LGBTQ+ Inclusive Nursing Care: Terminology, Health Disparities, and Clinical Priorities

LGBTQ+ inclusive care requires nurses to understand key terminology, recognize health disparities, communicate respectfully, and apply clinical knowledge — especially around hormone therapy risks and anatomy-based screening. This note summarizes the high-yield concepts for nursing exams.

Core Definitions

• LGBTQ+: Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and other sexual and gender minorities.
• Sexual orientation: A person's emotional, romantic, and sexual attraction to others (heterosexual, homosexual, bisexual).
• Gender identity: A person's internal sense of their own gender, which may or may not align with their sex assigned at birth.
• Cisgender: Gender identity aligns with sex assigned at birth.
• Transgender: Gender identity differs from sex assigned at birth.
• Non-binary: Gender identity is not exclusively male or female.

Additional Terminology

• Lesbian: A woman attracted to women.
• Gay: A person attracted to the same gender.
• Bisexual: A person attracted to more than one gender.
• Asexual: A person with little or no sexual attraction.
• Intersex: A person with physical sex characteristics not typical of male or female.
• Transition: Aligning one's appearance with their gender identity. May be social (name, pronouns), medical (hormones, surgery), or legal (identification documents).

Always assess rather than assume a patient's orientation or identity based on appearance.

Health Disparities in LGBTQ+ Populations

• Higher rates of mental health conditions: depression, anxiety, and suicidality related to minority stress.
• Higher rates of substance use disorders, including tobacco, alcohol, and other drugs.
• Barriers to healthcare: fear of discrimination, lack of provider knowledge, and refusal of care.
• Higher rates of HIV and STIs in some populations — routine screening and PrEP are essential.
• Increased reported risk of intimate partner violence in some studies, with stigma, underreporting, and access barriers compounding the issue.

Creating an Inclusive Environment

Use Inclusive Language

• Use gender-neutral terms: say "partner" or "spouse" instead of "husband" or "wife."
• Ask "What pronouns do you use?" rather than assuming.
• Avoid binary language such as "ladies and gentlemen."
• Use anatomical terms instead of gender-based assumptions — e.g., "people with a cervix" need cervical cancer screening.

Ask Respectfully

• Ask all patients about sexual orientation and gender identity, not only those who appear LGBTQ+.
• Example: "What is your sexual orientation?" / "What is your gender identity?" / "What pronouns do you use?"
• Explain why you are asking: "We ask this to provide the best care for all patients."

Provide a Welcoming Environment

• Display rainbow flags or inclusive symbols.
• Post a non-discrimination policy that includes sexual orientation and gender identity.
• Provide gender-neutral restrooms when possible.
• Use the patient's chosen name in all communications.

Clinical Considerations for Transgender Patients

Hormone Therapy

• Estrogen therapy (transfeminine patients): increases risk of venous thromboembolism (VTE). Monitor for signs of DVT and pulmonary embolism.
• Testosterone therapy (transmasculine patients): increases risk of polycythemia (elevated hematocrit). Monitor hematocrit, liver enzymes, and lipids.
• Hormone therapy does not eliminate the need for other preventive care based on current anatomy.

Surgical History

• Patients may have had gender-affirming surgeries such as mastectomy, vaginoplasty, phalloplasty, or orchiectomy.
• Use patient-reported anatomy to guide examinations. Ask respectfully rather than assuming.

Preventive Screening

• Cervical cancer screening (Pap smear): needed for anyone with a cervix, regardless of gender identity.
• Prostate cancer screening: may be needed for anyone with a prostate, including some transgender women.
• Breast cancer screening (mammogram): needed for anyone with breast tissue. For transfeminine patients, risk increases with duration of estrogen therapy.
• Screening decisions involve shared decision-making, not solely anatomy-based rules.

Common Clinical Scenarios

• Scenario 1: A transgender man with a hysterectomy but retained ovaries has abdominal pain → include ovarian pathology in the differential.
• Scenario 2: A transgender woman on estrogen therapy reports calf pain and swelling → priority: assess for DVT given increased VTE risk.
• Scenario 3: A transgender man on testosterone therapy has a hematocrit of 54% → priority: notify provider; testosterone increases polycythemia risk.
• Scenario 4: A non-binary patient uses they/them pronouns. If you misgender them, apologize briefly, correct yourself, and move on.

Priority Nursing Actions

• Transgender woman on estrogen with chest pain: Assess for pulmonary embolism (VTE risk).
• Transgender man on testosterone with headache and fatigue: Assess hematocrit (polycythemia risk).
• Chosen name differs from legal name: Use chosen name in all communications except legal documents.
• Family uses the wrong pronouns: Use the patient's correct pronouns; do not defer to family.

Common Exam Traps

• Use patient-reported data as the primary source for orientation and identity, not appearance.
• Use "pronouns" rather than "preferred pronouns" — pronouns are not a preference.
• Obtain patient consent before disclosing LGBTQ+ status to family or visitors.
• Not all transgender patients pursue surgery or hormones.
• Do not let personal discomfort prevent asking essential health questions.
• Use the patient's chosen name in all communications, even if it differs from the legal name.
• Estrogen therapy → prioritize VTE risk. Testosterone therapy → prioritize polycythemia monitoring.

Key takeaways

• LGBTQ+ inclusive care requires terminology knowledge, awareness of health disparities, and respectful, patient-centered communication.
• Use gender-neutral language ("partner") and ask "What pronouns do you use?" — never assume based on appearance.
• Estrogen therapy increases VTE risk; testosterone therapy increases polycythemia risk. Monitor and assess accordingly.
• Preventive screening depends on current anatomy and duration of hormone therapy, not gender identity alone.
• Use the patient's chosen name in all communications and obtain consent before disclosure to family.
• Rely on patient-reported data rather than assumptions to guide assessment and care.