June celebrates the LGBTQ+ community through Pride Month.
Providing affirming care to LGBTQ+ patients is not only a matter of respect, it’s a clinical imperative based in both evidence and equity. As standards of care evolve, family physicians must stay current on best practices that address the distinct health risks, disparities, and lived experiences of LGBTQ+ individuals.
During a well-attended session at the 2025 ACOFP Convention, Jay Olson, DO, MS, delivered a case-based presentation that explored different, specific patients within the LGBTQ+ population. The following case studies and related treatments are neither exclusive to LGBTQ+ patients, nor exhaustive of all screenings and management.
Each of these cases underscores how sexual orientation, gender identity, and personal history shape screening practices, preventative health, and mental wellness strategies. The focus spans from routine maintenance and cancer screening to hormone therapy and substance use management, reflecting the broad spectrum of patient needs.
Dr. Olson reminds us of frequently used acronyms and vocabulary in the care of LGBTQ+ patients:
- Gay/Lesbian/Homosexual – attracted to the same gender identify
- Transgender – discordance from assigned gender at birth
- Genderfluid/Nonbinary/Intersex – nonconforming to either gender
- AFAB – Assigned Female At Birth
- AMAB – Assigned Male At Birth
- GAH – Gender Affirming Hormones
Case Study One: 58-Year-Old Gay Man
This patient presents for a routine exam with a history of hypertension and long-term HIV management. He is in a monogamous relationship and engages in receptive and insertive anal sex. Preventative care includes regular labs, mental health screening, and updated vaccinations. An anal Pap smear is recommended due to reported anogenital warts and risk factors such as HIV status and sexual practices. Immunizations like HPV and Hepatitis A are advised due to his sexual health risk profile. The importance of tailored screening and immunization is emphasized.
Case Study Two: 41-Year-Old Transgender Male
This AFAB (assigned female at birth) patient presents with abnormal uterine bleeding while on testosterone therapy and has a history of bilateral mastectomy. Labs showed anemia and testosterone within goal range. Screening for cervical cancer followed standard guidelines, as the patient retains reproductive organs, with Pap smear and pelvic ultrasound conducted. Breast cancer screening is adapted post-mastectomy through annual exams and scar assessments. The case highlights hormone monitoring and continuity in gynecologic screenings despite gender transition.
Case Study Three: 21-Year-Old Bisexual Female
This patient presents for a well-woman exam with mental health conditions and reports frequent unprotected sex with male and female partners. Her alcohol use is significant—daily wine and heavy weekend drinking, which escalated following a trauma-related event. Preventive screenings and contraception discussions are conducted, and labs return normal. The provider addresses her substance use with motivational interviewing, counseling referrals, and pharmacologic options such as naltrexone and acamprosate. This case underlines the importance of trauma-informed care and addressing behavioral health in sexual health visits.
Case Study Four: 11-Year-Old Gender Fluid Youth
Identifying as genderfluid and preferring "they/she" pronouns, this youth expresses a desire to stop puberty. Supportive family and counseling history are noted. Puberty suppression with leuprolide is considered, requiring Tanner stage 2 development and careful monitoring of hormone levels and side effects. Gender Affirming Hormone (GAH) therapy options for both MtF and FtM are explored, including spironolactone, estradiol, and testosterone. Additional considerations include bone health, voice therapy, and fertility. The case emphasizes early, affirming, and multidisciplinary care.
These cases emphasize the importance of meeting LGBTQ+ patients where they are –clinically, emotionally, and socially. A holistic approach rooted in empathy, cultural competence, and ongoing dialogue is essential to deliver equitable and effective care. Tailoring interventions to each individual's identity and goals fosters trust, promotes health equity, and supports long-term well-being.
Watch the Full Session On Demand
Dr. Olson’s full session, LGBTQ+ Primary Care: Exploring Changes to Standards of Care for this Unique Population Through Case Examples, is now available on demand. Purchase access to the full convention or specific bundles to earn up to 38 AOA or AMA credits.
