Research

Addressing Gaps, Improving Outcomes, and Promoting Equity for Sexual and Gender Minorities in Gastroenterology

Research in sexual and gender minority (SGM) health in the field of digestive diseases is vital for addressing significant gaps in knowledge, improving health outcomes, and promoting equity in healthcare. This is especially important now in our ever changing political climate. 

Here are other reasons why this research matters.

1. Disparities in Health Outcomes

SGM individuals face higher rates of mental health issues, stress, and discrimination and often have less access to health insurance. This can theoretically lead to greater rates of GI disorders, but this has not been studied. Research is essential to understanding how these factors contribute to disease prevalence and severity in SGM populations.

2. Underrepresentation in Research

SGM populations are underrepresented in clinical trials and research, leading to limited understanding of how digestive diseases manifest and progress in these communities. This lack of representation can perpetuate biases and gaps in treatment guidelines, resulting in suboptimal care.

3. Barriers to Care

Stigma, discrimination, and fear of disclosure can deter many SGM individuals from seeking care for digestive health issues, delaying diagnosis and treatment. Addressing these barriers requires tailored research to inform provider training and create inclusive clinical environments.

5. Intersectionality

SGM individuals often experience compounded health disparities due to overlapping identities (e.g., race, socioeconomic status, gender, socioeconomic status), further emphasizing the need for nuanced research to understand these intersections in the context of digestive diseases.

6. Improving Patient-Centered Care

Research can guide the development of culturally competent care models, ensuring that GI healthcare providers understand and address the unique needs of SGM patients.

Investing in SGM health research in digestive diseases is essential to ensure that advancements in gastroenterology and hepatology benefit everyone equitably, reduce disparities, and improve quality of life for diverse patient populations.

Key Papers

Below are key papers related to SGM health in digestive diseases, some by our own board members (in bold)!

• Paul S. Overcoming the Challenges and Mitigating the Disparities in Our LGBTQI+ Patients. The American Journal of Gastroenterology. 2021 June 30. doi: 10.14309/ajg.0000000000001359
• Paul S. Embracing many rainbows: the realities of being a gay physician, mother and patient. Nat Rev Gastroenterol Hepatol. 2021 Dec 7. doi: 10.1038/s41575-021-00562-x.
• Vélez C, Casimiro I, Pitts R, Streed C Jr, Paul S. Digestive Health in Sexual and Gender Minority Populations. Am J Gastroenterol. 2022 May 9. doi: 10.14309/ajg.0000000000001804.
• Newman KL, Jencks K, Chedid V, Paul S, Higgins PDR, Kane SV, Long M. Response to Mansoor et al: ‘Epidemiology of inflammatory bowel disease in men with high-risk homosexual activity’. Gut. 2022 Oct 13:gutjnl-2022-328802. doi: 10.1136/gutjnl-2022-328802.
• Duong N, Lee TH, Newman KL, Goldowsky A, Jencks KJ, Chedid V, Barrow J, Burbridge R, Chiang A, Targownik L, Simonetto DA, Paul S. Overcoming Disparities for Sexual and Gender Minority Patients and Providers in Gastroenterology and Hepatology: Introduction to Rainbows in Gastro. The Lancet Gastroenterology & Hepatology. 2023 Feb 13:S2468-1253(23)00005-5. doi: 10.1016/S2468-1253(23)00005-5. Epub ahead of print.
• Goldowsky A, Ding J, Velez C, Paul S. Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology & Hepatology. Gastroenterology 164, 510–514. (Part of AGA Journals DEI Section; also published in Clinical Gastroenterology & Hepatology).
• Newman KL, Vélez C, Paul S, Radix AE, Streed CG, Targownik LE. Research Considerations in Digestive and Liver Disease in Transgender and Gender-Diverse Populations. Clin Gastroenterol Hepatol. 2023 Sep;21(10):2443-2449.e2. doi: 10.1016/j.cgh.2023.06.008 (Part of AGA Journals DEI Section; also to be published in Gastroenterology).
• Lee TH, Paul S, Kahn J. Model for End-Stage Liver Disease 3.0: One step forward to mitigate sex and gender disparities in liver transplant. Am J Transplant. 2024 Jan;24(1):145-146. doi: 10.1016/j.ajt.2023.09.013.
• Lee TH, Duong N, Sutha K, Simonetto DA, Paul S. Liver transplantation for people of minoritised sexual and gender identities in the USA. Lancet Gastroenterol Hepatol. 2023 Dec;8(12):1152-1162. doi: 10.1016/S2468-1253(23)00238-8. Epub 2023 Oct 11.
• Chen P, Simonetto DA, Paul S, Patel A. Health disparities experienced by sexual and gender minority individuals living with or at risk of chronic liver disease. Clin Liver Dis (Hoboken). 2023 Sep 14;22(4):152-156. doi: 10.1097/CLD.0000000000000073.
• Vélez C, Newman KL, Paul S, Berli JU, Tangpricha V, Targownik LE. Approaching Digestive Health Care in Transgender and Gender-Diverse Communities. Gastroenterology. (2024 Mar;22(3):441-447.e2. doi: 10.1016/j.cgh.2023.12.001. (Part of AGA Journals DEI Section; also published in Clinical Gastroenterology & Hepatology).
• Huynh DJ, Paul S, Duong N. Promoting allyship to support and uplift the LGBTQIA+ community. Nat Rev Gastroenterol Hepatol. 2024 Apr 5. doi: 10.1038/s41575-024-00928-x. Epub ahead of print. PMID: 38580787.
•  Nikzad N, Duong N, Paul S. Improving culturally safe engagement with sexual and gender minority populations. Nat Rev Gastroenterol Hepatol. 2024 Apr 2. doi: 10.1038/s41575-024-00927-y. Epub ahead of print. PMID: 38565649.
• Singh S, Duong N, Targownik L, Paul S, Vélez C, Feld LD. Transgender health care in the United States: legal, ethical and practical concerns for gastroenterologists in a changing landscape. Nat Rev Gastroenterol Hepatol. 2024 Jun;21(6):370-371. doi: 10.1038/s41575-024-00933-0. PMID: 38693299.
• Nikzad N, Fisher AR, Pillai A, Targownik LE, Te HS, Aronsohn A, Paul S. Considerations in gender-affirming hormone therapy in transgender and gender diverse patients undergoing liver transplantation. Am J Transplant. 2024 May 8:S1600-6135(24)00296-X. doi: 10.1016/j.ajt.2024.05.002. Epub ahead of print. PMID: 38729612.

Contact us for more information if you would like to be involved in current or future research endeavors.