Lesbian, gay, bisexual and trans people are as diverse as the general Canadian population in their experiences of health and well-being. Social determinants of health such as income, housing status and education level impact the health of all of us in different ways, and we all vary in how much we exercise, what we eat and what our genetics have in store for us.

But there are some specific health issues that are generally more likely to affect LGBT people, and it is important to note that these increased health risks are largely a result of social marginalization and the stress of coping with prejudice and discrimination.

Here are some of the health issues that are of concern to LGBT people:

Mental Health
There are many reasons why people may develop emotional or psychological problems during their lives, but LGBT people face particular challenges. Negative attitudes, discrimination and violence can contribute to mental and emotional distress for LGBT people. For trans people, transition itself can be stressful with many barriers to be overcome. Coming out can also be emotionally tough with many people having to deal with rejection from family and friends, and bisexual people face a unique stressor in coming out to partners or potential partners. Staying in the closet can also be stressful, leading to isolation and fear of discovery for some people. Bisexuals may experience the double closet, hiding their same-sex attractions from heterosexual friends and family and their other-sex attractions from gay and lesbian communities. Bisexuals may also experience social pressure to identify as either gay or straight. All of these stressors have a profound impact on the self-esteem and self-identities of LGBT people and studies show that LGBT people suffer from depression, anxiety and suicide at higher rates than the general population. 

Substance Use
Research indicates that LGBT people are more likely to use alcohol and other drugs compared to the general population. Lesbians and gay men are more likely to report experiencing problems from alcohol use and to continue to drink as they age, and bisexual people are the most likely to report experiencing problems from alcohol use. Gay men also use some recreational drugs at a higher rate than the general population. These “party” drugs are associated with the dance clubs and circuit parties that are popular with many gay and bisexual men, and their use is accepted by some men as part of the gay scene. There is little information about the rates of alcohol and drug use among trans people, but the evidence suggests that substance abuse is a serious concern for some trans people. In LGBT communities, alcohol or drugs may be used to cope with discrimination, internalized negative feelings and depression, and bars and dance parties often provide the only comfortable space to meet other LGBT people. 

Tobacco
While 16% of the Ontario population smokes, a 2007 Toronto study showed that 36% of LGBT people were current smokers. These findings are similar to other research which shows that LGBT people smoke at much higher rates than the general population. Lesbians are also more likely to be heavy smokers than heterosexual women and bisexual people are more likely to be current or past smokers than gay men or lesbians. Several factors contribute to these higher rates including high levels of social stress, frequent socializing in bars, higher rates of alcohol and drug use and targeted promotions by the tobacco industry. LGBT people who smoke cigarettes are at increased risk for developing lung cancer, heart disease, and emphysema. There are also specific health risks for trans people as smoking increases the risk of blood clots in trans women who take estrogen, and it increases the risk of heart disease in trans men who take testosterone. Smoking also slows down healing after any surgery and increases the chance of scarring. 

Sexual Health
The increased risk of HIV infection is well known in the gay community, and for many years this has dominated any discussion of LGBT sexual health. Sexually transmitted infections (STIs) such as syphilis and gonorrhea also occur in sexually active gay and bisexual men at high rates. While HIV, chlamydia and gonorrhea are rarely transmitted, STI’s such as herpes, HPV (genital wart virus) and trichomoniasis are transmitted fairly easily between women during sex. Lesbians and bisexual people who have partners of another sex also need to consider the risks of transmission of HIV and other STI’s, as well as the risk of unplanned pregnancy. Very little is known about the sexual health risks for trans women and trans men, who are mostly invisible in sexual health research. There is some evidence that suggests that trans people have a high frequency of unprotected sex. This may be due to social isolation and low self-esteem caused by transphobia as well as the lack of relevant sexual health information. Other risk factors include sharing needles to inject hormones or silicone and using drugs or alcohol during sex. 

Violence and Safety
LGBT people are more likely to be physically and verbally victimized than the general population. This is especially true for those who do not fit gender norms, such as the gay man who is effeminate or the lesbian who is butch. For trans people, the dangers are even more extreme. A 2004 Statistics Canada study showed that compared with heterosexuals, the odds of being victimized were nearly 2 times greater for gays and lesbians and 4.5 times greater for bisexuals. LGBT youth also experience high rates of bullying and harassment in schools.

Nutrition, Fitness and Weight
LGBT communities have particular cultural norms about body weight and appearance. Gay male culture has long valued physical beauty and youth, while cultural norms in lesbian communities may encourage acceptance of heavier body weights and the rejection of dieting and thinness as a desirable standard. For some gay men, the cultural pressure to achieve the perfect body has resulted in compulsive exercising and steroid use which can create emotional distress and physical health problems. Gay men are more likely than straight men to have a poor body image and are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. In contrast, on average lesbians are more likely to be overweight or obese than heterosexual women, which can put them at greater risk for heart disease and stroke as well as some other health conditions. Many trans people have a negative body image due to discomfort with the gender of their physical bodies. Some trans people may diet or exercise to make physical changes as they transition to their desired gender. Trans people who take hormones often gain weight and this may also lead to dieting or other changes in behaviour.