LGBTQ+ Health Guide: Testing, Prevention and Mental Health

Many people have told me they were afraid to see a doctor: afraid of judgemental questions, of being looked at strangely, or of having to explain themselves over and over. As a result, small problems are left until they become big ones. So let me say this first: whether you are gay, lesbian, bi, trans, non-binary, or would rather not use any label at all, you have the same right to good health care as everyone else.

This article is a kind of "map" of the areas LGBTQ+ people should look after, with links to more detailed articles on each topic.

Identity can change, and it's part of getting to know yourself

Gender isn't just male or female, and it isn't one-dimensional. Sex assigned at birth, gender identity, gender expression and sexual orientation are separate axes (read more in gender identity and the axes of gender). Some people know clearly from childhood, some discover it gradually, and some feel their identity shifts across different stages of life (genderfluid). None of this is a disorder.

I have met people who used feminising hormones for a while and then one day felt, "Hmm, maybe I don't want to be a woman in that way after all." Reconsidering like this isn't a failure; it's getting to know yourself better. What matters is being able to talk with someone who understands before you decide on body changes that can't be reversed.

Regular HIV and STI testing

In Thailand, men who have sex with men (MSM) and trans women still have higher rates of HIV and syphilis than the general population. This isn't because of "being gay", but because of the shape of sexual networks and still-limited access to services.

• If you have new or multiple partners, test for HIV and syphilis at least every 3–6 months.
• Gonorrhoea and chlamydia in the throat or rectum often cause no symptoms, so PCR testing from several sites helps a lot (see the 14-pathogen PCR STI test).
• If you're nervous about visiting a clinic, an HIV self-test is a good place to start.

Prevention first: PrEP, PEP, vaccines and condoms

Today we have highly effective tools for HIV prevention.

• PrEP is medication taken before a possible exposure. Taken correctly, it greatly reduces the risk of getting HIV through sex. For some people, on-demand "2-1-1" dosing is suitable.
• PEP is emergency medication after an exposure. It must be started within 72 hours (the sooner the better) and taken for 28 days.
• The HPV vaccine protects against genital warts and several cancers, including anal cancer (see the HPV vaccine).
• Hepatitis A and B vaccines: get your immunity checked and be vaccinated if you aren't protected.
• Condoms with a water- or silicone-based lubricant are still the foundation, protecting against many infections at once.

Gender-affirming hormones: possible, but they must be done safely

For trans people and people with gender incongruence (the ICD-11 term) or gender dysphoria (the DSM-5-TR term), gender-affirming hormone therapy (GAHT) helps the body align with who they are, and there is evidence that it reduces distress.

The problems I see most often are people buying hormones and taking them on a friend's advice, using doses that are too high, or using contraceptive pills containing ethinyl estradiol, which increases the risk of blood clots. Blood tests before starting and regular monitoring make treatment far more effective and safer.

Cancer screening based on the organs you actually have

The simple rule is "screen the organs, not the title on your ID".

• Trans men who still have a cervix still need regular cervical cancer or HPV screening, even while taking testosterone.
• Trans women still have a prostate. At the appropriate age, talk to your doctor about screening, and after long-term hormone use, breast care matters too.
• MSM and trans women, especially those living with HIV, have a higher risk of anal cancer. Read more in anal cancer screening.

Mental health: stress that doesn't come from you

Research explains this with the idea of minority stress: being stigmatised, teased, having to hide yourself or fearing rejection builds up into chronic stress, raising LGBTQ+ people's risk of depression, anxiety and substance use. The problem isn't who you are; it's the environment around you.

What really helps is having accepting people around you, a space where you can speak without fear, and getting help when things start to feel too much. If you use substances with sex, read chemsex and harm reduction.

Builds up as stress

• Stigma, being teased
• Having to hide yourself
• Fear of rejection
• Risk of depression, anxiety, substance use

Protects your mind

• Accepting people around you
• Spaces where you can speak without fear
• Help when you start to struggle
• Mental-health hotline 1323, 24 hours (Thai language)

vs

The problem is not who you are; it is the environment.

When to see a doctor, and how the clinic can help

See a doctor if you:

1. Have had sexual risk and aren't sure what to test for, or had a risk within the last 72 hours.
2. Want to start, or are already using, hormones, especially if you bought them yourself.
3. Have sores, bumps, pus or bleeding from the genitals or anus.
4. Feel stressed, low or confused about your identity to the point that it affects daily life.

At Dr. Kris Clinic, I practise family medicine, which means looking at body, mind, relationships and family together. We offer HIV/STI testing, PrEP/PEP, vaccines, gender-affirming hormones and counselling on sexuality, at the clinic in Surat Thani and online across Thailand, with English-speaking consultations available. You don't have to explain yourself to anyone before you get care.

LGBTQ+ health

Regular testing

• HIV and syphilis every 3-6 months with new partners
• Multi-site PCR STI tests

Prevention

• PrEP before risk / PEP within 72 hours
• HPV, hepatitis A and B vaccines
• Condoms and lubricant

Gender-affirming hormones

• Blood tests before and during
• Avoid buying and self-medicating

Cancer screening

• Screen the organs you actually have
• Anal cancer in higher-risk groups

Mental health

• Minority stress
• Chemsex and harm reduction