Ewha Med J.  2024 Apr;47(2):e14. 10.12771/emj.2024.e14.

Health of Korean sexual and gender minorities: a narrative review of quantitative studies

Affiliations
  • 1Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
  • 2Korean Initiative for Transgender Health, Seoul, Korea
  • 3Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
  • 4Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea

Abstract

This study reviewed quantitative research on the health of sexual and gender minorities (SGMs) in Korea and aimed to propose a role for healthcare professionals in improving their health and access to medical care. We searched PubMed through February 29, 2024 for articles published since 2000, using terms related to SGMs and the keyword “Korea.” This process yielded 33 quantitative studies on Korean SGMs. Of these, 17 focused on sexual minorities and 16 on gender minorities. The findings indicate that Korean SGMs experience many symptoms of depression and anxiety, as well as high rates of suicidal ideation, planning, and attempts. They also report diminished health-related quality of life. SGM individuals who have faced discrimination or pressure to change their sexual or gender identity face an elevated risk of mental health issues. To improve the health of Korean SGMs and improve their access to healthcare, we recommend several approaches. First, more research on the health of Korean SGMs is necessary. Second, education and training programs for health professionals are essential to promote their understanding of SGM health issues and their advocacy for SGM health. Third, strategies are required to develop and implement program interventions that improve SGM health, such as increasing the availability of gender-affirming care, which is known to benefit the health of transgender and gender-diverse individuals. Finally, healthcare professionals should actively advocate for SGM health and call for shifts in public perception and institutional change, grounded in a broad understanding of SGMs and their health needs.

Keyword

Sexual and gender minorities; Homosexuality; Transgender persons; Gender-affirming care; Health inequities

