Conflating sexual orientation and gender identity

It is ironic that an editorial which highlights the lack of knowledge of lesbian, gay, bisexual and transgender (LGBT) issues among healthcare professionals should open with a sentence that conflates sexual orientation with gender identity. ¹ Using ‘heterosexual’ as a contrast to LGBT is inaccurate, as any number of trans heterosexual individuals could attest to. In their discussion of Miranda-Mendizábal et al's paper, ² Meader & Chan make it clear that the paper only covers LGB youth, and that differing sexual orientations within this group may lead to differing experiences; however, in the rest of their editorial ‘LGBT youth’ is treated as a monolithic entity. For example, Public Health England has two toolkits on suicide prevention in sexual minority groups, one for LGB individuals and one for transgender individuals, in recognition of the different needs of these groups (www.gov.uk/government/publications/preventing-suicide-lesbian-gay-and-bisexual-young-people), rather than a single LGBT toolkit as suggested in the editorial.

It is also perhaps disappointing that the first suggestion of why transgender young people have a greater risk of suicidally is ‘higher rates of stigma’. Although this is undoubtedly important, there is increasing evidence that supporting transgender young people to live and present as their gender identity improves mental health outcomes. For example, Olson et al found that transgender children who were supported in their gender identities had rates of depression the same as their cisgender peers, rather than the much higher rates of depression previously reported for transgender children living as their birth-assigned gender. ³ In this context, the waiting times for gender identity clinics (GICs) should be highlighted. For many in the UK, this is more than a year: for example, the Tavistock GIC currently gives a waiting time of 14 months from referral to first appointment (https://gic.nhs.uk/appointments/waiting-times). In fact, many people transition socially without contact with a GIC, and others self-medicate with hormone therapy bought online.

Psychiatry and psychiatrists often have a poor reputation among sexual minority groups, for very understandable historical reasons. To overcome this, we need to provide genuinely inclusive care – which starts with knowledge and understanding.