increasing among men who have sex with men in recent years (Fox et al., 2001; Heffelfinger et al., 2007).

While less research has been conducted on STIs among women who have sex with women, Diamant and colleagues (2000a) note that self-identified lesbians participate in a variety of sexual activities that may put them at risk for acquiring STIs. Drawing on a convenience sample of 1,200 self-identified lesbian and bisexual women, Stevens and Hall (2001) found that 20 percent of the women who were sexually active with men reported having unprotected anal, oral, and vaginal sex. Of the women who were sexually active only with women, 56 percent reported having unprotected oral, vaginal, and anal sex, as well as sharing uncovered dildos and sex toys. Lack of knowledge about risk behavior and disease transmission was also notable in this population.

Transgender-Specific Physical Health Status

As mentioned in the discussion of mental health status, some research has been conducted on the impact of hormone therapy and surgery on gender dysphoria. However, limited research has examined the effects and side effects of hormone therapy on physical health (e.g., Gooren et al., 2008; Moore et al., 2003), and no clinical trials on the subject have been conducted. This research, conducted mainly abroad, indicated a risk of venous thromboembolic disease and elevated levels of prolactin associated with feminizing hormone therapy, and elevations in liver enzymes, loss of bone mineral density, and increased risk for ovarian cancer associated with masculinizing hormone therapy (Dizon et al., 2006; Hage et al., 2000; Van Kesteren et al., 1997, 1998). Research on increased risk for cardiovascular disease remains inconclusive, in part because of methodological limitations of studies conducted to date (Elamin et al., 2010; Gooren and Giltay, 2008). Little research, beyond case studies, has examined the cosmetic and functional outcomes of genital reconstructive surgery (Klein and Gorzalka, 2009; Lawrence, 2006).

RISK AND PROTECTIVE FACTORS

The literature addresses a number of risk factors that affect the health of LGBT adults. Conversely, research on protective factors is largely lacking.

Risk Factors

The primary risk factors for LGBT adults examined in the literature are stigma, discrimination, and victimization; violence; substance use; and childhood abuse.



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