LGBT Health

India’s 2014 Supreme Court ruling in National Legal Services Authority v. Union of India affirmed transgender and gender-diverse (TGD) persons as equal citizens with a right to self-identified gender. This scoping review (2014–2024) sought to map TGD mental health research in India, characterize study details and themes, and identify gaps to guide future research and interventions.

Following Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of peer-reviewed literature (PubMed, PsycINFO, Web of Science, Google Scholar, specific journal search, hand search) and grey literature (Google Scholar, websites of LGBTQ organizations, and digital thesis repositories Shodh Ganga and Shodh Gangotri). All publications between April 2014 and December 2024 that focused on the mental health of the Indian transgender population were included.

From 246 initial sources, 124 were included in the review. The reviewed studies described prevalence rates of common mental disorders, transgender-specific psychosocial stressors, positive psychology variables, role of mental health professionals, mental health interventions and guidelines, forced gender “correction” practices, mental health impact of gender-affirming surgeries, links between sexual health and mental health, and experiences during the COVID-19 pandemic.

This review demonstrates substantial mental health needs among TGD communities in India but a narrow, uneven evidence base. Several articles revealed researcher misconceptions indicating ethical and epistemic harm. Priority next steps are adequately powered, intersectional longitudinal studies and rigorously evaluated, community-partnered interventions (including family support and mental health professional training) to advance gender-affirming, evidence-based care.

Cardiovascular diseases (CVDs) are a significant cause of death, with health conditions and lifestyle behaviors playing essential roles. We sought to explore CVD risk classes, their associations with self-reported CVD, and differences among classes as a function of intersectional minority stressors (IMS) among sexual and gender minority people of color (SGM POC).

A sample of 232 SGM POC (mean age = 33.50 ± 9.77) completed an online survey in 2020 assessing CVD risk indicators and specific IMS, measured using the LGBT People of Color Microaggressions Scale subscales. Latent class analyses were conducted to identify CVD risk classes, followed by logistic regressions to examine associations between classes and self-reported CVD, classes and IMS on self-reported CVD, and interactions between the classes and IMS on self-reported CVD.

Three classes emerged: a low-risk class with low probabilities for all indicators, a lifestyle-risk class with high probabilities for smoking, alcohol use, and substance use, and a high-risk class with greater probabilities for most CVD indicators. Significant interactions showed that increased LGBT racism was associated with a lower likelihood of self-reported CVD (b = −0.40, standard error [SE] = 0.19, adjusted odds ratio [aOR] = 0.67, p = 0.036) whereas greater heterosexism within communities of color (b = 0.57, SE = 0.22, aOR = 1.77, p = 0.008) was associated with a higher likelihood of self-reported CVD in the high-risk compared with the low-risk class.

These exploratory findings support the existence of three distinct CVD risk classes among SGM POC and highlight that specific IMS moderate CVD risk for SGM POC.

This study reviewed the U.S. insurance landscape for gender-affirming surgery (GAS) and examined how regional, legislative, and health care infrastructure factors influence coverage patterns to inform policy reform and advocacy.

Policies from the top three insurers in each state, identified via the National Association of Insurance Commissioners, were analyzed in November 2024. Coverage was compared across census regions, and criteria concordance with the World Professional Association for Transgender Health (WPATH) Standards of Care, Version 8, was assessed. GAS fellowship availability, policy information accessibility (7-point Likert scale), and legislative favorability (Movement Advancement Project scores) were also evaluated. Coverage rates were compared across procedures using analysis of variance with post hoc Tukey tests. Poisson regression identified predictors of coverage, and ordinal logistic regression assessed predictors of policy information accessibility. All analyses were conducted in R 4.4.1.

We included 144 state insurance policies, representing 77% of the U.S. market. Overall GAS coverage was 67.7%, with significantly lower rates for fertility cryopreservation (6.6%), facial feminization (37.3%), and GAS reversal (65.7%). GAS fellowship presence positively predicted coverage (p < 0.001). States with fair (p = 0.041) or medium legislative favorability (p = 0.004) had higher coverage compared with negatively rated states. Only 61.9% of policies were concordant with WPATH guidelines. Coverage information access was uniformly limited and was more limited in Southern states than in other regions (p < 0.001).

Insurance coverage for GAS was inconsistent and strongly influenced by political and health care infrastructure factors rather than medical necessity. The lack of guideline concordance and systematic information barriers highlights the need for targeted reforms.

This study examined factors associated with Italian healthcare practitioners’ clinical skills when working with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients across primary, sexual and reproductive, and mental health domains.

A cross-sectional sample of 165 practitioners completed measures assessing clinical skills, heteronormative beliefs, and prejudice against sexual and gender diversity, along with sociodemographic and professional variables, between May 2024 and June 2025.

Participants (44 assigned male at birth, 121 assigned female at birth; mean age = 39.3 ± 11.4 years; 163 cisgender, 2 nonbinary; 49 identifying as LGBTQ) yielded significant differences across healthcare domains: primary care practitioners reported lower overall clinical skills, more negative attitudes and prejudice than mental health practitioners, as well as the lowest attendance at LGBTQ specific training among groups. Across the whole sample, greater clinical skills were associated with lower heteronormative beliefs and prejudice, attendance at LGBTQ training, and having at least one LGBTQ person among friends or relatives.

These findings underscore the need for comprehensive educational interventions aimed at enhancing both knowledge and attitudinal components of LGBTQ clinical skills. Policy efforts should prioritize mandatory, experiential, and context-specific training programs and promote inclusive guidelines to reduce heteronormativity in Italian healthcare. Strengthening practitioners’ LGBTQ clinical skills can foster more equitable, compassionate, and accessible health services across all domains of care.

This study examined differences in rates of gynecological health care utilization among lesbian, gay, and bisexual (LGB) women veterans relative to heterosexual women veterans.

Women veterans (N = 1729) recruited via the Veterans Affairs/Department of Defense Identity Repository (14.3% LGB, n = 248) answered questionnaires related to gynecological health care utilization between September 2018 and June 2019. Binary logistic regression was used to examine differences in Pap smear receipt and gynecological care visits, controlling for age, race/ethnicity, posttraumatic stress disorder symptoms, and sexual trauma exposure.

LGB women veterans were equally likely to receive Pap smears compared to heterosexual veterans (ps > 0.05). Gay or lesbian, but not bisexual, veterans were less likely to undergo routine gynecology visits relative to heterosexual women veterans (71% vs. 81%, p = 0.004).

Given that annual gynecology visits are recommended for reproductive-aged women for preventive and interventional care, it is important to address factors that may contribute to underutilization among gay or lesbian women veterans.