We take a look at four factors at play when it comes to incompetent, un-affirming care for the queer community.

Here at Lighthouse, we believe that everyone — and we mean everyone — deserves access to holistic and LGBT-friendly healthcare. That means being able to walk into a facility and be open about every aspect of your physical, sexual, and mental health without fear of judgment.

Seems pretty straightforward, right? So why do gay, lesbian, trans, and queer people continue to encounter roadblocks to care?

Let’s take a look at four of the major drivers of incompetent or non-affirming LGBTQ healthcare — and what providers, advocates, and allies can be doing to remedy them.

1. Who Your Doctor Is and How They’re Trained

For the LGBT community, limited access to proper health care is in many cases caused by a shortage of qualified physicians. The vast majority of healthcare practitioners possess only a limited knowledge of community-specific treatments like hormone replacement therapy, gender affirmation surgery, HIV prevention and treatment, and an understanding of intersex genitalia; while some doctors may be equipped to handle gay and lesbian people, they may lack the knowledge to help a trans person, and vice versa. Just because a person specializes in one LGBTQ identity does not mean they are prepared or educated to handle others.

In fact, a 2011 JAMA study reported that the average time dedicated to LGBTQ health issues in American medical programs was a mere five hours. And while resources like Lighthouse work to connect patients with doctors who can understand and affirm them, there remains a vast shortage of LGBT-friendly physicians who can meet the needs of a growing LGBTQ population.

Read More: A Doctor’s Guide to Providing LGBTQ-Affirming Care

2. A Lack of LGBTQ-Identifying Doctors

Another issue? Barriers to acceptance for queer medical students lead to fewer LGBT-identifying doctors. A recent study conducted by Stanford University found that 30 percent of sexual minority medical students hide or don’t reveal their sexual and gender identity, and 40 percent of medical students who identified as “not heterosexual” reported they were afraid of discrimination from faculty, peers, and patients. While many LGBT patients may prefer to work with a doctor who has experienced similar health issues and concerns, the fact that many doctors remain professionally in the closet means that LGBT people are less comfortable opening up and getting their needs met.

3. Stereotypes, Binaries, and Bias Reduce LGBT-Friendly Healthcare

Inadequately trained physicians inevitably provide subpar care, and a lack of interest in LGBT-friendly healthcare perpetuates a lack of interest in or need for training. Whether it’s not knowing about drug-store HIV tests, being unaware of best practices for PrEP, or assuming a level of promiscuity based on one’s sexual orientation, overt discrimination and microaggressions can discourage LGBTQ patients from seeking care when they need it. In fact, a 2015 study showed that 81 percent of first year medical students showed implicit bias against gay/lesbian people and 50 percent showed explicit bias.

Even waiting room paperwork highlights the insidious assumptions that can emerge in healthcare settings. Forms that only list “male” and “female” disregard patients who do not claim binary gender labels, and other trans identities and can alienate patients. Similarly, asking for “sex” rather than “gender” and using terms like “women’s health” instead of “vaginal health” quickly leave trans and gender nonconforming people feeling misunderstood from the outset.

Because of prior experiences of bias or the expectation of poor treatment, many LGBTQ patients report reluctance to volunteer information about their sexual orientation or gender identity to healthcare providers. At the same time, research from JAMA found that nearly 80 percent of emergency room doctors and nurses don’t even ask patients about their gender identity or sexual orientation because they assume patients will be uncomfortable disclosing personal information during an ER visit. But a survey of patients as part of the same study found that only 10 percent would hesitate to disclose if asked. With both patient and doctor afraid of inciting a negative reaction from the other, it falls to doctors to ask professionally, rather than assume patients will volunteer information about sexual orientation or gender identity.

Read More: 10 Stats You Need to Know About LGBTQ Healthcare

4. The Transgender Care Gap

A recent survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 19 percent of trans and GNC people have been refused care outright because they were transgender or gender nonconforming. What’s more, doctors routinely use abusive language and overtly transphobic terminology, ignore the specific medical needs of trans and GNC individuals, and often use shame and normative gender/sexual assumptions to alienate trans patients during visits.

The same survey found that more than 50 percent of respondents reported having to explain certain aspects of transgender-specific medical necessities to their healthcare providers — a reality that can allow for an exchange of misinformation or discourage trans patients from seeking care altogether, particularly since trans-friendly doctors can be hard to find in many areas around the U.S.

Read More: 3 Major Ways the American Healthcare System Is Failing Trans Patients

Better Research For A Brighter Future

Though these problems are still alarmingly pervasive, recent developments are pointing to a better future for LGBTQ healthcare. In October of last year, the NIH designated the LGBTQ community a “health disparity population,” giving priority to this group when it comes to localized research. The potential benefits of a more medically incorporated LGBTQ community are immeasurable — and academic institutions and healthcare nonprofit organizations are finally realizing it.

Culturally competent healthcare providers and administrators can help end the health disparities faced by LGBTQ people by providing welcoming, knowledgeable and equitable care. At Lighthouse, we work to connect patients with knowledgeable, affirming providers. Our rapidly expanding network of doctors is experienced, thoroughly vetted, and invested in the health of the LGBTQ population.

Click here to find an LGBTQ+ AFFIRMING Provider In your Area