, R., Kaplan, E.H., McKenna, M.T., & Janssen, 

R.S. for the HIV Incidence Surveillance Group. (August 6, 2008). Estimation of HIV incidence in the United States. Journal of the 

American Medical Association, 300(5), 520.
D–6 • Top Health Issues for Gay Men

47 Centers for Disease Control and Prevention. (2010). CDC fact sheet, substance abuse among gay and bisexual men. Atlanta: Author.

48 Centers for Disease Control and Prevention. (December 2007). CDC fact sheet, syphilis & MSM (Men who have sex with men). 

Atlanta: Author.

49 Palefsky, J., Holly, E., et al. (2000). Anal cancer: In gay and bisexual men. San Francisco: AIDS Research Institute at University of 

California at San Francisco. From http://ari.ucsf.edu/science/s2c/anal.pdf (accessed June 1, 2011).

50 Nagle, D. (2009). Anal squamous cell carcinoma in the HIV-positive patient. Clinics in Colon and Rectal Surgery, 22(2), 102–106.

51 Vajdic, C.M., van Leeuwen, M.T., Jin, F., et al. (2009). Anal human papillomavirus genotype diversity and co-infection in a communitybased sample of homosexual men. Sexually Transmitted Infections, 85, 330–335. 

52 Tider, D.S., Parsons, J.T., & Bimbi, D.S. (2005). Knowledge of human papillomavirus and effects on sexual behavior of gay/bisexual 

men: A brief report. International Journal of STD & AIDS, 16, 707–708.

53 Centers for Disease Control and Prevention. (December 2007). CDC fact sheet, syphilis & MSM (Men who have sex with men). 

Atlanta: Author.

54 Centers for Disease Control and Prevention (2012). Hepatitis. Retrieved from http://www.cdc.gov/hepatitis/

55 Klenerman, P. & Kim, A. (2007). HCV-HIV coinfection: Simple messages from a complex disease. PLoS Medicine Research in 

Translation, Volume 4, Issue 10: 1608-1614.

56 Centers for Disease Control and Prevention. (2010). Viral hepatitis: Information for gay and bisexual men. CDC publication #21-1090. 

Atlanta: Author. From http://www.cdc.gov/hepatitis/Populations/PDFs/HepGay-FactSheet.pdf (accessed June 1, 2011).

57 Urbanus, A.T., van Houdt, R., van de Laar, T.J., & et al. (2009). Viral hepatitis among men who have sex with men, epidemiology and 

public health consequences. Euro Surveillance, 14(47), 11–16.
Top Health Issues for Bisexual Men and Women

Top Health Issues for

Bisexual Men and Women

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Top Health Issues for Bisexual Men and Women

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

PHYSICAL HEALTH

HEART DISEASE

Some studies have shown that bisexual women are more likely to self-report higher rates of heart disease than 

heterosexual women, but lower rates than lesbians. Among the risk factors for heart disease, bisexual women 

are more likely to report higher smoking rates than heterosexual women, higher blood pressure levels than 

heterosexual and lesbian women, a higher body mass index (BMI) than heterosexual women, higher cholesterol 

levels than heterosexual and lesbian women, and higher alcohol use than heterosexual women.1,2 

Similarly, heart disease remains a significant concern for men of all sexual orientations. Major risk factors for 

heart disease among men include tobacco use and alcohol use—behaviors prevalent among bisexual men 

and women.3,4,5 

CANCER

A U.S. study of women ages 50–79 has indicated that bisexual women are more likely to self-report higher rates 

of cancers—specifically, breast cancer. Similarly to lesbian women and in contrast with heterosexual women, 

bisexual women face risk factors for breast cancer such as not having given birth and consumption of alcohol. 

Some studies have found that not giving birth and/or giving birth at an early age may increase the risk for adverse 

health outcomes—including ovarian and endometrial cancers—among bisexual women.6,7

Bisexual men who are sexually active with men, as well as anyone who has receptive anal sex, are at higher risk 

for anal cancer due to an increased risk of becoming infected with human papillomavirus (HPV), the virus that 

causes genital and anal warts. Smoking is also among the risk factors for anal cancer. However, it may be more 

relevant for bisexual women than men.8

FITNESS

Some research has shown that bisexual adults are significantly more likely to report engaging in sufficient 

amounts of physical activity (71.1 percent) than heterosexual adults (54.1 percent). When compared by gender, 

the difference is most significant between bisexual women (70.4 percent) and heterosexual women (51.6 

percent).9

OBESITY

Research has shown mixed results as to whether bisexual women are more likely to be overweight than 

heterosexual women. Some studies suggest that lesbian and bisexual women are more likely to be overweight 

and obese than heterosexual women (lesbians are most likely). However, data show that more bisexual women 

are underweight than heterosexual and lesbian women.10,11 Providers should encourage all clients to seek routine 

health assessments.

E–1
E–2 • Top Health Issues for Bisexual Men and Women

INJURY/VIOLENCE

Data show that bisexual adults (47.4 percent) are significantly more likely to report experiencing intimate partner 

violence than heterosexual adults (17.2 percent).12 Providers should routinely assess all clients for any history of 

domestic violence and/or victimization.

TESTING BEHAVIORS

Studies have also yielded mixed results relative to testing and screening behaviors among bisexual women. One 

study found that among women ages 40 to 64 years old, bisexual women (89.5 percent) are more likely to report 

having had a mammogram in the past 2 years than heterosexual women (70.1 percent).13

However, another study found that among heterosexual, lesbian, and bisexual women, bisexual women have 

the highest rate of never having received a Pap test—a key step in the prevention and early detection of HPV.14

Providers should therefore encourage all clients to seek routine health assessments.

SEXUAL HEALTH

Research shows that bisexual women are more likely to report higher risk sexual behaviors than heterosexual 

women. For example, bisexual women are more likely to report engaging in sex with a man who is known to have 

sex with men, engaging in sex with an HIV positive man, having multiple male sexual partners, engaging in sex 

with injecting drug users, and having a sex partner who has had sex with a prostitute.15 

Recent research has also found that lesbian women, as well bisexual women with larger numbers of female 

partners, are more likely to experience vaginal infections including bacterial vaginosis, trichomonas vaginalis, 

and herpes.16 Lastly, when compared with heterosexual women and lesbians, bisexual women exhibit the highest 

rates of combining substance and/or alcohol use with sex.17

Data have shown that some groups of bisexual men report less risky sexual behavior with males (e.g., less anal 

sex, less anal receptive sex), but are more likely than heterosexual men to have sex with female prostitutes and 

to have anal sex with women. 

However, other groups of bisexual men, such as HIV-positive injecting drug users (IDU), have been more likely to 

engage in unprotected sex, report less education, less income, more anxiety, more hostility, more childhood sex 

abuse, and greater unemployment than gay and bisexual men who have not used drugs.18 

Studies have generally found that bisexual and gay men are more likely to report having a sexually transmitted 

infection than are people of other sexual orientations. Building a safe environment for individuals to share 

sensitive information, such as sexual behaviors, could lead to more opportunities for the screening and monitoring 

of critical sexual health indicators.19
E–3 • Top Health Issues for Bisexual Men and Women

BEHAVIORAL HEALTH

MENTAL HEALTH

Many factors, similar to those that affect lesbian women and gay men, affect the mental health of bisexuals. 

However, some studies have suggested that the quality of life and available support for bisexual adults is similar 

to or lower than that of lesbian women or gay men. Researchers have suggested that bisexual adults have the 

lowest level of emotional well-being among people of other sexual orientations.20

Recent studies have also shown that bisexual men and women report consistently higher levels of depression 

and anxiety than heterosexuals. In some studies, bisexual adults were twice as likely (37.2 percent) to report 

depression-related symptoms than heterosexual adults (17.2 percent).21,22

It is important for providers to note that lesbian and bisexual women consult general practitioners for emotional 

reasons more often than heterosexuals, if their primary care physician is aware of their sexual orientation. 

However, not all lesbian and bisexual women want to disclose their sexual orientation. Building a safe 

environment for individuals to share sensitive information, such as sexual orientation and/or sexual behaviors, 

could lead to more opportunities for the screening and monitoring of critical behavioral health indicators such as 

smoking status, alcohol use, and mental health.23 

SUICIDE

Results of an anonymous survey administered in 33 healthcare sites across the United States showed that sexual 

orientation was associated with an increased likelihood of emotional stress and other types of mental health 

disorders. 

