Thieme is proud to celebrate Pride Month and promote LGBTQI+ representation in medicine by featuring educational articles about LGBTQI+ healthcare and medicine, highlighting historical and contemporary LGBTQI+ pioneers in medicine, and presenting recent breakthroughs in research to better treat LGBTQI+ patients.
In 2024, Thieme Group published LSBTI* in Pflege und Medizin, a German-language book that aims to guide medical professionals in caring for LGBTQI+ patients. In English, LGBTQI+ in Nursing and Medicine: Basics and recommendations for action on caring for queer people, discuss sexuality and gender diversity throughout the healthcare industry.
We asked the authors and some contributors of LSBTI* in Pflege und Medizin about working on the project and how medical professionals can improve outcomes for their LGBTQI+ patients.
Volker Wierz (he/him), born in 1964, gay man; I work as a nursing manager in an infectious disease clinic in Berlin, and I am an author and lecturer for nursing professions. I have been professionally involved with HIV since the end of the 1980s. My books, lectures at congresses and work as a teacher focus on teaching skills for the care of people with HIV and queer people.
How did you come up with the LGBTI* in nursing and medicine project and what appeals to you about it?
In 2022, my colleague Dr. Michael Nürnberg and I published a book with the title "HIV in Nursing". In this book, we also addressed the situation of gay men and trans people with regard to HIV, among other things. Many readers asked us where they could find literature specifically on the situation of queer people with regard to health. During our own research, we discovered that there are a few publications on individual groups of people, such as trans people, in German-speaking countries. What did not yet exist, however, was a book that dealt with the health and life situation of queer people in a compact form. This was the incentive for us to tackle such a project. We very quickly realized that we could not create such a comprehensive work on our own. From the very beginning, our aim was to have the individual topics written by people who work in the healthcare sector and come from the community. In addition to their professional expertise, we also wanted their own experiences to flow into the texts. It took us almost a year to get this team of people together, with whom we were then able to realize the book project in an extensive process with many conversations and discussions.
This book is a guide for nurses and other healthcare professionals to better care for LGBTQI+ patients. What major challenges do LGBTQI+ people face in the medical system, and how does this affect their outcomes as patients?
Queer people experience time and again that due to the heteronormative nature of society, and therefore also of the healthcare system, their life circumstances are not taken into account. For example, the fact that a man has a male life partner instead of a wife is not considered at all. Trans people are often not taken seriously. They are ridiculed or have to endure disparaging remarks. Women’s sexuality and the associated prevention is often only seen in connection with contraception. The fact that women can also be infected with STIs is rarely discussed, or screening is simply not being offered.
The fact that queer people have an increased risk of certain mental illnesses, such as depression, is not known in the healthcare system. And it is precisely this lack of knowledge that often leads to incorrect assumptions and conclusions on the part of healthcare providers. This increases the risk of queer people not receiving adequate medical and nursing care.
Are there any policy changes in medical facilities or elsewhere that you would recommend?
Medical institutions should be much more concerned with the issue of sexual and gender diversity. It is a fact that up to 10% of the population are queer people. The healthcare system must also recognize this and adapt in order to provide adequate care. Employees in the healthcare system need to be made aware of this and trained accordingly. In large cities such as Berlin, we have many doctors who specialize in the care of queer people. But there are also many regions in Germany where this is not the case. Our book is intended as a small contribution to raising awareness of this issue and thereby improving the care situation for LGBTI people. There is now also a growing awareness at a political level of the need to address this issue.
You contributed to a section on gay men's issues. Are there any particular concerns or considerations for this group when accessing healthcare?
Gay men are the most visible in the queer group. Certainly, the AIDS pandemic has contributed to a greater focus on the lives of gay men. However, society's view is often characterized by a highly sexualized perception. The fact that gay life is more than just sex is ignored. At the same time, studies show that gay men have an increased risk of sexually transmitted diseases and HIV compared to heterosexual people. However, the area of "sexuality" is often bypassed or not sufficiently addressed in the medical context. Examinations for sexually transmitted diseases or HIV tests, for example, are not even offered. As a result, infections are not treated and - as with HIV - can end in a health "catastrophe".