Reference

References

1. Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health. 2008; 98(6):989–995. DOI: 10.2105/AJPH.2007.127811. PMID: 18445789. PMCID: PMC2377288.
2. American Psychological Association. Understanding sexual orientation and homosexuality [Internet]. Washington (DC): American Psychological Association;c2008. [cited 2024 Jan 24]. Available from: https://www.apa.org/topics/lgbtq/orientation.
3. American Psychological Association. Understanding transgender people, gender identity and gender expression [Internet]. Washington (DC): American Psychological Association;c2023. [cited 2024 Jan 24]. Available from: https://www.apa.org/topics/lgbtq/transgender-people-gender-identity-gender-expression.
4. Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022; 23(sup1):S1–S259. DOI: 10.1080/26895269.2022.2100644. PMID: 36238954. PMCID: PMC9553112.
5. American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol. 2015; 70(9):832–864. DOI: 10.1037/a0039906. PMID: 26653312.
6. Conron KJ, Goldberg SK. Adult LGBT population in the United States. Los Angeles: The Williams Institute;2019.
7. Government of Netherlands. LGBTI equality in the Netherlands. The Hague: Government of Netherlands;2018.
8. Jones JM. LGBTQ+ identification in U.S. now at 7.6% [Internet]. Washington (DC): GALLUP®;c2024. [cited 2024 Jan 24]. Available from: https://news.gallup.com/poll/611864/lgbtq-identification.aspx.
9. APA Commission on Psychotherapy by Psychiatrists. Position statement on therapies focused on attempts to change sexual orientation (reparative or conversion therapies). Am J Psychiatry. 2000. 157(10):p. 1719–1721.
10. Zeeman L, Sherriff N, Browne K, McGlynn N, Mirandola M, Gios L, et al. A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. Eur J Public Health. 2019; 29(5):974–980. DOI: 10.1093/eurpub/cky226. PMID: 30380045. PMCID: PMC6761838.
11. Yi H, Lee H, Park J, Choi B, Kim SS. Health disparities between lesbian, gay, and bisexual adults and the general population in South Korea: Rainbow Connection Project I. Epidemiol Health. 2017; 39:e2017046. DOI: 10.4178/epih.e2017046. PMID: 29056030. PMCID: PMC5790982.
12. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: a review. Lancet. 2016; 388(10042):412–436. DOI: 10.1016/S0140-6736(16)00684-X. PMID: 27323919.
13. Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet. 2016; 388(10042):390–400. DOI: 10.1016/S0140-6736(16)00683-8. PMID: 27323925.
14. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995; 36(1):38–56. DOI: 10.2307/2137286. PMID: 7738327.
15. Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pract. 2012; 43(5):460–467. DOI: 10.1037/a0029597.
16. Hatzenbuehler ML, Lattanner MR, McKetta S, Pachankis JE. Structural stigma and LGBTQ+ health: a narrative review of quantitative studies. Lancet Public Health. 2024; 9(2):E109–E127. DOI: 10.1016/S2468-2667(23)00312-2. PMID: 38307678.
17. White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health. 2016; 1(1):21–31. DOI: 10.1089/trgh.2015.0008. PMID: 27595141. PMCID: PMC5010234.
18. Mahfouda S, Moore JK, Siafarikas A, Hewitt T, Ganti U, Lin A, et al. Gender-affirming hormones and surgery in transgender children and adolescents. Lancet Diabetes Endocrinol. 2019; 7(6):484–498. DOI: 10.1016/S2213-8587(18)30305-X. PMID: 30528161.
19. Lee HL, Lee HM, Yoon JW, Park JY, Kim SS. Transgender people’s access to health care in Korea. Health Soc Welf Rev. 2015; 35(4):64–94. DOI: 10.15709/hswr.2015.35.4.64.
20. Padula WV, Baker K. Coverage for gender-affirming care: making health insurance work for transgender Americans. LGBT Health. 2017; 4(4):244–247. DOI: 10.1089/lgbt.2016.0099. PMID: 28708447.
21. Park H. A study on National Health Insurance coverage of transition-related care for transgender people. Pub Int Hum Rights. 2018; 18:191–235.
22. Lee HM, Park JY, Kim SS. LGBTQI health research in South Korea: a systematic review. Health Soc Sci. 2014; (36):43–79.