The study found that lesbian and bisexual women who are “out” had experienced more emotional stress as 

teenagers and were also 2 to 2.5 times more likely to have experienced suicidal ideation in the past 12 months 

than heterosexual women. Meanwhile, lesbian and bisexual women who are not “out” were more likely to have 

attempted suicide than heterosexual women.24 

Other studies have suggested that bisexuals are much more likely to report higher levels of self-harm, thoughts 

of suicide, and suicidal attempts than heterosexuals, gay men, and lesbians.25 A recent study also found that a 

significantly higher percentage of bisexual adults (13.3 percent) reported being dissatisfied or very dissatisfied 

with their lives as compared to straight adults (5.2 percent).26 

It is critical for providers to discuss their clients’ coming out experiences or their plans to come out to friends and 

family. Many clients will need resources and support for this critical milestone. 

SUBSTANCE ABUSE

Bisexual men and women seem to have the highest smoking rates of any subgroup for which data are readily 

available. States that have collected data on bisexuals via surveys found smoking rates within the population 

to be between 30 and 40 percent.27 Further studies have shown that differences in smoking rates are most 

significant between bisexual women (39.1 percent) and heterosexual women (19.4 percent).28
E–4 • Top Health Issues for Bisexual Men and Women

Data have also shown that bisexual adults exhibit significantly higher rates of binge drinking (22.6 percent) 

than their heterosexual counterparts (14.3 percent). This significant difference in rates was evident only among 

bisexual women (23.7 percent). When compared by gender, bisexual women were significantly more likely to 

binge drink than straight women (8.3 percent). However, the difference between bisexual men (19.8 percent) and 

heterosexual men (20.3 percent) was not significant.29

This publication lists non-Federal resources to provide additional information. The views and content in these 

resources have not been formally approved by the U.S. Department of Health and Human Services (HHS). 

Listing of the resources is not an endorsement by HHS or its operating divisions.

REFERENCES

1 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

2 National Women’s Health Information Center. (n.d.) Lesbian and bisexual health. From http://womenshealth.gov/faq/lesbian-health.cfm

(accessed May 31, 2011).

3 World Heart Federation. (2012). Cardiovascular disease risk factors. Retrieved from 

http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/

4 American Lung Association. (2010). Smoking out a deadly threat: Tobacco use in the LGBT community. From http://www.lungusa.org/

about-us/our-impact/top-stories/smoking-out.html (accessed May 31, 2011).

5 VanKim, N.A. & Padilla, J.L. (2010). New Mexico’s progress in collecting lesbian, gay, bisexual, and transgender health data and its 

implications for addressing health disparities. Albuquerque, NM: New Mexico Department of Health, Chronic Disease Prevention and 

Control Bureau. From http://nmhealth.org/erd/healthdata/pdf/2010_LGBT_Report.pdf (accessed May 31, 2011).

6 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

7 Case, P., Austin, S.B., Hunter, D.J., Manson, J E., Malspeis, S., Willett, W.C. & Spiegelman, D. (2004). Sexual orientation, health risk 

factors, and physical functioning in the Nurses’ Health Study II. Journal of Women’s Health, 13, 1033-1047.

8 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

9 VanKim, N.A. & Padilla, J.L. (2010). New Mexico’s progress in collecting lesbian, gay, bisexual, and transgender health data and its 

implications for addressing health disparities. Albuquerque, NM: New Mexico Department of Health, Chronic Disease Prevention and 

Control Bureau. From http://nmhealth.org/erd/healthdata/pdf/2010_LGBT_Report.pdf (accessed May 31, 2011).

10 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

11 Struble, C.B., Lindley, L.L., Montgomery, K., Hardin, J., & Burcin, M. (2010). Overweight and obesity in lesbian and bisexual college 

women. Journal of American College of Health, 59(1), 51–56.

12 VanKim, N.A. & Padilla, J.L. (2010). New Mexico’s progress in collecting lesbian, gay, bisexual, and transgender health data and its 

implications for addressing health disparities. Albuquerque, NM: New Mexico Department of Health, Chronic Disease Prevention and 

Control Bureau. From http://nmhealth.org/erd/healthdata/pdf/2010_LGBT_Report.pdf (accessed May 31, 2011).

13,14,15 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

16 Bailey, J.V., Farquhar, C. & Owen, C. (2004). Bacterial vaginosis in lesbians and bisexual women. Sexually Transmitted Diseases, 31(11).
E–5 • Top Health Issues for Bisexual Men and Women

17 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

18 Ibanez, G.E., Purcell, D.W., Stall, R., Parsons, J.T. & Gomes, C.T. (2005). Sexual risk, substance use, and psychological distress in 

HIV-positive gay and bisexual men who also inject drugs. AIDS, 19(supplement 1).

19,20,21 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

22 VanKim, N.A. & Padilla, J.L. (2010). New Mexico’s progress in collecting lesbian, gay, bisexual, and transgender health data and its 

implications for addressing health disparities. Albuquerque, NM: New Mexico Department of Health, Chronic Disease Prevention and 

Control Bureau. From http://nmhealth.org/erd/healthdata/pdf/2010_LGBT_Report.pdf (accessed May 31, 2011).

23 King, M., & Nazareth, I. (2006). The health of people classified as lesbian, gay, and bisexual attending family practitioners in London: A 

controlled study. BMC Public Health, 6, 127.

24 Koh A.S., & Ross, L.K. (2006). Mental health issues: a comparison of lesbian, bisexual and heterosexual women. Journal of 

Homosexuality, 51(1), 33–57.

25 Dobinson, C. (2007) Top ten bisexual health issues. As cited in Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual 

health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force 

Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

26 VanKim, N.A. & Padilla, J.L. (2010). New Mexico’s progress in collecting lesbian, gay, bisexual, and transgender health data and its 

implications for addressing health disparities. Albuquerque, NM: New Mexico Department of Health, Chronic Disease Prevention and 

Control Bureau. From http://nmhealth.org/erd/healthdata/pdf/2010_LGBT_Report.pdf (accessed May 31, 2011).

27 American Lung Association. (2010). Smoking out a deadly threat: Tobacco use in the LGBT community. From 

http://www.lungusa.org/about-us/our-impact/top-stories/smoking-out.html (accessed May 31, 2011).

28,29 VanKim, N.A. & Padilla, J.L. (2010). New Mexico’s progress in collecting lesbian, gay, bisexual, and transgender health data and its 

implications for addressing health disparities. Albuquerque, NM: New Mexico Department of Health, Chronic Disease Prevention and 

Control Bureau. From http://nmhealth.org/erd/healthdata/pdf/2010_LGBT_Report.pdf (accessed May 31, 2011).

Top Health Issues for Transgender People

Top Health Issues for

Transgender People

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Top Health Issues for Transgender People

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

PHYSICAL HEALTH

Available research related to physical health issues among transgender people is extremely limited and mainly 

conducted abroad. Furthermore, studies of how medical interventions, such as hormone therapy and/or sexual 

reassignment surgeries, affect overall physical health and well-being remain extremely limited.

There is limited evidence to suggest an association between feminizing hormone therapies, such as estrogenprogestin combinations, and an elevated risk for venous thromboembolic disease and increased levels of 

prolactin. Some research also suggests an association between masculinizing hormone therapies, such as 

testosterone, and elevated liver enzymes, loss of bone mineral density, and increased risk for ovarian cancer. 

However, no clinical trials have been conducted to examine, longitudinally, the long-term effects of hormone 

therapies on overall physical health.1,2,3,4

INJURY AND VIOLENCE

Violence against transgender people, especially transgender women of color, continues to occur in the United 

States. Numerous studies have suggested that between 16 to 60 percent of transgender people are victims 

of physical assault or abuse, and between 13 to 66 percent are victims of sexual assault. Intimate partner 

violence has also been found to be a prominent issue for transgender people. Social stigmatization and 

other factors may additionally lead to an under-reporting of acts of violence committed against transgender 

people.5,6,7,8,9,10,11,12,13,14,15,16

BEHAVIORAL HEALTH

SUICIDE 

Studies have shown that suicidal ideation is widely reported among transgender people and can range from 38 to 

65 percent. More alarmingly, studies have also found that suicide attempts among transgender people can range 

from 16 to 32 percent. Access to culturally-sensitive suicide prevention resources and supportive services for 

transgender people remains a critical priority.17,18,19,20,21,22,23,24,25 

MENTAL HEALTH

Data about the prevalence of mental health disorders such as depression, anxiety, and other clinical conditions 

among transgender people are extremely limited. To date, most studies focusing on mental health disorders 

among transgender people use nonprobability samples, and few compare the mental health of transgender to 

non-transgender people.26

The few recent studies that have compared the mental health status of transgender people to non-transgender 

people have yielded mixed results. On one hand, a recent study found that transgender women were more likely 

than non-transgender men and heterosexual women to report suicidal ideation and attempts, take psychotropic 

medications, and have a problem with alcohol; but no such differences were found between transgender women 

