Growing evidence indicates that lesbian, gay, bisexual, transgender and queer adults experience worse cardiovascular health than their cisgender heterosexual peers according to the American Heart Association.

For instance, transgender men are twice as likely to have a heart attack than cisgender men and four times as likely than cisgender women, according to the AHA. Transgender people are also more likely to experience blood clots when undergoing estrogen hormone therapy, the AHA reported.

The scientific paper appeared in the AHA’s scientific journal Circulation last week. It described the multi-layered ways LGBTQ or questioning individuals have higher risk factors – primarily due to stress from discrimination – for cardiovascular disease when compared to their cisgender heterosexual peers.

Leaders in the New Mexico LGBTQ community responded that this information, though not tracked before, is nothing new to those impacted.

Adrien Lawyer, co-founder and executive director of Transgender Resource Center, said he is glad to see the data come out but “within the (LGBTQ) community we look at that stuff and go ‘duh.’”

“Marginalized people have worse disparities period,” he said.

LGBTQ individuals can feel stress due to internalized homophobia, discrimination in individual encounters and structuralized discrimination, according to AHA.

Marshall Martinez, executive director of Equality New Mexico, said “trauma doesn’t go away.” He said he came out at the age of 16 and his parents were very accepting but for two years, he hid his identity because he was afraid of what would happen.

“That fear for two years follows me around everywhere I go. For so many of us, we keep reexperiencing that trauma and fear over and over again. The first day of school, going away to college, getting a job in entry level food service or retail, we don’t know how accepting and open minded and educated our peers and supervisors are,” he said.

Martinez cited the cultural moment when singer-songwriter Melissa Etheridge came out to the public as a moment that had a negative impact on him as an example of internalized stress.

“So many people who were fans were angry because she came out. ‘Why do we need to know she’s a lesbian?’ What I heard was, ‘do good work, be accomplished and hide your sexual orientation from people.’ There’s a constant water drip in the back of the mind that you hear and internalize,” he said.

Lawyer said the trauma and stress LGBTQ individuals experience is often “not a single catastrophic event.”

“It’s an accumulated experience. A lack of attachment or lack of authenticity. Kids need to be authentic. Most LGBTQ kids never are. For many families, you can’t be yourself unabashedly if you’re gay,” he said.

Forms of structural discrimination that contribute to stress include feeling protected under the law.

While it is against the law to fire someone in New Mexico for sexual identity or orientation, that “doesn’t mean every queer person knows that or feels protected,” Martinez said. Laws protecting LGBTQ individuals are a patchwork across the U.S.

“From a policy perspective, the lack of federal level protections is creating some of those structural discrimination issues,” Martinez said.

Martinez also cited “our broken health care system” as another element of structural discrimination.

“This broken health care system means we are experiencing those traumas most of the time without support or a way to get better because most LGBTQ don’t have access to good mental healthcare and can’t find a good counselor or therapist,” he said.

Internalized stress can take the form of internalized discrimination but also expectations of rejection as well as the need to conceal sexual identity or orientation, the AHA said.

“We internalize all those things that happen where (LGBTQ) protections don’t exist. Thirty-eight states had anti-trans legislation in the legislature. Kids engage on the internet. They kept hearing attacks on trans people in sports and healthcare,” he said.

Martinez cited the recent U.S. Supreme Court decision, Fulton v. the City of Philadelphia, which at first glance looked as if the Supreme Court had ruled in favor of LGBTQ discrimination and sided with the Catholic-based organization that brought the suit, Martinez said.

Related: Advocates: SCOTUS decision emphasizes need for more LGBTQ protections

But, the decision was nuanced and narrow and said, instead, that the city of Philadelphia was not uniformly applying its nondiscrimination policies, so therefore, the Catholic agency won its case. Legal experts have said the ruling would not likely lead to discrimination in New Mexico.

But, Martinez said LGBTQ youth might miss the nuance of that decision and think that the Supreme Court, by ruling in favor of an organization that engages in discrimination when finding foster parents for children, were opening the door to discrimination against LGBTQ families.   

Other stress

LGBTQ individuals also experience stress from interpersonal relationships that involve discrimination, family rejection and violence. This, in turn, can lead to substance abuse disorders, poor mental health and the increased likelihood of experiencing cardiovascular events or diabetes, according to the paper.

LGBTQ individuals are four times more likely to experience violent victimization, including rape, sexual assault, aggravated or simple assault than non-LGBTQ individuals, according to a study produced late last year by the University of California at Los Angeles School of Law Williams Institute.

The Human Rights Campaign, an advocacy organization for LGBTQ rights, reported late last year that hate crimes based on sexual orientation represent nearly 17 percent of hate crimes in the U.S., the third largest category. The Human Rights Campaign also reported an uptick in gender identity based hate crimes, from 2.2 percent in 2018 to 2.7 percent in 2019.

Even while the stress itself negatively impacts cardiovascular health, engaging in substance abuse can exacerbate heart health even further. But, when faced with such stress, substance abuse disorders and smoking cigarettes become coping mechanisms, Lawyer said.

“We seek out substances to block out how this feels. Parents don’t love you and you’re 15 and in high school. Substance use soothes some of that pain,” he said.

Another stress factor for LGBTQ is visiting a health care provider, which is particularly important for heart health. According to the AHA, 56 percent of LGBTQ adults and 70 percent of those who are transgender or gender non-conforming reported experiencing some form of discrimination from a health care professional.

Martinez said even the most well-intentioned medical professionals often don’t know how to treat LGBTQ patients. But there are also medical professionals who do not engage in patient-centered care, he said.

“When I was 16, I had a physical. The doctor who gave it argued with me about whether or not I was gay and when I wouldn’t back down from that argument, he refused to have a conversation about sexual health,” Martinez said.

Lawyer said a significant problem in the medical profession is the lack of training available. He said a person can practice medicine “without getting one hour of training on (the transgender) population.

“One of the biggest barriers is being asked to educate the provider once you’re in the room. This is a well-meaning provider. But the patient is like, ‘I’m not here to educate you. How can I teach you how to be a doctor? I’m not a doctor.’ This cultural fluency training should be standard. That’s an almost criminal oversight,” Lawyer said.

There is also a lack of data. The National Institutes of Health established the Sexual & Gender Minority Research Office and designated LGBTQ individuals as a health disparity population in the past six years. But knowledge gaps for the health of LGBTQ individuals remain, the paper said.

Martinez said a bill, SB 316, had it passed, would have addressed a data gap that exists in New Mexico.

If the state had data based on gender identity and orientation, then certain demographic groups who are, for instance, disproportionately on food stamps or not getting the flu shot would lead to the state making targeted interventions, he said.

“The state could start to identify more specific interventions to increase the overall health of LGBTQ folks,” he said.

Another nuanced layer to the issue, according to the AHA, is that culturally, LGBTQ are lumped into one group, but there are race, socio-economic and ethnic layers.

For instance, Lawyer said transgender individuals, in general, face more discrimination than gay and lesbian individuals.

“We’re still 30 years behind in terms of legal protections, cultural and media representation,” he said.

Martinez said that LGBTQ individuals have consciously formed a group identity because the discrimination and opposition individuals face is so similar and mostly based around shame. But, health care needs are “incredibly individualized.”

“If we (the state) were collecting data in a systematic and uniformed way, we could start to pull that data in part to understand a Black gay man or a trans Native person,” he said.

Lawyer said he tries to “teach folks this is so intersectional in nature.”

“It’s not a community, it’s a bunch of communities,” he said.