What advice would you give medical professionals to improve the care of LGBTQI+ patients?
The most important advice I can give doctors and nurses is to be open to other life circumstances and lifestyles. And also to deal intensively with the life situations and the resulting health consequences of queer people on a professional level.
Michael Nürnberg, a medical doctor working in internal medicine, infectious diseases and tropical medicine since 2015. Since 2022 working at the Institute for International Health at Charité in Berlin.
How did you get involved in the project, LSBTI* in Pflege und Medizin, and what excites you about it?
I wrote the book together with my good friend and colleague Volker Wierz. It is the follow-up project to our book "HIV infection in care - a guide for the care of people with HIV".
Volker and I worked together for several years in in-patient HIV care in two hospitals in Berlin. The aim of our first project was to help to improve care and to reduce stigmatization towards people with HIV. Among other things, we focused more on people from the gay and trans community. During the research for the first project, we quickly noticed that there was a lack of recommendations for people from the queer community. It was therefore important for us to close this "gap".
In the course of planning the follow-up project, we very quickly became aware of the complexity. We couldn't manage this project alone. Together with a great team, we were able to give equal representation to the individual sub-topics so that people with a medical background can contribute something specific to their topics. For example, a trans man writes something about trans and non-binary people.
The book has just over 90 pages of text. This is not a lot. Nevertheless, we have managed to present an incredible amount of specific information and general recommendations in a compact and clear way. This would not have been possible without our co-authors. It is great that we are able to present broad information as an overview with a very dedicated team.
I very much hope that with this book we can contribute to improving the medical care of people from the LGBTQI+ community and generally raise awareness about the care of minorities.
This book is a guide for nurses and other medical professionals to better care for LGBTQI+ patients. What are some major challenges LGBTQI+ people face in the medical system, and how does it affect their outcome as patients?
The book is generally aimed at all people working in the healthcare sector and, of course, anyone who is interested. The healthcare sector is predominantly cis-heteronormative. There is rarely room for deviations from this. Ignorance and a lack of awareness on the part of healthcare providers with regard to the needs of their LGBTQI+ patients is probably one of the biggest problems.
On the one hand, this is already evident during training/studies. Secondly, scientific studies are rarely designed in such a way that this very diverse group of people is fully included. In addition, sexuality and sexual identity are rarely addressed in the context of medical care. And LGBTQI+ people are more frequently exposed to discrimination than cis-heteronormative people, resulting in further problems. This ultimately means that specific needs are not perceived and people's realities are not recognized. This adds up and ultimately leads to inadequate medical care and patient suffering
Are there specific health issues that affect LGBTQI+ people exclusively or in greater proportion when compared to the general population?
As already mentioned, LGBTQI+ people are more frequently exposed to discrimination with the corresponding consequences. This can contribute to mental health problems, e.g. depression, anxiety disorders or substance use. It can also lead to avoidance behavior with regard to preventive medical check-ups.
Depending on the individual lifestyle, sexually transmitted infections play a relevant role. HIV continues to be a relevant issue here. Fortunately, from a medical point of view, HIV infection has lost its great horror thanks to well-tolerated therapies, provided it is diagnosed at an early stage. Regular testing and the possibility of appropriate testing services are of course a prerequisite for this. Especially in view of an increasingly diverse society, it is important to address sexuality in a medical context in order to be able to offer appropriate education and diagnostic services - for all people.
This is just a small selection of relevant topics.
What advice would you give to medical professionals to improve how they care for LGBTQI+ patients?
Patients should generally be treated with respect and without prejudice, regardless of their sexual orientation and identity. Open and good communication is the key to this. If relevant medical aspects are then individually considered and implemented according to the patient's needs, a great deal has already been achieved.