F–1
F–2 • Top Health Issues for Transgender People

and lesbians. On the other hand, another study found that, when compared to men who have sex with men 

and bisexually active women, transgender women were most likely to report depressive symptoms and suicidal 

ideation.27,28

SUBSTANCE ABUSE 

Alcohol and substance abuse has been identified as a major concern among transgender people in the United 

States. Some studies have shown that marijuana, crack cocaine, and alcohol are the most commonly used 

drugs by transgender people. Other studies have also found alarming rates of methamphetamine use (4 to 46 

percent; with the highest rates found in Los Angeles and San Francisco), as well as injection drug use (2 to 40 

percent).29,30,31,32,33,34,35,36,37,38,389,40,41,42,43,44,45,46

High rates of tobacco use, specifically cigarette smoking, have also been found among transgender people. Some 

studies suggest that tobacco use rates can range from 45 to 74 percent. It is critical for prevention specialists 

and healthcare providers to note that, in transgender women who take estrogen, smoking greatly increases 

the chances for blood clots. These risks are similar to those faced by non-transgender women who smoke and 

take oral contraception or undergo hormone replacement therapy (HRT). In addition, transgender men who take 

testosterone increase their risk of heart disease, and smoking further increases that risk.47,48,49,50,51,52,53,54

Access to substance abuse treatment services can be very difficult for transgender people and therefore remains 

a critical priority. Studies have suggested that barriers to treatment services often include discrimination, provider 

hostility and insensitivity, strict binary gender (male/female) segregation within programs, and lack of acceptance 

in gender-appropriate recovery groups. Enhancing access to culturally-competent prevention and treatment 

providers for transgender people is essential in addressing the current behavioral health disparities within this 

population.55,56,57,58,59,60,61

SEXUAL HEALTH

SEXUALLY TRANSMITTED DISEASES: HIV/AIDS

The HIV/AIDS epidemic has had a significant effect on transgender people. However, due to a lack of systematic 

surveillance and reporting of HIV prevalence rates among transgender people, the exact prevalence of HIV 

among this population remains unknown. 

In a recent 12-city study, HIV prevalence rates among transgender women were found to vary from 5 to 68 

percent. Studies continue to suggest that HIV infection is highest among transgender women of color, with 

HIV prevalence rates ranging from 41 to 63 percent among African-American transgender women; 14 to 50 

percent among Latina transgender women; and 4 to 13 percent among Asian-Pacific Islander transgender 

women.62,63,64,65,66,67,68,69,70,71,72,73,74,75,76

Although under-examined, HIV prevalence in transgender men (FTMs) is estimated to range from 2 to 3 percent. 

In the first studies of HIV among MTF transgender youth, HIV prevalence varied from 19 to 22 percent, showing 

them to be at high risk for infection.77,78,79
F–3 • Top Health Issues for Transgender People

Despite high HIV prevalence rates among transgender women, some studies suggest a disparity in the availability 

of HIV treatment services. For example, a recent four-city study found that transgender women were less likely 

to receive highly active anti-retroviral therapy than a control group of men who have sex with men (MSM), 

heterosexual women and men, and male intravenous drug users (IDUs).80

SEXUALLY TRANSMITTED DISEASES: OTHER INFECTIONS

As with HIV/AIDS, there is a lack of systematic surveillance of sexually transmitted diseases (STDs) among 

transgender people. However, some research has found varying prevalence rates of syphilis (3 to 79 percent); 

gonorrhea (4 to 14 percent); chlamydia (2 to 8 percent); herpes (2 to 6 percent); and human papillomavirus (HPV) 

(3 to 7 percent) within the population.81,82,83,84,85,86,87

Prevalence rates of other infectious diseases among transgender people are not well known. Limited studies 

have found hepatitis C prevalence rates between 11 to 24 percent and hepatitis B rates from 4 to 76 percent 

among specific samples of transgender women. Other studies on non-sexually transmitted diseases, such 

as tuberculosis (TB), found a prevalence rate of up to 13 percent among transgender women in 

San Francisco.88,89,90,91,92,93

This publication lists non-Federal resources to provide additional information. The views and content in these 

resources have not been formally approved by the U.S. Department of Health and Human Services (HHS). Listing 

of the resources is not an endorsement by HHS or its operating divisions.

REFERENCES

1 Gooren, L.J., & Giltay, E.J. (2008). Review of studies of androgen treatment of female-to-male transsexuals: Effects and risks of 

administration of androgens to females. Journal of Sexual Medicine, 5(4), 765-776.

2 Moore, E., Wisniewski, A., & Dobs, A. (2003). Endocrine treatment of transsexual people: A review of treatment regimens, outcomes, 

and adverse effects. Journal of Clinical Endocrinology & Metabolism, 88(8), 3467-3473.

3 Hage, J.J., Dekker, J.J., Karim, R.B., et al. (2000). Ovarian cancer in female-to-male transsexuals: Report of two cases. Gynecologic 

Oncology, 76(3), 413-415.

4 Dizon, D.S., Tejada-Berges, T., Koelliker, S., et al. (2006). Ovarian cancer associated with testosterone supplementation in a femaleto-male transsexual patient. Gynecologic & Obstetric Investigation, 62(4), 226-228.

5 Xavier, J., Honnold, J., & Bradford, J. (2007). The health, health-related needs, and lifecourse experiences of transgender Virginians.

Richmond, VA: Virginia HIV Community Planning Committee and Virginia Department of Health. From: 

http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf (accessed 

March 5, 2012). 

6 Reback, C., Simon, P., Bemis, C., et al. (2001). The Los Angeles transgender health study: Community report. Los Angeles: University 

of California at Los Angeles. 

7 Kenagy, G. (2005). The health and social service needs of transgender people in Philadelphia. International Journal of 

Transgenderism, 8(2/3), 49-56. 

8 Kenagy, G. & Bostwick, W. (2005). Health and social service needs of transgender people in Chicago. International Journal of 

Transgenderism, 8(2/3), 57-66. 

9 Xavier, J., Bobbin, M., Singer, B., et al. (2005). A needs assessment of transgendered people of color living in Washington, DC. 

International Journal of Transgenderism, 8(2/3), 31-47. 

10 McGowan, C.K. (1999). Transgender needs assessment. New York: New York City Department of Health, HIV Prevention Planning Unit. 

11 Risser, J., Shelton, A., McCurdy, S., et al. (2005). Sex, drugs, violence, and HIV status among male-to-female transgender persons in 

Houston, Texas. International Journal of Transgenderism, 8(2/3), 67-74. 
F–4 • Top Health Issues for Transgender People

12 Cambridge Cares About AIDS. (2006). Transgender Care and Education Needs Diversity (TransCEND) community needs assessment 

report. Cambridge, MA: Cambridge Cares About AIDS. 

13 Lombardi, E., Wilchins, R., Priesing, D., et al. (2001). Gender violence: Transgender experiences with violence and discrimination. 

Journal of Homosexuality, 42(1), 89-101. 

14 Clements-Nolle, K., Guzman, R., & Harris, S. (2008). Sex trade in a male-to-female transgender population: Psychosocial correlates of 

inconsistent condom use. Sexual Health, 5(1), 49-54. 

15 Clements, K., Katz, M., & Marx, R. (1999). The transgender community health project: Descriptive results. San Francisco: San 

Francisco Department of Public Health. 

16 For Ourselves: Reworking Gender Expression (FORGE). (2005). Transgender sexual violence project. Milwaukee, WI: FORGE. From: 

http://www.forge-forward.org/transviolence/docs/FINAL_Graphs.pdf (accessed March 5, 2012). 

17 Xavier, J., Honnold, J., & Bradford, J. (2007). The health, health-related needs, and life course experiences of transgender Virginians.

Richmond, VA: Virginia HIV Community Planning Committee and Virginia Department of Health. From: 

http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf (accessed 

March 5, 2012). 

18 Kenagy, G. (2005). The health and social service needs of transgender people in Philadelphia. International Journal of 

Transgenderism, 8(2/3), 49-56. 

19 Kenagy, G. & Bostwick, W. (2005). Health and social service needs of transgender people in Chicago. International Journal of 

Transgenderism, 8(2/3), 57-66. 

20 Risser, J., Shelton, A., McCurdy, S., et al. (2005). Sex, drugs, violence, and HIV status among male-to-female transgender persons in 

Houston, Texas. International Journal of Transgenderism, 8(2/3), 67-74. 

