by Priya van Oosterhout

Graphic design by Josip Petrusa

The rights of those who are sexual- and gender-diverse (herein referred to as the LGBTQ+ community) have continued to expand within Canada over the past decades, including gradual changes to a medical system largely built on cisgender and heteronormative values.^1,2 Despite such advances, the LGBTQ+ community continues to face discrimination and marginalization across Canada, including within the healthcare system.^1–4 Access to quality care is not always a reality for those who identify as LGBTQ+, with many facing extended delays to care, or healthcare practitioners (HCPs) who refuse to administer treatment or medication.^1,3 It is unsurprising then that people within the LGBTQ+ community face significantly poorer health outcomes as compared to their non-LGBTQ+ counterparts,^1–3,5,6 with higher rates of depression,^1–3,5,6 suicide,^1–3,5,6 anxiety,^1,3,6 cancer,^1,3,6 and arthritis,^1,3 to name a few.  Systems-level changes need to be made in the way our healthcare system addresses the medical needs of one of Canada’s most vulnerable populations. This change may, in part, be addressed by further educating the HCPs that patients interact with at every level of care. 

Inequities within the healthcare system are structural, involving a complex interaction of social, political, and cultural factors.^2,3 For instance, the sociopolitical climate influences healthcare delivery, with those in less accepting communities being more likely to conceal their sexual or gender identities in anticipation of mistreatment from medical staff.^1,2 Research has shown that people in the LGBTQ+ community often report longer wait times,¹ bias and discrimination in healthcare settings, and poor healthcare experiences.^2–4 Other studies have found that members of the LGBTQ+ community are much more likely to avoid healthcare entirely,^1,2 with one survey finding that one fifth of respondents even reported avoiding emergency medical care due to fear of maltreatment.³ However, it’s not just discrimination affecting LGBTQ+ healthcare, but also the lack of culturally competent care offered by most institutions. For example, transmasculine individuals are much more likely to avoid screening for breast and cervical cancers because of the distress associated with such tests, increasing their risk of developing advanced metastatic disease.¹ A safe and culturally informed environment may mitigate reduced screening rates and healthcare avoidance behaviours, thereby providing a better medical experience.

Frankly, conversations about LGBTQ+ health are incomplete without discussing the unique medical needs of gender diverse patients. In 2019, a national survey found that 44% of transgender respondents reported an unmet healthcare need.⁷ Other systematic reviews have found that more than half of participants in Canadian transgender studies report negative gender-related experiences with the healthcare system,^1,3 with one third being refused help, and many observing longer wait times.¹ Much of the healthcare needs for gender diverse individuals center around medically supervised transition, with the first point of care often being their primary physician.¹ Despite this, the number of clinicians with the training to properly support this group is low, forcing many gender-diverse patients to join long waitlists or pay expensive travel costs to receive adequate care.¹ 

With such inequalities, what are the solutions? How do you change a system with deeply engrained values that are often at odds with LGBTQ+ healthcare? The largest modifiable factor when it comes to addressing inequities the healthcare system is education.¹ Surprisingly, there is no national standard for healthcare education in Canada, so there are no federal guidelines or resources to transform the current lack of inclusive curricula.¹ In surveys, many HCPs have reported feeling that their lack of training negatively impacts their ability to care for patients.¹ When asked, 41% of medical students at the University of Ottawa reported witnessing anti-LGBTQ+ attitudes within the education system,¹ and only 7% of medical students surveyed across Canada felt like they had enough knowledge to address the needs of a transgender patient.⁴ In fact, only one third of medical schools in Canada and the USA provide education regarding gender-affirming hormone therapy and surgical transition.^1,4 With such little education, many primary care HCPs refer LGBTQ+ patients to specialists for sexual- or gender-related concerns, even when not medically necessary. Not only does this significantly increase wait times, but LGBTQ+ patients may interpret the referral as an unwillingness to treat concerns related to their identities by their primary care physicians.¹ 