Alexander Hahne (he/ him), gay trans man, German based trainer and speaker for trans-specific topics in the field of sexual health, sex educator (gsp), somatic counselor, sexological bodyworker (ISB), systemic sexual therapy in training, dancer and pleasure activist. Leader of workshops and individual counselling on the topics of body awareness, intimacy and sexuality. With my work I make a practical contribution to more visibility and inclusion of trans and non-binary people. Furthermore, I directly support them in their own experience of the body as well as the possibility of uncovering and using access to their own pleasurable potential.
How did you get involved in the project, LSBTI* in Pflege und Medizin, and what excites you about it?
I knew the two editors from their previous publication and was in contact with them about it. When the next book project came up, they asked me if I would like to contribute a chapter.
What excites to me about LSBTI* in Pflege und Medizin was that it addresses a very broad target group in the medical field. To give nurses, administrative staff and doctors from all disciplines an insight into the everyday life of trans and non-binary people and their diverse transitions was a great opportunity.
This book is a guide for nurses and other medical professionals to better care for LGBTQI+ patients, and you contributed a section on trans and non-binary people. What are some major barriers this group faces when trying to access gender-affirming care?
It often starts with the fact that many healthcare professionals know little to nothing about trans and non-binary people. Many people cling to the binary system that there are only men and women and find it difficult to imagine changing or shaping their own gender identity. This can mean that the trans or non-binary person has to deal with the irritation of the other person, right up to private, curious questions. All of this distracts from the reason why the person has come to the doctor and leads to stress. There is often little knowledge about the individuality of a transition and this can lead to a lack of clarity about, for example, the underlying reference values for trans or non-binary people. Being offered appropriate language and labelling, including for altered body parts, by medical staff.
Trans and non-binary people also face challenges and discrimination when trying to access medical care unrelated to gender affirmation. What are some common challenges they face, and how does it affect their patient outcomes?
Often trans and non-binary people are reluctant to seek medical care because of many bad experiences. This increases the urgency of the issue. Common challenges include finding specialist care that can deal with the issue in a relaxed manner. For example, if the first name or legal gender marker has not yet been changed and a new name and form of address is already used in the practice.
Another challenge can be physical examinations if you have not previously discussed being trans or non-binary and then come out involuntarily.
What policy changes, in medical institutions or otherwise, would you recommend for improved outcomes for trans and non-binary patients?
In addition to a clinic-wide mission statement, there needs to be mandatory training on the topic for all staff, ideally resulting in an affirming attitude. Equal recognition of binary and non-binary trans people and therefore inclusive documentation, questionnaires and anamnesis interviews are needed.
A publicly accessible contact address for a diversity counsellor or a complaints office makes it easier to provide feedback on difficult or discriminatory situations but also positive experiences and good best practices.
What advice would you give to medical professionals individually to improve their care for trans and non-binary patients?
Deal proactively with the topic and ask questions that relate to the patient's concerns. Use collegial exchanges, quality circles and supervision to train and relieve pressure. If you feel like you don't know something or would rather refer someone else, feel free to do so. Build a network of other medical professionals to whom you can refer with a clear conscience.
I am 28 years old and a trans-nonbinary psychologist and use they/them pronouns. I work in geriatric neuropsychology as well as in Diversity, Intersectional Antidiscrimination and Queer Psychology. I have a lot of passion for educating people and enjoy giving workshops and lectures for other health care professionals.
How did you get involved in the project, LSBTI* in Pflege und Medizin, and what excites you about it?
I first learned about the project through my colleague and one of the authors of the book, Volker Wierz. We are both employed by St. Joseph Krankenhaus Berlin Tempelhof. In Summer 2022 we realized together with some coworkers that our company would greatly profit from greater education about LGBTQI+ people as we not only have many LGBTQI+ colleagues but also patients. We are not only Co-founders of our intersectional Diversity (a work group specified in antidiscrimination and diversity) at St. Joseph but also started to offer workshops to educate - especially - nurses about specific needs of LGBTQI+ patients. When Volker then asked me to join the book project, it felt very natural and exciting to work on a project to spread information far beyond our hospital.