21 Cambridge Cares About AIDS. (2006). Transgender Care and Education Needs Diversity (TransCEND) community needs assessment 

report. Cambridge, MA: Cambridge Cares About AIDS. 

22 Carson, L. (2009). Physical and emotional health needs of transgender individuals living in Philadelphia: Summary of key findings.

Philadelphia: Public Health Management Corporation.

23 Zians, J. (2006). The San Diego County transgender assessment report. San Diego: Family Health Centers of San Diego, CA. From: 

http://www.calendow.org/uploadedFiles/san_diego_transgender_assessment.pdf (accessed March 5, 2012). 

24 Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based 

discrimination and victimization. Journal of Homosexuality, 51(3), 53-69. 

25 Nuttbrock, L., Hwahng, S., Bockting, W.O., et al. (2009). Psychiatric impact of gender-related abuse across the life course of male-tofemale transgender persons. Journal of Sex Research, 47(1), 12-23. 

26 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.

27 Mathy, R.M. (2002). Transgender identity and suicidality in a nonclinical sample—Sexual orientation, psychiatric history, and 

compulsive behaviors. Journal of Psychology & Human Sexuality, 14(4), 47-65.

28 Rogers, T.L., Emanuel, K., & Bradford, J. (2003). Sexual minorities seeking services: A retrospective study of the mental health 

concerns of lesbian and bisexual women. Journal of Lesbian Studies, 7(1), 127.

29 Xavier, J., Honnold, J., & Bradford, J. (2007). The health, health-related needs, and life course experiences of transgender Virginians.

Richmond, VA: Virginia HIV Community Planning Committee and Virginia Department of Health. From: 

http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf (accessed 

March 5, 2012). 

30 Reback, C., Simon, P., Bemis, C., et al. (2001). The Los Angeles transgender health study: Community report. Los Angeles: University 

of California at Los Angeles. 

31 Kenagy, G. (2005). The health and social service needs of transgender people in Philadelphia. International Journal of 

Transgenderism, 8(2/3), 49-56. 

32 Kenagy, G. & Bostwick, W. (2005). Health and social service needs of transgender people in Chicago. International Journal of 

Transgenderism, 8(2/3), 57-66. 

33 Xavier, J., Bobbin, M., Singer, B., et al. (2005). A needs assessment of transgendered people of color living in Washington, DC. 

International Journal of Transgenderism, 8(2/3), 31-47. 

34 McGowan, C.K. (1999). Transgender needs assessment. New York: New York City Department of Health, HIV Prevention Planning Unit. 

35 Risser, J., Shelton, A., McCurdy, S., et al. (2005). Sex, drugs, violence, and HIV status among male-to-female transgender persons in 

Houston, Texas. International Journal of Transgenderism, 8(2/3), 67-74. 
F–5 • Top Health Issues for Transgender People

36 Cambridge Cares About AIDS. (2006). Transgender Care and Education Needs Diversity (TransCEND) community needs assessment 

report. Cambridge, MA: Cambridge Cares About AIDS.

37 Clements, K., Katz, M., & Marx, R. (1999). The transgender community health project: Descriptive results. San Francisco: San 

Francisco Department of Public Health. 

38 Carson, L. (2009). Physical and emotional health needs of transgender individuals living in Philadelphia: Summary of key findings.

Philadelphia: Public Health Management Corporation.

39 Zians, J. (2006). The San Diego County transgender assessment report. San Diego: Family Health Centers of San Diego, CA. From: 

http://www.calendow.org/uploadedFiles/san_diego_transgender_assessment.pdf (accessed March 5, 2012). 

40 Garofalo, R., Deleon, J., Osmer, E., et al. (2006). Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic 

minority male-to-female transgender youth. Journal of Adolescent Health, 38(3), 230-236. 

41 Clements-Nolle, K., Marx, R., Guzman, R., et al. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of 

transgender persons: Implications for public health intervention. American Journal of Public Health, 91(6), 915-921. 

42 Rose, V., Scheer, S., Balls, J., et al. (2001). Investigation of the high HIV prevalence in the transgender African American 

community in San Francisco. San Francisco: University of California-San Francisco Center for AIDS Prevention Studies. From: 

http://www.hawaii.edu/hivandaids/High%20HIV%20Prevalence%20in%20the%20Transgender%20African%20American%20Community.pdf

(accessed March 5, 2012).

43 Boles, J. & Elifson, K. (1994). The social organization of transvestite prostitution and AIDS. Social Science & Medicine, 39(1), 85-93. 

44 Reback, C. & Lombardi, E. (1999). HIV risk behaviors of male-to-female transgender participants in a community-based harm 

reduction program. International Journal of Transgenderism, 3(1&2). 

45 Brown, N.C. (2002). Special concerns populations: Transgender needs assessment. Chicago: Chicago Department of Public Health, 

Office of Gay and Lesbian Health. 

46 Nemoto, T., Sausa, L., Operario, D., et al. (2006). Need for HIV/AIDS education and intervention for MTF transgenders: Responding to 

the challenge. Journal of Homosexuality, 51(1), 183-202.

47 Xavier, J., Honnold, J., & Bradford, J. (2007). The health, health-related needs, and life course experiences of transgender Virginians.

Richmond, VA: Virginia HIV Community Planning Committee and Virginia Department of Health. From: 

http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf (accessed 

March 5, 2012). 

48 Cambridge Cares About AIDS. (2006). Transgender Care and Education Needs Diversity (TransCEND) community needs assessment 

report. Cambridge, MA: Cambridge Cares About AIDS. 

49 Carson, L. (2009). Physical and emotional health needs of transgender individuals living in Philadelphia: Summary of key findings.

Philadelphia: Public Health Management Corporation.

50 Zians, J. (2006). The San Diego County transgender assessment report. San Diego: Family Health Centers of San Diego, CA. From: 

http://www.calendow.org/uploadedFiles/san_diego_transgender_assessment.pdf (accessed March 5, 2012). 

51 Garofalo, R., Deleon, J., Osmer, E., et al. (2006). Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic 

minority male-to-female transgender youth. Journal of Adolescent Health, 38(3), 230-236. 

52 Sanchez, N., Sanchez, J., & Danoff, A. (2009). Health care utilization, barriers to care, and hormone usage among male-to-female 

transgender persons in New York City. American Journal of Public Health, 99(4), 713-719. 

53 National Association of Lesbian Gay, Bisexual, and Transgender Community Centers. (2003). The National Association Of Lesbian, 

Gay, Bisexual, and Transgender Community Centers tobacco control program: Final report. Garden Grove, CA: The National 

Association of Lesbian, Gay, Bisexual, and Transgender Community Centers. From: 

http://www.lgbttobacco.org/files/tobaccofinalreport.pdf (accessed March 5, 2012).

54 Gay, Lesbian, Bisexual and Transgender Community Center of Colorado, OMNI Research and Training. (2002). Tobacco control 

needs of the lesbian, gay, bisexual and transgender (LGBT) community in Colorado: A priority population statewide needs assessment 

conducted for Colorado STEPP (State Tobacco Education and Prevention Partnership). Denver: OMNI Research and Training. From: 

http://www.lgbttobacco.org/files/CoNeedsAssesment.pdf (accessed March 5, 2012).

55 Kammerer, N., Mason, T., Connors, M., et al. (1999). Transgender health and social service needs in the context of HIV risk. 

International Journal of Transgenderism, 3(1+2). From: 

http://www.wpath.org/journal/www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/kammerer.htm (accessed March 5, 2012).

56 Clements, K., Wilkinson, W., Kitano, K., et al. (1999). HIV prevention and health service needs of the transgender community in San 

Francisco. International Journal of Transgenderism, 3(1&2). 

57 Sperber, J., Landers, S., & Lawrence, S. (2005). Access to health care for transgendered persons: Results of a needs assessment in 

Boston. International Journal of Transgenderism, 8(2/3), 74-91. 
F–6 • Top Health Issues for Transgender People

58 Nemoto, T., Operario, D., & Keatley, J. (2005). Health and social services for male-to-female transgender persons of color in San 

Francisco. International Journal of Transgenderism, 8(2/3), 5-19. 

59 Lurie, S. (2004). Identifying training needs of health-care providers related to treatment and care of transgendered patients: A 

qualitative needs assessment conducted in New England. International Journal of Transgenderism, 8(2/3), 93-111. 

60 Lombardi, E.L. & van Servellen, G. (2002). Building culturally sensitive substance use prevention and treatment programs for 

transgendered populations. Journal of Substance Abuse Treatment, 19, 291-296. 

