Sexual and Gender Minority Health in Neurology

Abstract

ittle is known about the neurologic health needs of sexual and gender minority (SGM) individuals (ie, those in the lesbian, gay, bisexual, transgender, and queer [LGBTQ+] spectrum). Understanding an individual's identity is essential for patientcentered communication, which improves patient satisfaction and reduces health disparities. SGM identity directly impacts a variety of neurologic conditions, including epilepsy, 1 dementia, 2 and stroke. 3,4 Neurologists receive little to no dedicated SGM health training, 5 which may lead to conscious or unconscious behaviors that contribute to existing disparities. 6 A 2018 study 3 of US neurologists, for example, found that while most reported comfort in caring for SGM individuals, fewer demonstrated SGM-related medical knowledge. Nearly half of respondents believed that sexual orientation and gender identity had no bearing on the management of neurologic illness. 3 This scoping review seeks to describe the cur-rent state of science in SGM health in neurology to highlight areas of knowledge and gaps to inform future research. MethodsGuided by an experienced medical librarian (E.W.), we developed, tested, and finalized a PubMed search using medical subject headings and keywords with SGM descriptors 7 and neurologic disorders (eAppendix 1 in the Supplement). The disorders were compiled based on clinical expertise, the National Institute of Neurologic Disorders and Stroke website, 8 and prior research. 9 This search was modified for Embase, Web of Science, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and BIOSIS Previews. IMPORTANCE Little is known about the neurologic health needs of sexual and gender minority (SGM) individuals, and existing research indicates health care disparities for this group. OBJECTIVE To describe the current state of science in SGM neurology and highlight areas of knowledge and gaps to guide future research.EVIDENCE REVIEW All articles published before April 12, 2020, in PubMed, Embase, Web of Science, PsycInfo, CINAHL, and BIOSIS Previews were searched using a search string encompassing SGM descriptors and neurologic disorders. A total of 8359 items were found and entered into EndNote, and 2921 duplicates were removed. A blind title and abstract review was performed followed by full-text review in duplicate, with conflicts settled through consensus, to identify 348 articles eligible for data abstraction. Articles presenting primary data about an identified adult SGM population addressing a clinical neurology topic were included. Descriptive statistics were used for abstracted variables.FINDINGS Of 348 studies, 205 (58.9%) were case reports or series, 252 (72.4%) included sexual minority cisgender men, and 247 (70.9%) focused on HIV. An association was found between autism spectrum disorder and gender dysphoria in 9 of 16 studies (56.3%), and a higher risk of ischemic stroke in transgender women was shown in other studies. Literature in neuroinfectious disease, the most common topic, largely focused on HIV (173 of 200...

Sex differences in neurology: a scoping review

“…Previous research has explored the potential impact of excluding non-English language literature and did not identify evidence of systemic bias based on this exclusion criteria. 16 As such, our observations raise the concern that sex-based neurological data are over-represented by three main regions and underrepresented by some of the most population dense regions in the world that may have unique biological and cultural influences on sex-based and gender-based research in neurology.…”

“…Although our scoping review focused on binary terms of male and female, men and women, we recognise that sex and gender issues in the neurosciences reflect a spectrum, including transgender, intersex and non-binary identities as examples of the diversity that truly reflects the greater population. 16 …”

Primary Care in the Spinal Cord Injury Population: Things to Consider in the Ongoing Discussion

“…Preventive care in this patient population is paramount because there are reports of depression, substance use, health care disparities including lower rates of cancer screening, higher incidence of certain cancers, and higher cancer mortality rates [ 86 – 88 ]. Providers should also manage their personal biases when caring for the LGBTQIA + as the literature reports that the patients may conceal their sexual orientation and gender identity for fear of suboptimal quality of care [ 85 , 89 – 91 ]. For patients using gender-affirming hormone therapy (GAHT) such as exogenous feminizing hormones or masculinizing hormones, their unique needs cannot be ignored, highlighting the importance of health care providers being aware so that proper care is delivered and timely referrals to specialists made [ 13 , 89 ].…”

Exploring Stroke Risk Factors and Outcomes in Sexual and Gender Minority People

“…1 , 2 Despite the community's diversity in racial, ethnic, socioeconomic, and cultural backgrounds, they face common adversities which can translate into poor health outcomes, 3 although to date most research has disproportionately focused on psychiatric conditions and HIV. 4 For example, stroke is the leading cause of disability and fifth leading cause of death in the United States 5 ; however, little is known about stroke in SGM people. 6 Previous studies have identified increased cardiovascular risk among SGM people, 7 , 8 as well as unique and disproportionate stroke risk factors in transgender people, 9 although none have compared SGM and non-SGM people with stroke to assess for differences in clinical outcomes.…”