This book is a guide for nurses and other medical professionals to better care for LGBTQI+ patients. What do you see as major issues around discrimination for LGBTQI+ people, and how does it affect patient outcomes?
In my opinion, the biggest issues when treating LGBTQI+ people are 1) lack of knowledge and 2) ignorance and discrimination. Both can lead to a shortened life span, reduced physical health as well as a higher rate of mental illnesses. There are many studies that emphasize greater health risks for LGBTQI+ people. The cis-heteronormative assumption (the assumption that everybody is cisgender and heterosexual) leads to a certain blindness or overlook that some people have different, specific needs the majority does not have. Some of my coworkers have asked - "I treat everybody the same, why do LGBTQI+ people need special treatment"? But as a trans person myself I do have medical needs cisgendered people don't. Lack of knowledge can mean not knowing what health risks or special healthcare needs a lesbian woman might have in comparison to a heterosexual woman. And direct discrimination, for example by a practitioner, when making use of health care services could lead to termination of a life-saving treatment. Every person deserves the same chance for health but that can only be achieved if LGBTQI+ sensitive and affirmative health care is offered.
You contributed to a section on lesbian issues. Are there particular concerns or considerations for this group when accessing medical care?
I think, the biggest issue lesbian and queer women face is heterosexism - the intersectional discrimination due to their sex and gender as well as their sexual orientation. And this doesn’t consider other forms of discrimination such as racism or classism yet. In the book I tried to point out specifically that lesbian women and non-binary people not only face a so-called lesbian invisibility in general, but also in health care. People think about men first when thinking about a homosexual person. There are less scientific studies about lesbian woman and health care than about men. For example, there is less knowledge about the transmission of STIs between women. But there is also an ignorance of protective health factors lesbian women can have due to their sexual orientation and community that heterosexuals might not have.
What advice would you give to medical professionals to improve their care for LGBTQ+ patients?
That would clearly be get educated about LGBTQI+ people. But be sure that you are getting the education not only from cis-heterosexual people talking about LGBTQI+ people, also talk to the community itself. It reduces stereotypes and the risk of misinformation. And last, remember to reflect on your own behavior: Am I presenting myself, my medical practice, my treatment as inclusive? How can I improve that? And am I maybe unconsciously excluding specific people by not creating a discrimination-free environment? It does not take much to take the first step!
Florian Eero Däbritz, I have an academic background in linguistics and cultural studies. Currently, I am working as a psychiatric nurse and thus I am also one of the rare people working in health care who are intersex themselves. I live in Northern Germany in the town Lüneburg, from where I delve into being an intersex activist as e.g., being chairperson of an intersex organization (Intergeschlechtliche Menschen Landesverband Niedersachen e.V.) and also being a counselor for anything regarding intersex in the local queer center (Checkpoint Queer).
Link to my organization
My instagram is @dbrtzf
How did you get involved in the project, LSBTI* in Pflege und Medizin, and what excites you about it?
As the editors of this project had the aim of publishing a guide improving better care for LGBTQI+ people, I was asked if I’d like to contribute to that project as they were in search of an intersex person working in health care. Openly living intersex people, especially those working in health care and who also happen to be trained academically, are even more rare as intersex people in general. As the topic of intersex was not addressed within my training to be a nurse to the extent that I would have liked or that I felt was necessary, I recognized this as an opportunity for any intersex person to be heard and to be seen. Thieme is popular in Germany among any medical professional; it is also known by students of any kind, and it has a significant impact. Publications concerning health care for intersex people have either been published by professionals, such as nurses, or just by intersex people. Either they have been in an impenetrable form, or they were published in very small publishing houses. All these publications have dealt with different important spotlights, so far, they have been missing a solid and amenable foundation to start from.
This book is a guide for nurses and other medical professionals to better care for LGBTQI+ patients, and you contributed a section on intersex people. What are some major challenges intersex people face in the medical system, and how does it affect their patient outcomes?