61 Center for Substance Abuse Treatment. (2001). A provider’s introduction to substance abuse treatment for lesbian, gay, bisexual and 

transgender individuals, 91-98. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health 

Services Administration, Center for Substance Abuse Treatment, DHHS Pub. No. (SMA) 01-3498. From: http://www.kap.samhsa.gov/

products/manuals/pdfs/lgbt.pdf (accessed March 5, 2012).

62 Kenagy, G. & Bostwick, W. (2005). Health and social service needs of transgender people in Chicago. International Journal of 

Transgenderism, 8(2/3), 57-66. 

63 Xavier, J., Bobbin, M., Singer, B., et al. (2005). A needs assessment of transgendered people of color living in Washington, DC. 

International Journal of Transgenderism, 8(2/3), 31-47. 

64 McGowan, C.K. (1999). Transgender needs assessment. New York: New York City Department of Health, HIV Prevention Planning Unit. 

65 Risser, J., Shelton, A., McCurdy, S., et al. (2005). Sex, drugs, violence, and HIV status among male-to-female transgender persons in 

Houston, Texas. International Journal of Transgenderism, 8(2/3), 67-74. 

66 Carson, L. (2009). Physical and emotional health needs of transgender individuals living in Philadelphia: Summary of key findings. 

Philadelphia: Public Health Management Corporation.

67 Clements-Nolle, K., Marx, R., Guzman, R., et al. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of 

transgender persons: Implications for public health intervention. American Journal of Public Health, 91(6), 915-921. 

68 Rose, V., Scheer, S., Balls, J., et al. (2001). Investigation of the high HIV prevalence in the transgender African American 

community in San Francisco. San Francisco: University of California-San Francisco Center for AIDS Prevention Studies. From: 

http://www.hawaii.edu/hivandaids/High%20HIV%20Prevalence%20in%20the%20Transgender%20African%20American%20Community.pdf

(accessed March 5, 2012).

69 Odo, C. & Hawelu, A. (2001). Eo na Mahu o Hawai`i: The extraordinary health needs of Hawai`i’s Mahu. Pacific Health Dialogue, 8(2), 

237-334.

70 Rodríquez-Madera, S. & Toro-Alfonso, J. (2005). Gender as an obstacle in HIV/AIDS prevention: Considerations for the development 

of HIV/AIDS prevention efforts for male-to-female transgenders. International Journal of Transgenderism, 8(2/3), 113-122. 

71 Elifson, K., Boles, J., Posey, E., et al. (1993). Male transvestite prostitutes and HIV risk. American Journal of Public Health, 83(2), 260-262. 

72 Simon, P., Reback, C., & Bemis, C. (2000). HIV prevalence and incidence among male-to-female transsexuals receiving HIV 

prevention services in Los Angeles County. AIDS, 14(18), 2953-2955. 

73 Kenagy, G. (2002). HIV among transgender people. AIDS Care, 14(1), 127-134. 

74 Thornhill, L. & Klein, P. (2010). Creating environments of care with transgender communities. Journal of the Association of Nurses in 

AIDS Care, 21(3), 230-239. 

75 Nemoto, T., Operario, D., Keatley, J., et al. (2004). HIV risk behaviors among male-to-female transgender persons of color in San 

Francisco. American Journal of Public Health, 94(7), 1193-1199. 

76 Nuttbrock, L., Hwahng, S., Bockting, W., et al. (2009). Lifetime risk factors for HIV/sexually transmitted infections among male-tofemale transgender persons. Journal of Acquired Immune Deficiency Syndromes, 52(3), 417-421. 

77 Garofalo, R., Deleon, J., Osmer, E., et al. (2006). Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic 

minority male-to-female transgender youth. Journal of Adolescent Health, 38(3), 230-236. 

78 Kenagy, G. & Hsieh, C.M. (2005). The risk less known: Female-to-male transgender persons’ vulnerability to HIV infection. AIDS Care, 

17(2), 195-207. 

79 Wilson, E., Garofalo, R., Harris, R., et al. (2009). Transgender female youth and sex work: HIV risk and a comparison of life factors 

related to engagement in sex work. AIDS and Behavior, 13(5), 902-913. 

80 Melendez, R., Exner, T., Ehrhardt, A., et al. (2005). Health and health care among male-to-female transgender persons who are HIV 

positive. American Journal of Public Health, 95(10), 5-7. 

81 Reback, C., Simon, P., Bemis, C., et al. (2001). The Los Angeles transgender health study: Community report. Los Angeles: University 

of California at Los Angeles. 

82 Kenagy, G. & Bostwick, W. (2005). Health and social service needs of transgender people in Chicago. International Journal of 

Transgenderism, 8(2/3), 57-66. 
F–7 • Top Health Issues for Transgender People

83 Risser, J., Shelton, A., McCurdy, S., et al. (2005). Sex, drugs, violence, and HIV status among male-to-female transgender persons in 

Houston, Texas. International Journal of Transgenderism, 8(2/3), 67-74. 

84 Cambridge Cares About AIDS. (2006). Transgender Care and Education Needs Diversity (TransCEND) community needs assessment 

report. Cambridge, MA: Cambridge Cares About AIDS. 

85,86 Elifson, K., Boles, J., Posey, E., et al. (1993). Male transvestite prostitutes and HIV risk. American Journal of Public Health, 83(2), 260-262. 

87 Nuttbrock, L., Hwahng, S., Bockting, W., et al. (2009). Lifetime risk factors for HIV/sexually transmitted infections among male-tofemale transgender persons. Journal of Acquired Immune Deficiency Syndromes, 52(3), 417-421. 

88 Cambridge Cares About AIDS. (2006). Transgender Care and Education Needs Diversity (TransCEND) community needs assessment 

report. Cambridge, MA: Cambridge Cares About AIDS. 

89 Zians, J. (2006). The San Diego County transgender assessment report. San Diego: Family Health Centers of San Diego, CA. From: 

http://www.calendow.org/uploadedFiles/san_diego_transgender_assessment.pdf (accessed March 5, 2012). 

90 Elifson, K., Boles, J., Posey, E., et al. (1993). Male transvestite prostitutes and HIV risk. American Journal of Public Health, 83(2), 260-262. 

91 Nuttbrock, L., Hwahng, S., Bockting, W., et al. (2009). Lifetime risk factors for HIV/sexually transmitted infections among male-tofemale transgender persons. Journal of Acquired Immune Deficiency Syndromes, 52(3), 417-421. 

92 Nemoto, T., Keatley, J., Eleneke, M., et al. (2001). Critical health needs for MTF transgenders of color—Preliminary findings. San 

Francisco: University of California at San Francisco, Center for AIDS Prevention Studies. 

93 Centers for Disease Control and Prevention. (2000). HIV-related tuberculosis in a transgender network—Baltimore, Maryland, and 

New York City area, 1998-2000. Morbidity and Mortality Weekly Report, 49(15), 317-320. From: 

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4915a1.htm (accessed March 5, 2012).

Selected Web-based Resources

Selected Web-based 

Resources

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

Selected Web-based Resources 

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

G–1

The following resources are provided to assist prevention specialists and healthcare 

providers in understanding the health issues of LGBT populations. Resources are 

organized into three categories: Substance Abuse-Related Resources; Other LGBT HealthRelated Resources; and LGBT Advocacy, Education, Research, and Services Resources. 

Within these three categories, the resources are separated into Federal Resources, State/

National Resources, and Other Research-Based Resources. This list of resources is not 

intended to be exhaustive. Rather, it is meant to provide additional sources of information on 

health-related issues for LGBT populations to supplement the information provided in this 

information and resource kit. 