23. Park H. Legislative suggestion on the legal gender recognition for transgender people. Human Rights Justice. 2021; (498):41–60.
24. Lee DY, Kim SH, Woo SY, Yoon BK, Choi DS. Associations of health-risk behaviors and health cognition with sexual orientation among adolescents in school: analysis of pooled data from Korean nationwide survey from 2008 to 2012. Medicine. 2016; 95(21):e3746. DOI: 10.1097/MD.0000000000003746. PMID: 27227939. PMCID: PMC4902363.
25. Kwak Y, Kim JS. Associations between Korean adolescents’ sexual orientation and suicidal ideation, plans, attempts, and medically serious attempts. Iran J Public Health. 2017; 46(4):475–484.
26. Yu KY, Kim Y, Calzo JP, Levinson JA, Bryn Austin S. Sex of sexual partners and disordered weight control behaviors in a nationally representative sample of South Korean adolescents. Psychiatry Res. 2018; 262:1–5. DOI: 10.1016/j.psychres.2018.01.028. PMID: 29407562.
27. Kim JS, Seo Y. Victimization as a mediator in the relationship between sexual orientation and adolescent alcohol use. Arch Psychiatr Nurs. 2020; 34(1):27–34. DOI: 10.1016/j.apnu.2019.12.005. PMID: 32035586.
28. Cho B, Sohn A. How do sexual identity, and coming out affect stress, depression, and suicidal ideation and attempts among men who have sex with men in South Korea? Osong Public Health Res Perspect. 2016; 7(5):281–288. DOI: 10.1016/j.phrp.2016.09.001. PMID: 27812485. PMCID: PMC5079205.
29. Lee H, Operario D, Yi H, Choo S, Kim SS. Internalized homophobia, depressive symptoms, and suicidal ideation among lesbian, gay, and bisexual adults in South Korea: an age-stratified analysis. LGBT Health. 2019; 6(8):393–399. DOI: 10.1089/lgbt.2019.0108. PMID: 31746660.
30. Lee H, Park J, Choi B, Yi H, Kim SS. Association between discrimination and depressive symptoms among 2,162 lesbian, gay, and bisexual adults in South Korea: does community connectedness modify the association? J Homosex. 2019; 68:70–87. DOI: 10.1080/00918369.2019.1624456. PMID: 31194923.
31. Park J, Lee H, Choi B, Kim JH, Yoon J, Yi H, et al. Adolescent bullying victimization at secondary school and adult suicidality and depressive symptoms among 2152 lesbian, gay, and bisexual adults in South Korea. Asia Pacific J Public Health. 2022; 34(4):338–345. DOI: 10.1177/10105395211073283. PMID: 35073785.
32. Lee H, Streed CG, Yi H, Choo S, Kim SS. Sexual orientation change efforts, depressive symptoms, and suicidality among lesbian, gay, and bisexual adults: a cross-sectional study in South Korea. LGBT Health. 2021; 8(6):427–432. DOI: 10.1089/lgbt.2020.0501. PMID: 34061676.
33. Choo S, Lee H, Yi H, Kim SS. Expectation of rejection and its association with health care avoidance and delay among 2175 Korean lesbian, gay, and bisexual adults: a nationwide cross-sectional survey. LGBT Health. 2022; 9(4):282–286. DOI: 10.1089/lgbt.2021.0269. PMID: 35275735.
34. Choo S, Kim R, Lee H, Yi H, Kim R, Kim SS. Association between discrimination and poor sleep health outcomes among 2192 South Korean gay, lesbian, and bisexual adults: a nationwide cross-sectional survey. Sleep Health. 2022; 8(6):587–592. DOI: 10.1016/j.sleh.2022.09.006. PMID: 36220734.
35. Kim S, Choi-Kwon S. Physical and mental health related quality of life and their influencing factors on sexual minority women in Korea. Int J Environ Res Public Health. 2021; 18(4):2115. DOI: 10.3390/ijerph18042115. PMID: 33671565. PMCID: PMC7926774.
36. Kim S, Lee SY, Choi-Kwon S. Cervical cancer screening and human papillomavirus vaccination among Korean sexual minority women by sex of their sexual partners. Int J Environ Res Public Health. 2020; 17(23):8924. DOI: 10.3390/ijerph17238924. PMID: 33266281. PMCID: PMC7731128.
37. Jung M. Behavioral predictors associated with COVID-19 vaccination and infection among men who have sex with men in Korea. J Prev Med Public Health. 2024; 57(1):28–36. DOI: 10.3961/jpmph.23.381. PMID: 38062718. PMCID: PMC10861333.