Intersex people worldwide are facing crimes against humanity. They deal with unnecessary gender assignment, unconsented surgeries, therapies, and treatments, which often result in subsequent treatments primarily caused by the former. Often, they do not learn about being intersex, which results in feelings of being left alone, feeling alienated, or not belonging. They learn that their bodies are not autonomous to themselves; they are taught to feel shame for just existing, that their bodies are wrong, and that they must conform to either being a male or female human being.
What needs to change to improve care for intersex people?
To improve care for intersex people, any medical professional must learn about it. This leads to including gender-sensitive care in the mandatory syllabus for professionals. This should start from any freshman year to workshops, as diversity is the key to any patient-oriented care. In the case of intersex, it means that intersex organizations must be included as they have community-based knowledge, which is missing to know how to adequately care for intersex people. Also, people working within the German health care system should look out and search for any further training regarding intersex. There are quite a few available, though there will be an additional online training that will start in 2024 in that intersex people have been participating.
What advice would you give to medical professionals individually to improve their care for intersex patients?
They must listen to their patients, ask about them, and do this independently of whether they are intersex or not, as that is common sense, e.g., as in the ICN code of ethics for nurses. Further, professionals need to understand that a lot of intersex people have faced discrimination, trauma, being shamed, and being abused for just being intersex, and that this does result in resistance against professionals within the health care system. Professionals should also know about local intersex organizations, self-help initiatives, or intersex counselors so that they are able to refer their patients to these offers. They should be open, as in knowing that intersex people are experts on their own – they have huge knowledge about their own bodies.
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CCC-SLP (The George Washington University)
I am an Associate Professor and speech-language pathologist. My aim is to improve accessibility to evidence-based and culturally-responsive voice and communication services for trans and non-binary people who are dissatisfied with their current communication situation.
You were the guest editor for a special issue of Seminars in Speech and Language called Innovations in Voice Care for Trans and Non-Binary People. Can you share the story of how this issue came together?
It was important to have authors who could respect but also represent the populations covered in this Issue. Additionally, an issue with innovations should include our newest investigators (students, clinicians). I reached out to people I had seen present recently and/or had chatted with informally about their research or clinical approaches. There are not many (visibly) trans researchers and teachers to choose from - especially who are not already busy doing more than their fair share of educating others and were available to write an article in a few months. That's why the articles with guidance for teaching student clinicians and researching with trans populations came about. For innovations to continue, we need to increase and amplify these perspectives in the pipeline.
Can you discuss some of the innovations covered in the issue? What is on the horizon in this field?
I'm excited to see the large diversity of perspectives coming together - the collection of authors and topics in this issue clearly reflects that! Research and practice are being informed by non-medical disciplines such as linguistics and mental health and through sociocultural lenses of inclusion and justice. We are seeing more clinicians and authors with lived experience in LGBTQIA+ community. These movements coincide - not coincidently, in my opinion - with a shift in the direct goal of voice and communication services away from gender conformity and toward well-being. I refer to this as a shift from gender-centered care to person-centered care.
How is voice care important for trans and non-binary individuals?
I've heard a variety of answers to that question so it really depends on the person. Some people tell me that hearing their own voice makes them uncomfortable, distressed, even suicidal. Some say that how they sound influences their treatment from others - what type of job they can get, for example. For most people it is both - gender attributions from themselves and from others - that has them seeking information or services for voice change. Keep in mind that not every trans and non-binary person thinks about their voice, let alone feels the need to modify or expand it in some way. But everyone deserves the opportunity to make an informed decision for themselves.
What advice would you give to fellow SLPs, who may not be familiar with trans/non-binary issues, on providing voice care for those patients?
First, realize that there are specific issues that will be influencing your care and your client's wellbeing. This is not just-like care for cisgender people with voice complaints. Second, take responsibility for learning those issues - don't rely on your client to educate you, although forming a relationship in which they feel comfortable to correct or educate you is valuable. For example, consider minority stress impacts and trauma-informed care principles. Third, be prepared to navigate those issues with cultural responsiveness. This includes self-reflection and humility as you learn more about each person you serve.
