CHESTThought Leader BlogFill Your Lungs With Pride

Fill Your Lungs With Pride

By: Gustavo A. Cortes Puentes, MD

Every year during Pride Month, we reflect on the history and legacy of the milestone gay rights demonstrations triggered by a police raid at a bar in Manhattan. Protesters took to the streets in the aftermath of the Stonewall riots in the summer of 1969. This liberation movement marked a turning point in the gay rights movement and continues to inspire the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) community around the world to live up to a promise of equality, inclusion, liberty, and justice for all.

Despite this progress and tangible societal efforts to adopt protections and to foster inclusion for LGBTQ+ individuals, I am convinced the medical community has an opportunity to continue to improve health care delivery for a population that still experiences disparities across the spectrum of care and outcomes. As pulmonary, critical care, and sleep medicine clinicians, we need to better understand and honor the unique needs of different members of the LGBTQ+ community.

A key first step would be to facilitate and improve access to medical care in the fields of pulmonary, critical care, and sleep medicine. To this end, intentional equity and inclusion efforts are required to welcome LGBTQ+ patients into our medical institutions. For example, national organizations committed to ensuring health equity for the LGBTQ+ community, such as GLMA (Health Professionals Advancing LGBTQ Equality, previously known as the Gay & Lesbian Medical Association), can assist LGBTQ+ patients in sourcing providers who identify as LGBTQ+ friendly and institutions committed to integrated and comprehensive gender-affirming care, with an easy-to-navigate provider directory and registry. Additional strategies may include increasing awareness and practice of appropriate differentiating terminology, such as sex and gender identity, as well as normalizing the practice of sharing pronouns among staff and patients. Consistently sharing your personal pronouns and using others' preferred personal pronouns creates a welcoming and inclusive environment.

With transgender visibility in the US at an all-time high, Pride Month offers an opportunity for allies and advocates to come forward and show their support. The percentage of US adults who self-identify as lesbian, gay, bisexual, transgender, or something other within any nonheterosexual identity has increased to a new high of 7.1%, which is double the percentage from 2012, when first measured by Gallup. This emphasizes the need for further education directed at pulmonary, critical care, and sleep medicine physicians on the general concepts of gender-affirming care, as well as the therapeutic nuances of both masculinizing and feminizing hormone therapies, which could significantly improve patient-provider interactions and humanize care.

There is a palpable paucity of research initiatives aimed at meeting the needs of the LGBTQ+ community. As gender-affirming care continues to evolve along with the growing number of patients who identify as transgender and gender-diverse, the pulmonary, critical care, and sleep medicine research community should commit to answer relevant clinical questions. Among many others, I think some of the most immediate questions to be answered as gender-affirming therapies are being established include: 1) Are there any changes in airway inflammatory, anatomical, and functional profiles? 2) What are the interactions between commonly used medications in pulmonary medicine (eg, antifibrotics and medications for the treatment of pulmonary hypertension) and both masculinizing and feminizing hormone therapies? and 3) What is the incidence of tobacco smoking and vaping, and adjunctively, what are the barriers for smoking cessation among members of the LGBTQ+ community?

Finally, I would like to take this opportunity to wish you all Happy Pride!

To all transgender and gender-diverse patients and providers, you belong.

Gustavo A. Cortes Puentes, MD
Dr. Cortes Puentes is currently a Consultant in the Division of Pulmonary and Critical Care Medicine in Rochester, MN, and an Assistant Professor of Medicine at Mayo Clinic School of Medicine. Dr. Cortes Puentes has expertise and an academic track record in pulmonary physiology, pulmonary mechanics, mechanical ventilation, and respiratory failure. He is also Chair of Equity, Inclusion and Diversity (E, I&D) for Critical Care Medicine. As a Latino immigrant and member of the LGBTQ+ community, his personal background uniquely qualifies him to practice pulmonary and critical care medicine with a sharp appreciation of socioeconomic reality and the need for social consciousness.