SUBSTANCE ABUSE-RELATED RESOURCES

FEDERAL RESOURCES

National Institute on Alcohol Abuse & Alcoholism (NIAAA): Social Work 

Curriculum on Alcohol Use Disorders: Module 10G: Sexual Orientation and 

Alcohol Disorders

The goal of this module is to increase social workers’ understanding of, and responsiveness to, the unique 

characteristics and concerns of LGBT individuals in relation to alcohol use, prevention, and treatment. Some of 

the contents of this module have been adapted for this article. 

http://pubs.niaaa.nih.gov/publications/social/Module10GSexualOrientation/Module10G.html

SAMHSA Center for Behavioral Health Statistics and Quality (CBHSQ) (formerly 

Office of Applied Studies [OAS]) OAS Data Spotlight, June 2010 

This brief report on data from the National Survey of Substance Abuse Treatment Services (N-SSATS) shows that 

only 777 of 13,688 (6 percent) substance abuse treatment facilities across the Nation offers special programs for 

gay and lesbian clients. 

http://oas.samhsa.gov/spotlight/Spotlight004GayLesbians.pdf

SAMHSA/CSAT: A Provider’s Introduction to Substance Abuse Treatment for 

Lesbian, Gay, Bisexual and Transgender Individuals Training Curriculum, 

First Edition

Based on the 2001 SAMHSA/CSAT publication, the curriculum was released in 2007 and offers skill-building 

knowledge to enhance sensitive, affirmative, culturally relevant, and effective treatment to LGBT individuals in 

substance use disorders treatment. 

http://www.attcnetwork.org/regcenters/generalContent.asp?rcid=12&content=STCUSTOM3
G–2 • Selected Web-based Resources

SAMHSA/CSAT Una Introducción para el Proveedor de Tratamiento de Abuso 

de Sustancias para Lesbianas, Gays, Bisexuales e Individuos Transgénero

In March 2010, the CSAT-supported Caribbean Basin & Hispanic Addiction Technologies Transfer Center released 

its Spanish-language curriculum based on the 2001 CSAT A Provider’s Introduction publication.

http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=553&rcID=1

STATE/NATIONAL RESOURCES

Association of Lesbian, Gay, Bisexual, and Transgender Addiction Professionals 

and Their Allies (NALGAP)

NALGAP is a membership organization founded in 1979 and dedicated to the prevention and treatment of 

alcoholism, substance abuse, and other addictions in LGBT communities. In 1994, the group issued a threepage Prevention Policy Statement & Guidelines document accessible in PDF format in the LGBT Resources 

section of its site.

http://www.nalgap.org

LGBT TRISTAR

This is a San Francisco-based technical assistance contractor funded by the California Department of Alcohol and 

Drug Programs to improve access to appropriate substance abuse prevention, treatment, and recovery services 

for California’s LGBT population. TRISTAR has issued a series of “Best Practices” papers, archived on its site, 

that include information likely to help in designing effective prevention for this population. 

http://www.lgbt-tristar.com/

Some documents are archived at http://gilgerald.com.

Los Angeles Gay & Lesbian Center: Alcohol, Tobacco, & Other Drug Prevention

This calendar of substance-free events is offered through the Center’s Alcohol, Tobacco, & Other Drug Prevention 

program. Some events were developed as environmental prevention strategies to counter alcohol and tobacco 

promotions at LGBT festivities. 

http://laglc.convio.net/site/PageServer?pagename=YH_PH_Alcohol_Tobacco_Other_Drug_Prevention

National LGBT Tobacco Control Network

Housed at The Fenway Institute (see separate listing), the network works to support the many local tobacco 

control advocates in helping to eliminate tobacco health disparities for all LGBTs. Within the Guidelines and Best 

Practices area of its Resources pages are community assessments and other documents useful in developing 

substance abuse prevention for LGBTs.

http://www.lgbttobacco.org/
G–3 • Selected Web-based Resources

National Network to Eliminate Disparities (NNED) in Behavioral Health

NNED is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), National 

Institutes of Health/National Center on Minority Health and Health Disparities, and the Annie E. Casey 

Foundation. The NNED Web site archives files of documents and presentations relating to events and news 

about health disparities. For example, a description of the June 2010 SAMHSA LGBT Pride Month program and 

recommended resource links are at http://nned.net/index-nned.php/ news_announcement/P30/. However, the site 

does not have a search feature at this time, making it necessary to scroll through chronological postings of past 

news to locate items of interest.

http://nned.net/

OTHER RESEARCH-BASED RESOURCES

American Lung Association (ALA): Smoking Out: A Deadly Threat: Tobacco Use 

in the LGBT Community

Published in 2010 as part of ALA’s Disparities in Lung Health series, this report summarizes recent data on 

smoking prevalence among lesbian, gay, bisexual, and transgender (LGBT) individuals and reviews contributing 

factors and potential strategies to reduce smoking in this population.

http://www.lungusa.org/assets/documents/publications/other-reports/lgbt-report.pdf

American Legacy Foundation: Lesbian, Gay, Bisexual, and Transgender (LGBT) 

Communities and Smoking Factsheet

This January 2011 two-page summary contains key facts from published sources about LGBT tobacco use, with 

footnoted reference citations.

http://www.legacyforhealth.org/PDFPublications/LGBTfactsheet.pdf

Arizona Division of Behavioral Health Services LGBTQ Advisory Committee 

Training Webinar Series

Beginning in August 2010, the advisory group hosted a series of training Webinars on a broad range of LGBTQ 

behavioral health topics. Fifteen of these training programs were recorded and archived; several relate directly to 

substance abuse.

http://www.azdhs.gov/bhs/pdf/LGBTQSeriesRecordings.pdf

WHO Guidelines for the Prevention and Treatment of HIV among men who have 

sex with men and transgender people 

The Guidelines focus on the prevention and treatment of HIV and other sexually transmitted infections 

(STIs) among men who have sex with men (MSM) and transgender people. They include evidence-based 

recommendations, the summary and grading of evidence, implementation issues and key research gaps. 

http://www.who.int/hiv/pub/guidelines/msm_guidelines2011/en/index.html 
G–4 • Selected Web-based Resources

OTHER LGBT HEALTH-RELATED RESOURCES

FEDERAL RESOURCES

Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health 

and Human Services (HHS)

Documents archived in the AHRQ Web site’s Innovations Exchange pages include a snapshot of a statewide 

LGBT tobacco cessation program in Minnesota, New Communication Protocols, Inclusive Policies, and Ongoing 

Training Lead to Culturally Competent Care for Lesbian, Gay, Bisexual, and Transgender Patients, issued at the 

end of 2010, and a quit guide for LGBT communities. 

http://www.innovations.ahrq.gov/innovations_qualitytools.aspx?search=LGBT

CDC Compendium of HIV Prevention Interventions with Evidence of 

Effectiveness

Interventions identified by CDC’s HIV/AIDS Prevention Research Synthesis Project were found to be effective in 

reducing sex- and drug-related risk behaviors or improving health outcomes. Some target LGBTs; others target 

groups likely to include LGBTs. 

http://www.cdc.gov/hiv/resources/reports/hiv_compendium/

CDC Health Risks Among Sexual Minority Youth

This section of the CDC Web site summarizes the findings of a June 6, 2011, report published in Morbidity and 

Mortality Weekly Report, Vol. 60. LGBT youth were found to be more likely than their non-LGBT peers to engage 

in a list of unhealthy behaviors in an analysis of data from Youth Risk Behavior Surveys that was conducted 

during 2001–2009 in seven States—Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, 

and Wisconsin—and six large urban school districts—Boston, Chicago, Milwaukee, New York City, San Diego, 

and San Francisco. Report sections provide specific estimates for alcohol, tobacco, and drug use among 

this population.

http://www.cdc.gov/healthyyouth/disparities/smy.htm

CDC Lesbian, Gay, Bisexual and Transgender Health

This CDC site provides information and resources on health issues and inequities affecting LGBT communities for 

both professional and general public audiences, including links to other sources. 

http://www.cdc.gov/lgbthealth/

HHS Healthy People 2020

HHS’s Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all 

Americans. The document integrates input from public health and prevention experts, a wide range of Federal, 

State, and local government officials, a consortium of more than 2,000 organizations, and the public. More than 

8,000 comments were considered in drafting a comprehensive set of Healthy People 2020 objectives. Based 

on this input, a number of new topic areas are included in the new initiative, including LGBT health. (Note: As of 

December 2010, specific objectives for LGBT health were in development.)

http://www.healthypeople.gov/2020/default.aspx
G–5 • Selected Web-based Resources

SAMHSA Homeless Resource Center (HRC)

The Homeless Populations: LGBTQI2-S pages of the HRC site contains links to numerous articles, publications, 

archived listening tours and teleconferences, and other resources on various aspects of homelessness as it 

relates to this population.

http://www.homeless.samhsa.gov/Channel/LGBTQ-153.aspx

SAMHSA/Office of Behavioral Health Equity (OBHE)

Announced in February 2011, the SAMHSA/OBHE mission is to improve access to quality behavioral health 

services for populations that experience disparities in health care, including sexual minorities.

http://www.samhsa.gov/about/obhe.aspx

STATE/NATIONAL RESOURCES

Advocates for Youth

Advocates for Youth is dedicated to creating programs and policies that help young people make informed and 

responsible decisions about their sexual and reproductive health.

www.advocatesforyouth.org

Ambientejoven (Spanish)

Advocates for Youth (see above) provides a separate Web site for Spanish-language information.

http://ambientejoven.org/ 

American Psychological Association (APA)

APA is a scientific and professional organization established to advance the creation, communication, and 

application of psychological knowledge. Approximate membership is 154,000.

