Coming out to your provider

Clinical Editors: Megan Dodson, PA-C, Nina Metsovaara, FNP, and Bliss Temple, MD

Talking about sex with a health care provider is never easy. For many, it’s a conversation that’s nearly impossible to get through without blushing, cringing, or squirming. But while questions about sexual activity can be awkward and uncomfortable for anyone, they can be particularly anxiety-provoking and stressful for LGBTQIA+ and non-binary individuals. Many LGBTQIA+ patients worry that transparency about their sexual orientation or gender identity will be met with hostility and judgment, and unfortunately many have had negative interactions with healthcare providers in the past. According to a study by Lambda Legal, nearly 56 percent of lesbian, gay, and bisexual patients and 70 percent of transgender and gender-diverse individuals have experienced discrimination in a healthcare setting. Meanwhile, another study found that only 16 percent of LGBTQIA+ people choose to inform their provider of their sexual orientation because of these concerns.

While coming out is a personal choice, being open and honest with your provider may be critical in managing your health. Understanding your sexual activity and gender identity can help a provider personalize your care plan, as well as your in-office experience.

Though it may not seem necessary to reveal your pronouns or sexual behaviors to your doctor, this information can better enable your provider to determine your course of care. While LGBTQIA+ individuals have the same basic healthcare needs as straight or cisgender people, they also face a unique set of risks and concerns that straight cisgender individuals do not, often due to barriers to care and the negative impact of discrimination on health. Research shows, for instance, that LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition, while transgender individuals are nearly four times as likely.

One Medical provider, Samuel Fam, DO, says transparency about sexual orientation and gender can help your provider tailor a care plan to your specific needs: “It's important for individuals to be open about their sexual orientation, gender identity and sexual practices as this information will help their provider customize a unique care plan for them according to known or expected needs of individuals in similar demographic groups. While your provider is hopefully already prompting conversations on these topics, being open and forthcoming with this information could change recommended screenings or treatments for things like cancer, STIs, mental health, safety and well-being, and vaccines for prevention of transmissible infections.”

Coming out to your provider can also enable them to make your visits more comfortable. Knowing your sexual history can help your provider avoid questions about your partners, relationships, or sexual activity that may be triggering or irrelevant. “Disclosing this information can reduce the risk of providers and their teams misgendering or referring to parts of a person with labels that make them feel uncomfortable and less likely to get care when needed in the future,” says Fam.

Ultimately the decision to tell your provider about your sexual orientation or gender identity is yours alone. But if you do decide to share this information with your provider, you may be unsure about how to start the conversation. Here are some tips for finding and being open with your provider:

Do your research

When looking for a new provider, it can be helpful to get recommendations from your community. One Medical provider, Nina Metsovaara, FNP recommends asking within your network: “I always tell people to do their research before they show up to a new practice if they can. I find most LGBTQIA+ patients find their provider by word of mouth from their community or partners, as well as internet community boards.” You can also use online directories like the Gay and Lesbian Medical Association's Healthcare Provider Directory, WPATH Provider Directory, or ask your local LGBTQIA+ health center. At One Medical, our providers aim to offer inclusivity and judgment-free care, so you can rest assured knowing that whoever you see will treat you with respect, compassion, courtesy, and professionalism. If you’d prefer to see someone who specializes in LGBTQIA+ health though, you can find each of our providers’ bios online with a short description of their areas of expertise. Many have indicated a specific interest in LGBTQIA+ care on their profiles. You can also call before booking an appointment to inquire about a provider’s experience with LGBTQIA+ patients or gender-affirming care.

Set the agenda

Rather than bringing this topic up during a separate appointment, it may be helpful to schedule a visit specifically for this conversation. “Whether with an existing provider relationship or a new provider, setting the agenda for this visit helps the provider identify that this is something important and valuable for the individual's well-being, as well as create space for asking questions, both to and receiving from the patient,” says Fam. “Simply asking to discuss sexual and gender health can prompt the provider to help navigate the conversation and meet the goals and intentions of the visit, while building trust and safety in the patient-provider relationship.” Setting your sexual health or gender health as the reason for your visit will help your provider prepare, as well as save you the anxiety and discomfort of trying to direct the conversation.

Bring a friend

It can be difficult being vulnerable with a stranger. If you’re anxious about talking to your provider, bring a close friend, family member, or partner as support. Just having someone you trust in the room can be calming. If you choose to bring your partner, simply introducing them as such may also be an easy way to “come out” or bring up the topic of conversation indirectly.

Make a list of questions

Write out a list of questions or goals for your conversation with your provider ahead of time so you don’t forget anything. Given that this is a vulnerable conversation, it can be easy to be distracted by nerves. You may even want to include questions about the provider’s experience. Asking your provider how much experience or interest they have with queer and trans healthcare, and whether they’ve ever had a queer or trans patient before, may help you determine if it’s a safe space. It’s also okay if you don’t know what the right questions are. “It’s ok not to know what you need to be aware of,” says Fam. “Making that known internally and externally with a simple phrase like, ‘I don't know if there is anything I need to be aware of to help me stay healthy,’ can help relieve that burden of responsibility off of the patient.”

Only share what you’re comfortable with

You may find that you aren’t ready to share the full details of your identity right off the bat and that’s okay. “A provider may ask you questions about your gender identity or sexual health to better support your health goals,” states Metsovaara, “But it is best practice when a provider asks for consent to talk about your health. You should not feel pressured and instead be empowered to answer them when you feel comfortable.” A starting place may be sharing a general statement about your health needs. You can share things like, “I’ve been exploring my gender identity and how I feel most embodied as my authentic self. I may want to discuss medical affirmation and hormone therapy - what would that look like?” Trust takes time to build. The more you talk about this subject with your provider, the more comfortable you’ll become.

Have the conversation when you feel comfortable

Since this conversation may leave you feeling vulnerable or exposed, you should do whatever you can to maximize comfort. For some, that may mean asking the provider to talk for a few minutes before you undress and switch into a gown. For others, that may mean talking in an office outside of the exam room entirely. Decide whether you’ll feel most at ease bringing this up at the beginning or at the end of the visit.

Know that it’s okay to feel like someone might not be the right provider for you

Finally, you should never feel stuck or obligated to stick with a provider. You can shop around as much as you want. It’s important to have a healthcare provider that you feel comfortable with, and it’s okay to choose another provider if you’re more comfortable with someone else.

Originally published June 1, 2021.