New Frontiers in LGBTQ+ Health Help Build Community
#Communities
Staff participated in the Stanford School of Medicine’s 4th Annual Pride Parade on June 5, 2024.
Stanford’s LGBTQ+ Health Program is forging new frontiers on so many fronts – from clinical care and research to medical education and advocacy – finally giving this community the focus it deserves.
A Lifetime of Whole-Person Care
Under the Department of Medicine’s Division of Primary Care and Population Health, the LGBTQ+ Health Program addresses the full spectrum of healthcare needs. “We’re one of the only programs that offers tailored LGBTQ+ primary care, unlike clinics that offer sexual or gender health care services only,” explains Benjamin Laniakea, MD, chief of the Stanford LGBTQ+ adult clinical program and a family medicine physician in the Department of Medicine. “If a patient has an issue, they don’t need to worry about which doctor to go to or who will advocate for them. They know our clinic is a caring and safe place to go for any healthcare need over their entire lifespan.”
Primary care patients in the LGBTQ+ Health Program have access to a full complement of specialists, offering groundbreaking care in endocrinology, obstetrics/gynecology, surgery, otolaryngology, and plastic surgery. One example: Stanford offers an innovative gender-affirming vocal surgery that allows trans women to have a matching feminine vocal pitch.
Family building – not something that has been traditionally part of LGBTQ+ health care – is another way the program is at the forefront of care for patients. “For generations, LGBTQ+ patients have been told that they’re committing to a life of loneliness, without a family of their own,” points out Laniakea. “And, actually, we’ve found LGBTQ+ patients to be phenomenal candidates for assisted reproductive technology. Many of our patients are building their families and finding a future for themselves through our Q+ Family Building Clinic.”
Research Draws from a National Community
The LGBTQ+ Health Program’s research arm seeks community input every step of the way – not only when deciding what issues to study, but also when analyzing and disseminating study results to ensure data are framed appropriately.
Much of LGBTQ+ research is conducted under The PRIDE Study, the brainchild of Mitchell Lunn, MD, associate professor of nephrology, and Juno Obedin-Maliver, MD, associate professor of obstetrics and gynecology, who co-direct the program. The PRIDE Study draws from a community of 30,000 people (ages 18 to 90+ from all 50 states) and has published an astounding 65 papers on LGBTQ+ health since 2019. While physicians can refer to the published scientific papers on its website, plain language summaries of study findings and next steps provide extra value to the LGBTQ+ community.
“If a patient has an issue, they don’t need to worry about which doctor to go to or who will advocate for them. They know our clinic is a caring and safe place to go for any healthcare need over their entire lifespan.”
– Benjamin Laniakea, MD
Benjamin Laniakea, MD, is chief of the Stanford LGBTQ+ adult clinical program and also oversees the Sex, Gender, and Sexual Function curriculum at the Stanford School of Medicine.
Thanks to support from the Department of Medicine and the Stanford Center for Clinical and Translational Research and Education (Spectrum), a revamp to the study’s digital platform will expand data collection to include electronic health records, devices (like Apple Watch), and genome sequencing. Says Lunn, “It’s very common for people who participate in research studies to never learn the results, and we want to close that loop. Participants will be able to see the specific scientific papers and studies their data were used in so they can see how they are contributing to science and be able to share it with healthcare providers, friends, and family. We want them to know their efforts are appreciated.”
Lunn and Obedin-Maliver also co-direct PRIDEnet, a research network of sexual and gender minority (SGM) individuals as well as health centers, community centers, and service/advocacy organizations across the country. PRIDEnet is the national community engagement partner for the All of Us Research Program, sponsored by the National Institutes of Health.
Describes Lunn, “Because sexual orientation and gender identity have not been collected in most health studies, there are really limited descriptions of LGBTQ+ people’s health. The All of Us Research Program is an exciting project that will be asking the sexual orientation and gender identity of at least 1 million people, giving us an enormous dataset. Study participants will also be able to have their entire genome sequenced, making this a unique opportunity to learn how environmental and societal exposures influence health at the molecular level.”
Cultural Competency Underlies the Stanford School of Medicine Curriculum
The mission of the Division of Primary Care and Population Health is to serve the community through caring, learning, and innovation for the whole person through all stages of life.
To further that mission, the School of Medicine’s LGBTQ+ curriculum includes nine lecture hours in the preclinical years, making it more robust than many other institutions. The medical school also offers a special LGBTQ+ track as part of the Family Medicine rotation.
Explains Laniakea, who is a clinical associate professor of Primary Care and Population Health, and oversees the Sex, Gender, and Sexual Function curriculum at the Stanford School of Medicine, “Our students will encounter trans patients for any number of reasons, including for gender-affirming hormone therapy. And they will encounter trans people in their everyday lives. In our preclinical training, we want students to understand the basics of sexuality and gender and gender-affirming hormone therapy to help inform their own clinical practices in the future, whatever specialty they pursue. We want to build cultural competency and compassion in our students.”
Mitchell Lunn, MD, and Juno Obedin-Maliver, MD, co-direct The PRIDE Study and PRIDEnet, two avenues for groundbreaking LGBTQ+ research at Stanford.
“Because sexual orientation and gender identity have not been collected in most health studies, there are really limited descriptions of LGBTQ+ people’s health. The All of Us Research Program is an exciting project that will be asking the sexual orientation and gender identity of at least 1 million people, giving us an enormous dataset.”
– Mitchell Lunn, MD
Research Data Support Advocacy Work
“We look for ways to use our research to advocate for our community,” says Lunn. One paper published last April in the American Journal of Public Health focused on the harmful practice of conversion therapy, an effort to change sexual orientation or gender identity through coercive means, usually with children or young adults.
“Using data from The PRIDE Study, we looked at the intersection of LGBTQ+ status and racial and ethnic minority status,” Lunn explains, “and found that people who have multiple minoritized identities were actually the most likely to be exposed to conversion practices.” Conversion therapy is illegal in only 23 states, and the data from this study can be used to advocate for the sexual and gender minority community as part of a social justice framework.
“We’re hoping to work more closely with our policy experts – including Stanford’s Department of Health Policy – to look at legislation to ban conversion therapy in other parts of the U.S. and in Canada,” adds Lunn.
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