http://www.apa.org/

LGBT Concerns Office (LGBTCO)

LGBTCO works to improve the health and well-being of LGBT people; increase understanding of gender identity 

and sexual orientation; and reduce stigma, prejudice, discrimination, and violence toward LGBT people. The 

LGBTCO Web site describes programs and activities (such as the Healthy LGBT Students Project, below) and 

provides links to many resources.

http://www.apa.org/pi/lgbt/index.aspx

Healthy LGBT Students Project 

A project supported by the Centers for Disease Control and Prevention (CDC) “...to provide capacity-building 

assistance to schools and other organizations that serve gay and bisexual young men at risk for HIV infection, 

especially African-American and Latino youth.” 

http://www.apa.org/pi/lgbt/programs/hlgbsp/index.aspx
G–6 • Selected Web-based Resources

Association for Lesbian, Gay, Bisexual & Transgender Issues in Counseling 

(ALGBTIC)

The Resources section of the ALGBTIC site has links to the contents of bibliographies on counseling LGBT 

clients. The Competencies area includes links to translations in French, Turkish, Chinese, Japanese, and 

Romanian. English-language competencies for working with transgender clients are available as well.

http://www.algbtic.org/

Association of Gay and Lesbian Psychiatrists (AGLP)

The association’s newsletters published since 2002 are archived on the AGLP Web site. The Referrals tab opens 

a searchable membership directory.

www.AGLP.org 

Campus Pride

This nonprofit organization works to create a safer college environment for LGBT students. The group has 

published a first-ever national research report, the 2010 State of Higher Education for LGBT People, that 

documents the experience of more than 5,000 students who identified as LGBT and offers free access to the 

report on its Web site.

http://www.campuspride.org/

Day of Silence Project: A Project of the Gay, Lesbian, and Straight Education 

Network (see separate listing)

Day of Silence raises awareness of the effects of anti-LGBT bullying and harassment in schools.

http://www.dayofsilence.org/index.cfm

The Family Acceptance Project

The Family Acceptance ProjectTM is a community research, intervention, and education initiative that studies 

the effects of family acceptance and rejection on the health and well-being of LGBT youth. Results will be used 

to help families provide support for LGBT youth; develop appropriate interventions, programs, and policies; and 

implement train-the-trainer models.

http://familyproject.sfsu.edu/

Fenway Health 

Fenway Health offers comprehensive LGBT health care and seeks to improve the overall health of the larger 

community, locally and nationally, through education and training, policy and advocacy, and research and 

evaluation. It includes the HIV/AIDS-focused Fenway Institute. The Fenway Institute also hosts the National LGBT 

Tobacco Control Network (see separate listing) and the Center for Population Research in LGBT Health.

http://www.fenwayhealth.org/

Fenway Health: Trans Health

Fenway Health provides primary medical and mental health care that is sensitive to the needs of people in the 

transgender spectrum. The Trans Health Program at Fenway helps to ensure quality informed care for transwomen, trans-men, genderqueer, affirmed men and women, and others who have health care needs unique to 

gender expressions.

http://www.fenwayhealth.org/site/PageServer?pagename=FCHC_srv_services_trans
G–7 • Selected Web-based Resources

Gay and Lesbian Medical Association (GLMA)

Founded in 1981 as the American Association of Physicians for Human Rights, the group now includes other 

LGBT health care professionals. GLMA offers tools to LGBT patients and their health care providers.

http://www.glma.org

GLBT National Help Center

The Center provides a robust Web portal with links to hundreds of LGBT-related public and private resources and 

enterprises, with an online locator to produce by-topic lists by ZIP code from a 15,000-item database. A nonprofit, 

tax-exempt organization, the Center has toll-free telephone services and online peer-support chat utilities. Alcohol, 

tobacco, drugs, and substance abuse are not topic headings in resources the Center database produces, but its 

Health category is likely to include professionals and programs in a given area that provide substance abuserelated services.

http://www.glnh.org/

GLBT National Youth Talk Line

Teenage and young adult volunteers provide free telephone and e-mail peer counseling and referrals to resources 

in the National Help Center database.

http://glbtnationalhelpcenter.org/talkline/index.html

It Gets Better Project

The It Gets Better Project began in September 2010, and offers brief videotaped messages of hope for LGBTQ 

youth who may have been bullied or harassed and may be contemplating suicide. Messages are produced and 

posted online by individual and group volunteers and may be accessed via the project’s Web site or at www.

youtube.com. In March 2011, the project published a book, It Gets Better: Coming Out, Overcoming Bullying, and 

Creating a Life Worth Living.

http://www.itgetsbetter.org/

National Coalition for LGBT Health

The coalition evolved during the writing of the Healthy People 2010 companion document for LGBT health. 

Potential local or State partners in LGBT prevention might be identified through the Coalition’s list of member 

organization links in its About Us Web area and categorical lists of links in its Resources & Research area.

http://www.lgbthealth.net/

National Resource Center for Permanency and Family Connections at the Hunter 

College School of Social Work

The Resources on LGBTQ Children and Youth pages of the Center’s Web site has numerous articles, reports, 

information packets, and other publications; videos; archived online trainings; PowerPoint presentations; and links 

to additional resources pertaining to the welfare of children who are LGBTQ.

http://www.nrcpfc.org/
G–8 • Selected Web-based Resources

The Trevor Project

Established in 1998, the Trevor Helpline is a nationwide, around-the-clock crisis and suicide prevention helpline 

for LGBT and questioning youth.

http://www.thetrevorproject.org/

World Professional Association for Transgender Health, Inc. (WPATH)

WPATH is a professional organization focused on the understanding and treatment of gender identity disorders. 

The group publishes a professional journal and Standards of Care (available in English, Spanish, and Croatian). 

These and links to other resources on transgender and intersex health are accessible on the WPATH Web site.

http://www.wpath.org/

YES Institute 

The Institute’s aim is to prevent suicide through communication and education about gender and orientation.

http://yesinstitute.org/ 

OTHER RESEARCH-BASED RESOURCES

Best Practices for Asking Questions About Sexual Orientation on Surveys (See 

also GayData.org)

This November 2009 report contains the recommendations of the Sexual Minority Assessment Research Team 

(SMART), a multidisciplinary and multi-institutional collaboration published by The Williams Institute, UCLA School 

of Law. 

http://www.law.ucla.edu/williamsinstitute/pdf/SMART_FINAL_Nov09.pdf

Casey Family Programs: Gay, Lesbian, Bisexual, Transsexual, and Questioning 

Guidebook Learning Plan

Developed to meet the needs for specific life skills related to LGBT issues among social workers, teachers, youth, 

and parents, the plan is designed to help develop life skills teaching curriculum and individual learning plans. It is 

based on and a companion to the Casey Life Skills GLBTQ Assessment Supplement.

http://www.caseylifeskills.org/pages/lp/GLBTQ%20Guidebook%206%2028%2007.pdf

Healthy People 2010: Companion Document for Lesbian, Gay, Bisexual, and 

Transgender Health (See also the listing for HHS Healthy People 2020.)

Developed under GLMA’s leadership in 2001, the Healthy People 2010 Companion document for LGBT Health 

provides a context for educating readers about LGBT health disparities and for addressing systemic challenges to 

overcome them. Separate chapters discuss HIV/AIDS, mental health, sexually transmitted diseases, substance 

abuse, tobacco use, and violence prevention. 

http://glma.org/_data/n_0001/resources/live/HealthyCompanionDoc3.pdf
G–9 • Selected Web-based Resources

Institute of Medicine (IOM) The Health of Lesbian, Gay, Bisexual, and Transgender 

People: Building a Foundation for Better Understanding

An IOM Consensus report of findings of an assessment requested by the National Institutes of Health (NIH) 

into the health status of LGBT populations. The report identifies research gaps and opportunities and a 

research agenda.

http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx

Suicide Prevention Resource Center (SPRC): Preventing Suicide among LGBT 

Youth Kit

The SAMHSA-supported SPRC developed this kit for schools, youth-serving organizations, and suicide 

prevention programs and makes it available for free downloading.

http://www.sprc.org/LGBTYouthWorkshopKit.asp

University of San Francisco Center for AIDS Prevention Studies (CAPS)

Since 1995, the Center has been publishing fact sheets on AIDS-related topics, many of them in both Englishand in Spanish-language editions. As of March 2010, more than 60 of these fact sheets were available from the 

CAPS Web site. Several recent fact sheets provide data about segments of the LGBT population and HIV/AIDS. 