Dr. John Fryer was a prominent American psychiatrist and gay rights activist renowned for his impactful speech delivered anonymously under the pseudonym Dr. Henry Anonymous, at the 1972 American Psychiatric Association’s annual conference. In the speech, he declared “I am a homosexual. I am a psychiatrist.” Dr. Fryer risked his career to change the course of LGBTQ+ history. His speech is cited as one of the deciding factors in the declassification of homosexuality from the APA Diagnostic and Statistical Manual of Mental Disorders as a mental illness in 1973, ending treatments such as chemical castration, electric shock therapy, and lobotomy and paving the way for advances in LGBTQ+ civil rights.
Dr. Alan L. Hart was an American physician, radiologist, and author. He was the first documented trans man in the United States to undergo gender confirmation surgery and pursue a career in medicine. Dr. Hart pioneered the use of X-ray photography to detect and diagnose tuberculosis early in patients with the disease.
Admiral Rachel Levine has served as the 17th Assistant Secretary for Health for the United States Department of Health and Human Services (HHS) under the Biden Administration since 2021. ADM Levine is one of the only openly transgender U.S. government officials and the first to hold an office that requires a nomination for appointment by the President of the United States and a Senate majority confirmation. ADM Levine has addressed the disparities in healthcare and medicine of LGBTQ+ youth and adults, people of color, older people, and immigrants. ADM Levine advocates for healthcare policies that are not based on politics and will better aid public health. She has criticized anti-LGBTQ+ bills such as the Florida Parental Rights in Education Bill, better known as the “Don't Say Gay” bill, and labeled them dangerous to LGBTQ+ youth.
Dr. Valerie Stone is a nationally recognized professor of medicine at Harvard Medical School and serves as vice chair for diversity, equity, and inclusion in the Department of Medicine at Brigham and Women's Hospital. She is an infectious disease expert specializing in HIV/AIDS, and her research focuses on disparities in HIV/AIDS healthcare by race, ethnicity, and gender and strategies for optimizing the care of the diverse patients living with HIV/AIDS. Dr. Stone is known for her exceptional contributions to promoting diversity in healthcare, research on current issues in primary care, inclusive patient care and education, and innovations in residency training. She has numerous publications about HIV/AIDS healthcare and policy, including the 2009 book HIV/AIDS in U.S. Communities of Color, which was recently republished in 2021 to build upon its previous edition by updating epidemiologic and clinical content including the epidemiology, prevention, diagnosis, and treatment of HIV/AIDS within diverse communities in the United States.
Phill Wilson is a prominent and renowned HIV/AIDS advocate and activist, particularly for people of color. His career in activism began after he and his partner, Chris Brownlie, were both diagnosed with HIV in the early 1980s when the AIDS epidemic first started in the United States. At the time, HIV/AIDS was synonymous with the gay community and ignored by the Reagan Administration, which prioritized politics over public health. Healthcare and outreach were primarily focused on white gay communities and disregarded black gay communities, which Wilson believed HIV/AIDS affected much more. When his partner died from an HIV-related illness in 1989, he channeled his grief into HIV/AIDS advocacy and activism. Mr. Wilson is the former President and CEO of the Black AIDS Institute and founded the organization in 1999 with a mission to end the AIDS pandemic in African American communities. Mr. Wilson has worked extensively on HIV/AIDS public policy, research, prevention, and treatment issues in various countries. He has been involved in the founding of a number of other AIDS service organizations and community-based organizations, including the National Black Lesbian and Gay Leadership Forum, the National Task Force on AIDS Prevention, the Chris Brownlie Hospice, the AIDS Healthcare Foundation, the National Minority AIDS Council, the Los Angeles County Gay Men of Color Consortium, and the CAEAR Coalition. In 2010, Mr. Wilson was appointed to the Advisory Council on HIV/AIDS, becoming the co-chair of the disparities subcommittee, under the Obama Administration.