"Our health concerns are easily ignored": Access to healthcare, an obstacle course for LGBTQIA+ people
They may experience painful family rejection, endure homophobia or transphobia from a segment of society on a daily basis, or hesitate to walk through the door of a doctor's office.
For the LGBTQIA+ community (1), access to care is a heightened problem, due to the specific care that these patients require in certain cases, but also because they sometimes face a lack of kindness from the medical community.
Few studies"A declarative survey in 2014 (there are no more recent studies) revealed that 45% of trans people avoided going to a doctor or hospital for fear of transphobic reactions and 64% reported having had an experience of this nature in the medical field," says Dr. Quentin Berl, gynecologist.
Within the brand new LGBTQIA+ Centre, opened in the premises of the Family Planning Centre in Toulon , he provides medical consultations, "a point of reference for these people who have sometimes experienced trauma and need special support" .
"Finding a primary care physician is complicated for everyone, and it's even more so for the community, especially trans people. I tend to think that it's linked to the lack of training - particularly the issue of hormonal treatments for conversion, which complicates care (2). But we can't eliminate cases of transphobic doctors. When patients come to us, they are quickly reassured on these points."
Specific and caring supportAt the Center, Dr. Berl provides – among other things – hormone therapy follow-ups . "I refer trans patients who wish to do so to surgery consultations, either at Sainte-Anne Hospital in Toulon, or in Marseille or Nice – but the wait times for treatment are long. Depending on their needs, I also refer them to other trans-friendly specialists."
This could be, for example, a speech therapist to learn how to position a voice that becomes more feminine or worsens during hormone therapy.
The psychiatrization of transgender people remains a problem. "I recently saw a person who was starting hormone therapy, whose initial assessment revealed a thyroid condition that had to be addressed first. Her doctor was thinking it was a disorder related to gender dysphoria. However, depsychiatrization is enshrined in law (2). As a professional, I don't need a psychiatric or psychological opinion to support a trans person. This need may arise during a consultation. Or never!"
Around parenthoodParenting issues are among the challenges in accessing care. "When the patient wishes, I address the topic of gamete preservation during the transition process, with a view to medically assisted procreation (MAP). It's not mandatory either. In fact, nothing is! For example, not all trans people change sex. The journeys are strictly personal. There is no end, no final objective: the goal is simply to feel good about yourself."
Another reason for consultation: the issue of pregnancy for same-sex couples. "We provide information on the options available to satisfy the desire for children, in France or abroad."
With kindness and without taboo, all health-related questions can thus be answered by the center's team.
1. LGBTQIA+: Refers to lesbian, gay, bisexual, transgender, queer, intersex, and asexual people. The + includes many other terms for gender and sexuality.
2. From now on, the curriculum for general practitioners in Marseille includes mandatory training with a health professional and a member of a Trans association.
3. In France, transsexualism is not a mental disorder. However, a transgender person sometimes experiences emotional distress or functional problems related to the feeling of inconsistency between their birth sex and their gender identity.
Dr. Quentin Berl cites examples of medical transphobia: "Using a person's former first name (the "dead name"), imposing it on them, as well as the gender written on their health insurance card, is already transphobia."
Of the same order, this other violence, generated this time by rigid administrative constraints: "a trans man whose civil status has been changed, but who has not been operated on, still has a vagina. But the smear test is no longer reimbursed by health insurance!"
LGBTQIA+ patients also testify to the indiscreet questions they are asked (read elsewhere). "We can ask about how sexual relations are going if it is a legitimate medical question ," recalls Dr. Berl. "But sometimes, these requests are just a matter of unhealthy curiosity and it is violence. If it is justified, we take care to explain our question: to understand, I must ask you if... and you have the right not to answer."
On the contrary, he highlights "a real evolution in the listening skills of professionals, particularly midwives" and explains that "when faced with a health problem to which he or she does not know how to respond, a doctor must be able to refer to the LGBTQIA+ center."
Family Planning also indicates that it has published a small "trans dictionary" intended to raise awareness among professionals about understanding trans vocabulary and to limit medical and institutional transphobia.
Coco, president of the Trans-Mission Var association, first highlights "the difficulties for those who need psychological support, due to a lack of will or training on the part of doctors."
For treating physicians, "it's a bit like: I don't know, I'm not taking it! When they don't have surgery, people suffer from the lack of understanding of the "trans body." Our health concerns are easily ignored and blamed on hormone therapy."
The difficulties are endless: "These are blood tests that take into account the female dosage for a boy because the papers have not yet been changed; pharmacists who refuse to dispense medication even though they are not authorized to do so."
However, he notes the arrival of a young generation of doctors "who are better trained or who show a desire to be so, and we can help them with this."
"The center ," Coco says happily, "allows easier access to care. We have a few names of LGBT-friendly doctors, of course, but they are already overwhelmed! Being here, in a safe place, to find information, exchange ideas, and share friendly moments, feels good! More and more people are joining us, relieved to have a place where they can speak freely, without fear of attacks or insults!"
Cédric, co-director of adult awareness-raising activities for SOS Homophobie and assistant secretary of the Toulon Pride Collective, weighs his words carefully: "The LGBTQIA+ center is vital: it saves lives. It is an essential place of welcome for people who have suffered discrimination and violence."
Regarding access to healthcare, he notes different attitudes towards the Trans community: "Often, we don't talk about our homosexuality with the doctor to avoid answering indiscreet questions or facing rejection. But without this dialogue, we can miss health issues. For example, questioning the possibility of sexual relations after an operation. The doctor doesn't spontaneously think about it: whether it's about parenthood, contraception or STIs, the heterosexual norm is presupposed!"
Taking care of one's mental health is also a challenge: "How can I go to a psychologist, for example after a separation, if they don't understand or accept my sexual orientation?"
Result: "Some people avoid consulting or exchange good addresses. The Center is very useful for directing people. But displaying a small LGBT flag in a waiting room can also be enough to reassure potential patients!"
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