“Drug use” is a topic of several of the CAPS fact sheets with information about the association of substance abuse 

and HIV/AIDS in this population.

http://caps.ucsf.edu/resources/fact-sheets/

LGBT ADVOCACY, EDUCATION, RESEARCH, 

AND SERVICES RESOURCES

STATE/NATIONAL RESOURCES

Center for American Progress

In the Media & Progressive Issues section of this nonprofit’s Web site, a number of documents relating to LGBT 

social justice topics are archived under the heading, Gay & Transgender Issues.

http://www.americanprogress.org/issues/culture/lgbt/

Center of Excellence for Transgender Health

The Center of Excellence for Transgender Health (CoE) combines the unique strengths and resources of a 

nationally renowned training and capacity-building institution, the Pacific AIDS Education and Training Center 

(PAETC), and an internationally recognized leader in HIV prevention research, the Center for AIDS Prevention 

Studies (CAPS), both of which are housed at the University of California San Francisco. The ultimate CoE goal is 

to improve the overall health and well-being of transgender individuals by developing and implementing programs 

in response to community-identified needs. http://www.transhealth.ucsf.edu/
G–10 • Selected Web-based Resources

Children of Lesbians and Gays Everywhere (COLAGE) 

COLAGE is an association by and for people of all ages who have one or more parents who are LGBTQ. The 

Web site has resources for children and their LGBTQ parents, a bookstore, and online activities.

http://colage.org/

Consortium of Higher Education LGBT Resource Professionals: Directory

This directory offers full contact information for almost 200 higher education institution LGBT studies programs. A 

criterion for inclusion is that listings must be for programs with at least one paid staff member. Some of these gay 

studies centers may have information and expertise relating to substance abuse and may be valuable partners in 

prevention activities. (See also, University LGBT/Queer Programs.)

http://www.lgbtcampus.org/directory/index.php?pageno=2

GayData.org

Web-based GayData.org is maintained by the Program for Lesbian, Gay, Bisexual and Transgender Health at 

Drexel University, School of Public Health and serves as a no-cost, open-access clearinghouse for the collection 

of sexual orientation and gender identity data and measures. The site provides links to key LGBT-related data 

sources, abstracts of significant journal articles reporting data analysis results for LGBT mental health and 

substance abuse, and has guidelines for incorporating LGBT questions into data instruments.

http://www.gaydata.org

Gay, Lesbian, and Straight Education Network (GLSEN)

In 2008, GLSEN became a client of the Ad Council as sponsor of Think Before You Speak, the “first national 

multimedia public service advertising (PSA) campaign designed to address the use of anti-gay language among 

teens.” GLSEN seeks to develop school climates where differences are valued for the positive contribution they 

make to creating a more vibrant and diverse community. GLSEN supports community-based chapters and GayStraight Alliances in many schools. The group sponsors the biennial National School Climate Survey. 

http://www.glsen.org/

Gay-Straight Alliance (GSA) Network 

GSA Network is a youth leadership organization to help GSAs in schools connect with each other and with other 

community resources. Several national reports on LGBT bullying and harassment in schools are available within 

the Web site’s Resources section.

http://www.gsanetwork.org/

Gender Education & Advocacy

This nonprofit organization provides education and advocacy on transsexual and transgender issues, primarily 

through its Web site.

http://www.gender.org/
G–11 • Selected Web-based Resources

Hetrick-Martin Institute/Harvey Milk High School

The New York City nonprofit organization provides supportive services for LGBT youth, including after-school 

programs in arts and culture, health and wellness, job readiness/career exploration, and academic enrichment. 

It also offers paid internships to program graduates and hosts the Harvey Milk High School operated by the New 

York City Department of Education. 

http://www.hmi.org/

Human Rights Campaign (HRC)

Claiming more than one million members, HRC advocates for social justice for LGBT people. The Issues tab on 

the HRC homepage leads to posted resources on a variety of topics (e.g., aging, health, military, and workplace).

www.hrc.org 

International Lesbian, Gay, Bisexual, Transgender and Queer Youth and 

Student Organisation

This is a worldwide network of LGBTQ student groups. The organization advocates for LGBTQ rights and 

publishes reports, newsletters, and campaigns, and it hosts a blog.

http://www.iglyo.com/

Los Angeles Gay & Lesbian Center: Model Program for LGBT Youth in 

Foster Care

On October 1, 2010, HHS announced that the L.A. Gay & Lesbian Center was awarded a $13.3 million, 5-year 

grant from the Administration on Children, Youth and Families to create a model program for LGBTQ youth in the 

foster care system. Visit the Center’s Web site for information about the project.

http://www.lagaycenter.org/

National Association of Lesbian, Gay, Bisexual and Transgender Community 

Centers

This association provides local-level support, activities, and meeting space for the LGBT community. Many 

centers offer programs specifically designed for LGBT youth, and some offer substance abuse prevention and/or 

treatment.

http://www.lgbtcenters.org

National Center for Transgender Equality (NCTE)

This national nonprofit organization works for the advancement of transgender rights. The Building Community tab 

in the NCTE Resources area of the Web site includes documents that may help community-based organization 

efforts to better serve transgender clients.

http://transequality.org/

Parents, Families, and Friends of Lesbians and Gays (PFLAG)

PFLAG is devoted to promoting the health and well-being of gay, lesbian, and bisexual persons and their families 

and friends through support, education, and advocacy.

www.pflag.org
G–12 • Selected Web-based Resources

Red Circle Project 

Hosted by AIDS Project Los Angeles (APLA), the Red Circle Project targets American Indian gay men (also 

known as Two-Spirit individuals). The Web site includes links to other Two-Spirit organizations, research relating 

to this audience, and training documents for working with women and men who are American Indian and are TwoSpirit- or LGBT-identified.

http://www.apla.org/native_american/RCP/

Safe Schools Coalition 

The Safe Schools Coalition is an international partnership supporting LGBT youth and promoting safer school 

environments. The group’s homepage has links to various resources, such as the Harvey Milk Day curricula for 

using during the observance to promote the health and safety of LGBT students.

http://safeschoolscoalition.org/safe.html

Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders 

(SAGE)

SAGE is the world’s oldest and largest nonprofit agency dedicated to serving and advocating for lesbian, gay, 

bisexual, and transgender seniors. Since its inception, SAGE has pioneered programs and services for seniors in 

the LGBT community, provided technical assistance and training to expand opportunities for LGBT older people 

across the country, and provided a national voice on LGBT aging issues.

http://www.sageusa.org/

SAGE National Resource Center on LGBT Aging

Established in 2010 through a Federal grant from HHS, the National Resource Center on LGBT Aging provides 

training, technical assistance, and educational resources to aging providers, LGBT organizations, and LGBT older 

adults.

http://www.lgbtagingcenter.org/

Trans Youth Family Allies (TYFA)

According to its Web site, “TYFA empowers children and families by partnering with educators, service providers, 

and communities to develop supportive environments in which gender may be expressed and respected.” Much 

of the site’s contents and links focus on preventing violence directed at LGBTQ youth and suicide.

http://www.imatyfa.org/

True Colors

True Colors works “to ensure that the needs of sexual and gender minority youth are both recognized and 

competently met.” The group’s Web site has descriptions of trainings it conducts and an application form, 

information about the annual LGBT youth conference True Colors sponsors, and details about its mentoring 

program for LGBT youth in Connecticut.

http://ourtruecolors.org/ 
G–13 • Selected Web-based Resources

OTHER RESEARCH-BASED RESOURCES

On the Streets: The Federal Response to Gay and Transgender Homeless Youth 

(June 2010)

Based on available data sources, the report offers a blueprint for considering and addressing this problem.

http://www.americanprogress.org/issues/2010/06/pdf/lgbtyouthhomelessness.pdf

This publication lists non-Federal resources to provide additional information. The views and content in these 

resources have not been formally approved by the U.S. Department of Health and Human Services (HHS). The 

resources listed are not an endorsement of HHS or its operating divisions.

PowerPoint Slides: Top Health Issues for LGBT Populations

PowerPoint Slides: 

Top Health Issues 

for LGBT Populations

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover

T O P H E A LT H I S S U E S F O R L G B T P O P U L AT I O N S I N F O R M AT I O N & R E S O U R C E K I T 

H–1

PowerPoint Slides

PowerPoint Slides: 

Top Health Issues for 

LGBT Populations

Note: The PowerPoint slides can be downloaded as a PPT file at http://store.samhsa.gov.
H–2 • PowerPoint Slides: Top Health Issues for LGBT Populations
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H–25 • PowerPoint Slides: Top Health Issues for LGBT Populations


HHS Publication No. (SMA) 12-4684

2012

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services 

 Administration

Center for Substance Abuse Prevention