LGBTQ+-specific education in healthcare would need to be multi-faceted to truly address current disparities. Recognizing and addressing implicit biases, increasing cultural competency, and providing information regarding sexual- and gender-related treatments and procedures are all critical to familiarize HCPs with the needs of their LGBTQ+ patients. Practices like acknowledging patient vulnerability, affirming sexual and gender identities, avoiding binary language, and considering the physical discomfort of different procedures are all critical in providing a positive healthcare experience.^1,4 Furthermore, interventions should be at different levels of each organization, such as creating inclusive physical environments, increasing workforce diversity, and education for both clinical and non-clinical staff. Creating a safe and comfortable environment would create a better experience for LGBTQ+ patients and reduce barriers to receiving care.¹ Furthermore, ensuring adequate health education would also make HCPs more comfortable with addressing LGBTQ+ related concerns, giving them the tools needed to effectively treat their patients.

Despite there being no standardized guidelines for health education in Canada,¹ there are many organizations working to close the gap in healthcare. Groups like TransCare BC, the Canadian Professional Association for Transgender Health, and Rainbow Health Ontario are all committed to creating conferences and workshops tailored to helping HCPs provide adequate healthcare for the LGBTQ+ community. Rainbow Health Ontario, for example, includes courses on being LGBTQ+-friendly, trauma-informed care, and referrals and post-operative care for gender affirming surgeries; to name a few. While it is important to showcase the incredible work of those pushing for change, the need for such organizations highlights a concerning trend. Should it not be the responsibility of medical schools to prepare their students for any patient they may treat? At the end of the day, it is the patients themselves who are forced to rely on a system that is predominantly uneducated about their needs on a good day, or actively hostile on a bad day.

In summary, the Canadian healthcare system is largely ill-equipped to treat our country’s LGBTQ+ community, exacerbating existing health disparities, and leaving one of our most vulnerable populations behind. Consequently, LGBTQ+ patients have reported discrimination, longer wait times, concealing their identities, and even avoiding medical care altogether. Many healthcare providers have also reported feeling unprepared to adequately treat LGBTQ+ patients, with medical students even observing anti-LGBTQ+ sentiment in their training. A strong way to revolutionize LGBTQ+ healthcare is by ensuring healthcare providers have the necessary education to treat their patients. Not only should they be trained on LGBTQ+-specific medical concerns, but also in helping providers address their implicit biases, thus creating a safe and informed practice. Organizations trying to bridge the gap in the healthcare system already exist, but a lot more work is needed to truly improve the medical care of sexual- and gender-diverse Canadians.

References

Trans PULSE Canada. Health and health care access for trans & non-binary people in Canada. London: Trans PULSE Canada; 2020 Mar 10 [cited 2025 Jul 26]. Available from: https://transpulsecanada.ca/results/report-1/ 

Comeau D, Johnson C, Bouhamdani N. Review of current 2SLGBTQIA+ inequities in the Canadian health care system. Front Public Health. 2023;11:1183284. doi: 10.3389/fpubh.2023.1183284.

Hatzenbuehler ML, Lattanner MR, Mcketta S, et al. Structural Stigma and LGBTQ+ Health: A Narrative Review of Quantitative Studies. Lancet Public Health. 2024;9(2):e109-27. doi:10.1016/S2468-2667(23)00312-2.

Zeeman L, Sherriff N, Browne K, et al. A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. Eur J Public Health. 2019;29(5):974-80. doi:10.1093/eurpub/cky226.

Chan B, Skocylas R, Safer JD. Gaps in Transgender Medicine Content Identified among Canadian Medical School Curricula. Transgend Health. 2016;1(1):142-50. doi:10.1089/trgh.2016.0010.

Government of Canada. Facts, stats and impact: 2SLGBTQI+ communities [Internet]. Ottawa: Government of Canada; 2025 Jun 18 [cited 2025 Jul 26]. Available from: https://www.canada.ca/en/women-gender-equality/free-to-be-me/federal-action-2slgbtqi-communities/facts-stats.html.

Blondeel K, Say L, Chou D, et al. Evidence and knowledge gaps on the disease burden in sexual and gender minorities: a review of systematic reviews. Int J Equity Health. 2016;15:16. doi:10.1186/s12939-016-0304-1.