Study finds LGBTQ+ adults may have greater risk of poor brain health, likely due to ‘minority stress’
September 27, 2024A recent study indicates that LGBTQ+ individuals may face a higher risk of negative brain health outcomes compared to cisgender heterosexual people—those who identify with the sex assigned to them at birth. This extensive research, consisting of over 393,000 adult participants, was published in the journal Neurology on Wednesday. It revealed a 15% higher risk of combined brain health issues, including dementia, stroke, and late-life depression, defined as a depressive episode occurring at or after the age of 60, according to ‘CNN’.
Lead study author Dr. Shufan Huo, a postdoctoral research fellow in the neurology department at Yale University School of Medicine, commented via email, “It is concerning to see the differences in brain health between sexual gender minority (SGM) individuals and cisgender straight people. At the same time, I am glad that we can raise awareness for this often overlooked group. Medicine has traditionally focused on white, male patients, but nowadays we realize that this approach does not sufficiently address the needs of our diverse population.”
The study authors noted that previous research on these groups is scarce, often involving small sample sizes, lacking detailed categories of sexuality or gender identity, and focusing predominantly on issues such as HIV, hormone use, substance use disorder, and mental health.
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Dr. Riccardo Manca, a research fellow in the life sciences department at Brunel University London, who wasn't involved in the study, stated, “The latest study is important because it is the first one of this kind to collect detailed information on sexual orientation and gender identity. Such a degree of diversity in the sample makes it more representative of the LGBTQ+ population.”
Dr. Huo mentioned that the findings could pave the way for future research exploring the increased risk of adverse outcomes in LGBTQ+ subgroups, to identify specific challenges each group faces.
To bridge the knowledge gap, the researchers analysed participants from the All of Us Research Program in the United States between May 2017 and June 2022. Participants reported whether they identified as a sexual minority—such as lesbian, gay, bisexual, having diverse or non-straight sexual orientations—and/or as a gender minority, such as gender diverse, transgender, or having a gender identity differing from the sex assigned at birth.
The authors focused specifically on brain health outcomes like dementia, stroke, and late-life depression, as these conditions are significant neurological, psychiatric, and cognitive disorders that share common risk factors and are interrelated.
Among the 393,041 adults with an average age of 51, roughly 10% were part of sexual or gender minority groups. In this subset, 97% identified as a sexual minority, 11% as a gender minority, with overlap between these groups.
Dr. Huo highlighted the “remarkable findings” regarding differences among subgroups: “People assigned male at birth (AMAB) had higher rates of late-life depression (compared to the cisgender population), whereas sexual minority people assigned female at birth (AFAB) and gender diverse people had higher rates of dementia. Transgender women had higher rates of stroke. These findings show that each group has distinct risk profiles, for example because of differences in societal stigma.”
Dr. Amir Ahuja, director of psychiatry at the Los Angeles LGBT Center, who was not part of the study, praised its use of a large database to highlight population-level disparities, but cautioned, “correlation does not equal causation, and we do not know why these disparities exist. What this does do is let us focus on this issue in particular, and message to transgender women so that we can get them into preventive care and reduce their risk factors in advance.”
Dr. Huo noted a “major limitation” in the study due to the absence of data on key aspects like gender-affirming hormone therapy, acknowledging that not all transgender individuals opt for this treatment.
Dr. Manca pointed out the participants’ relatively young average age compared to the typical onset age for dementia risk, which is 65. He added, “Interestingly, a recent epidemiological study from the UK has shown that dementia risk among non-heterosexual people was higher only in those younger than 55 years of age. This means that decline in brain functions in the LGBTQ+ community, or at least in some sub-groups within it, may occur earlier than expected in the heterosexual population. However, the reasons behind this effect remain elusive.”
Experts caution that there is no direct evidence that being a sexual or gender minority causes poorer brain health. Dr. Huo suggested that the increased risks likely arise from a mix of psychosocial and biological factors. Chronic stress, discrimination, and stigma can lead to mental health issues such as depression and anxiety, which can further deteriorate brain health.
While the researchers attempted to account for substance use and economic disparities, they could not fully control for them. Many identifying as sexual or gender minorities face lower income levels and housing insecurity, which can negatively affect health outcomes, according to Dr. Ahuja.
Experts also highlighted that structural inequities in healthcare access are likely contributory.
Dr. Ahuja emphasized the healthcare system’s role, stating, “Numerous studies, including the (US Trans Survey), consistently show that SGM populations are not always taken seriously by health care providers, and outright discrimination is common. This leads to patients not following up and tests not being done, and problems not being investigated, which can also lead to worse outcomes.”
Experts recommend that maintaining healthy habits, such as staying active, quitting smoking, working with informed health providers, and managing stress and cardiovascular risk factors, can help preserve brain health. Building positive and meaningful relationships, crucial for LGBTQ+ individuals who often rely on chosen families, is also beneficial, Dr. Manca said.
Nonetheless, experts stress that addressing broader issues such as inclusive healthcare and reducing discrimination is vital for long-term health improvements, ensuring individuals are not left to navigate these challenges alone.
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