Thomas Lawrence Long, Christine Rodriguez, Marianne Snyder, & Ryan Watson

The health and wellness of lesbian, gay, bisexual, transgender, queer and other sexual minority (LGBTQ) people in the United States are influenced by many factors: a sense of self-efficacy about one’s health, access to health care, health insurance, open self-disclosure with a queer-affirming health professional, and knowledge about the unique health challenges of LGBTQ people, including disease prevention and health promotion. According to the Institute of Medicine, LGBTQ health can be understood through four lenses:

• Minority stress model—chronic stress that sexual and gender minorities routinely experience can contribute to physical and mental health problems.
• Life course perspective—events at each stage of life influence subsequent stages, with LGBTQ people being particularly vulnerable in adolescence and young adulthood.
• Intersectionality perspective—an individual’s multiple identities and the ways in which they interact may compromise health so that gender and sexual identity may be complicated by racial or ethnic identity or economic status, for example. (Health disparities are already amplified among racial and ethnic minority populations, which queer sexual orientation is likely to intensify further.)
• Social ecology—individuals are surrounded by spheres of influence and support, including families, friends, communities, and society that shape self-efficacy and health (IOM, 2011). (Self-efficacy is the confidence that one knows how to live a healthy life, along with the intention, necessary knowledge, and resources to do so.)

In this chapter we keep in mind those four overlapping dimensions, exploring these topics:

1. LGBTQ people and the history and culture of medicine.
2. Their vulnerabilities across the lifespan and across intersectional identities (including race and ethnicity).
3. Transgender people’s health.
4. Guidelines for being a smart patient and health care consumer.