CREATING SAFE AND AFFIRMING CLINICAL ENVIRONMENTS

ManBrite co-founder Dr Sundeep Varma considers how to enhance LGBTQIA+ inclusivity in aesthetic medicine

DR SUNDEEP VARMA

Dr Sundeep Varma is a general practitioner with a special interest in aesthetic medicine and sexual health. He co-founded Manbrite, an aesthetic clinic dedicated to providing inclusive services. His work focuses on improving healthcare accessibility and quality for marginalised communities.

The increasing demand for aesthetic procedures calls for a closer look at inclusivity within aesthetic clinics, particularly concerning lesbian, gay, bisexual, trans, intersex and queer (LGBTQIA+) individuals. Despite advancements in LGBTQIA+ rights in the United Kingdom, many within this community face barriers when accessing aesthetic services due to fears of judgement or misunderstanding. Aesthetic medicine has grown significantly in recent years, offering a range of procedures aimed at altering physical appearance and boosting self-esteem. However, the traditional marketing and delivery of these services often cater predominantly to cisgender and heterosexual individuals, unintentionally marginalising LGBTQIA+ populations. Studies indicate that LGBTQIA+ individuals frequently encounter discrimination and inadequate care within healthcare settings, including aesthetic clinics.1,2

HISTORICAL CONTEXT OF LGBTQIA+ RIGHTS IN THE UK

Understanding the historical landscape of LGBTQIA+ rights is crucial for contextualising present challenges. Key legislative milestones include:

• Sexual Offences Act 1967: Decriminalised homosexual acts in private between men over 21 in England and Wales3

• Gender Recognition Act 2004: Allowed transgender individuals to obtain legal recognition of their gender4

• Equality Act 2010: Consolidated anti-discrimination laws, protecting individuals from discrimination based on sexual orientation and gender reassignment5

• Marriage (Same Sex Couples) Act 2013: Legalised same-sex marriage in England and Wales6

Despite these advancements, societal stigma and discrimination persist, impacting the healthcare experiences of LGBTQIA+ individuals.7

CHALLENGES FACED BY LGBTQIA+ PATIENTS

Discrimination and miscommunication LGBTQIA+ patients often report negative interactions with healthcare providers, including use of incorrect pronouns, assuming genders, use of inappropriate language, and assumptions based on stereotypes.8 Such experiences can deter individuals from seeking care or fully disclosing relevant information, compromising treatment outcomes.

Lack of provider knowledge

A study by Obedin-Maliver et al. revealed that medical education often lacks comprehensive training on LGBTQIA+ health issues.9 This gap extends to aesthetic medicine, where providers may be unprepared to address the unique needs of transgender or intersex patients, particularly regarding gender-affirming procedures.

Limited access to appropriate services
Transgender individuals may require specific aesthetic treatments as part of their transition, such as facial feminisation surgery or hair removal.10 Limited availability of these services and a lack of knowledgeable providers contribute to healthcare disparities.

IMPORTANCE OF INCLUSIVITY TRAINING

Enhancing patient–provider communication
Inclusivity training can improve communication skills, enabling providers to interact respectfully and effectively with LGBTQIA+ patients, such as correct use of pronouns. Effective communication is associated with increased patient satisfaction and adherence to treatment plans.11

Addressing unconscious bias
Training programmes that address unconscious bias have been shown to reduce discriminatory behaviours in healthcare settings.12 Examples of unconscious bias include asking a male-presenting patient, “Do you have a girlfriend?”, or suggesting to a transgender man that his request for chest contouring is unnecessary, without understanding its significance for his gender identity. By recognising and mitigating personal biases, providers can create more supportive environments.

Improving clinical competence
Educational initiatives focusing on LGBTQIA+ health can enhance providers’ clinical competence, ensuring they are equipped to offer appropriate care. This includes understanding specific health needs, such as hormone therapy considerations and surgical options for transgender patients.13

CURRENT LIMITATIONS IN CPD COURSES

Despite the recognised need, CPD courses specifically addressing intersex and transgender health remain limited.14 Expanding these offerings is essential to bridge knowledge gaps and promote best practices in aesthetic medicine.

STRATEGIES FOR ENHANCING INCLUSIVITY

Development of comprehensive training programmes
Aesthetic clinics should implement training programmes covering:

• LGBTQIA+ cultural competence: Education on terminology, history, and respectful communication

• Clinical guidelines: Familiarity with standards of care for transgender and gender-diverse individuals10

• Legal and ethical considerations: Understanding obligations under the Equality Act 2010 and relevant regulatory body guidelines

COLLABORATION WITH LGBTQIA+ ORGANISATIONS

Partnering with organisations such as Diversity Pride can provide valuable resources and expertise. Such collaborations support the development of tailored training and foster community engagement. Alex Storer, co-founder of Diversity Pride, has been instrumental in enhancing our understanding of inclusivity and supporting the development of inclusive practices.

ADVOCACY FOR EXPANDED CPD OPPORTUNITIES

Clinics and professional bodies should advocate for the inclusion of LGBTQIA+ health topics in CPD curricula. Recent studies suggest that enhancing medical education with LGBTQIA+ content improves provider readiness to address these patients’ needs.15 By highlighting the demand and demonstrating the impact on patient care, stakeholders can influence educational institutions to prioritise these areas.

IMPLEMENTATION OF INCLUSIVE POLICIES AND PRACTICES

Establishing clear policies that affirm the clinic’s commitment to inclusivity can set expectations for staff behaviour and patient interactions. Practices may include:

• Use of inclusive language: Incorporating preferred names and pronouns in patient records

• Creating welcoming environments: Displaying symbols of support, such as rainbow flags or inclusive signage

• Feedback mechanisms: Providing avenues for patients to report experiences and suggest improvements.

Enhancing LGBTQIA+ inclusivity in aesthetic clinics is a multifaceted endeavour requiring commitment at individual, institutional, and systemic levels. By investing in comprehensive training, advocating for expanded educational resources, and implementing inclusive policies, clinics can better serve LGBTQIA+ patients. Such efforts align with ethical and legal responsibilities and contribute to the overall quality of care.

Integrating recent medical research underscores the necessity of these initiatives. Addressing current gaps will require collaboration among healthcare providers, educators, professional bodies, and LGBTQIA+ organisations. Through concerted action, the aesthetic medicine community can foster environments where all patients feel respected, understood, and empowered in their healthcare journeys.