38. Jung M. Physical distancing for gay men from people living with HIV during the COVID-19 pandemic. J Homosex. 2024; Feb 6. [Epub]. DOI: 10.1080/00918369.2024.2314031. PMID: 38319682.
39. Kim TS, Cheon YH, Pae CU, Kim JJ, Lee CU, Lee SJ, et al. Psychological burdens are associated with young male transsexuals in Korea. Psychiatry Clin Neurosci. 2006; 60(4):417–421. DOI: 10.1111/j.1440-1819.2006.01525.x. PMID: 16884441.
40. Lee H, Operario D, van den Berg JJ, Yi H, Choo S, Kim SS. Health disparities among transgender adults in South Korea. Asia Pacific J Public Health. 2020; 32(2-3):103–110. DOI: 10.1177/1010539520912594. PMID: 32238067.
41. Lim HH, Jang YH, Choi GY, Lee JJ, Lee ES. Gender affirmative care of transgender people: a single center's experience in Korea. Obstet Gynecol Sci. 2019; 62(1):46–55. DOI: 10.5468/ogs.2019.62.1.46. PMID: 30671393. PMCID: PMC6333764.
42. Kim R, Choo S, Lee H, Eom YJ, Yi H, Kim R, et al. Does discrimination prevent transgender and gender diverse people from seeking healthcare?: a nationwide cohort study in South Korea. Int J Transgend Health. 2023; 25(2):283–294. DOI: 10.1080/26895269.2023.2215750. PMID: 38681498.
43. Lee H, Operario D, Yi H, Choo S, Kim JH, Kim SS. Does discrimination affect whether transgender people avoid or delay healthcare?: a nationwide cross-sectional survey in South Korea. J Immigr Minor Health. 2022; 24(1):170–177. DOI: 10.1007/s10903-021-01193-9. PMID: 33881679.
44. Lee H, Tomita KK, Habarth JM, Operario D, Yi H, Choo S, et al. Internalized transphobia and mental health among transgender adults: a nationwide cross-sectional survey in South Korea. Int J Transgend Health. 2020; 21(2):182–193. DOI: 10.1080/26895269.2020.1745113. PMID: 33015668. PMCID: PMC7430457.
45. Lee H, Operario D, Restar AJ, Choo S, Kim R, Eom YJ, et al. Gender identity change efforts are associated with depression, panic disorder, and suicide attempts in South Korean transgender adults. Transgend Health. 2023; 8(3):273–281. DOI: 10.1089/trgh.2021.0171. PMID: 37342483.
46. Lee H, Yi H, Nic Rider G, Operario D, Choo S, Kim R, et al. Transgender adults' public bathroom-related stressors and their association with depressive symptoms: a nationwide cross-sectional study in South Korea. LGBT Health. 2021; 8(7):486–493. DOI: 10.1089/lgbt.2021.0007. PMID: 34242110.
47. Choo S, Kim R, Lee H, Eom YJ, Yi H, Kim R, et al. Associations between discrimination experiences and symptoms of depression and anxiety among transgender adults: a nationwide cohort study of 269 transgender adults in South Korea. Soc Psychiatry Psychiatr Epidemiol. 2023; Aug 26. [Epub]. DOI: 10.1007/s00127-023-02554-5. PMID: 37632566.
48. Eom YJ, Lee H, Choo S, Kim R, Yi H, Kim R, et al. Situational avoidance and its association with mental health among transgender adults in South Korea: a nationwide cohort study. LGBT Health. 2024; 11(2):122–130. DOI: 10.1089/lgbt.2023.0060. PMID: 37831924.
49. Eom YJ, Lee H, Kim R, Choo S, Yi H, Kim SS. Discrimination keeps transgender people awake at night: a nationwide cross-sectional survey of 583 transgender adults in South Korea. Sleep Health. 2022; 8(6):580–586. DOI: 10.1016/j.sleh.2022.06.012. PMID: 36050274.
50. Lee H, Park J, Choi B, Yi H, Kim SS. Experiences of and barriers to transition-related healthcare among Korean transgender adults: focus on gender identity disorder diagnosis, hormone therapy, and sex reassignment surgery. Epidemiol Health. 2018; 40:e2018005. DOI: 10.4178/epih.e2018005. PMID: 29514430. PMCID: PMC6060334.
51. Oh JW, Park S, Lim S, Lee ES. Age of first experience of gender incongruence among transgender and non-binary individuals. Obstet Gynecol Sci. 2024; 67(1):132–141. DOI: 10.5468/ogs.23229. PMID: 38044615. PMCID: PMC10792301.
52. Yun Y, Kim D, Lee ES. Effect of cross-sex hormones on body composition, bone mineral density, and muscle strength in trans women. J Bone Metab. 2021; 28(1):59–66. DOI: 10.11005/jbm.2021.28.1.59. PMID: 33730784. PMCID: PMC7973405.
53. Kim DJ, Hwang NH, Lee JY, Park SH, Lee BI, Yoon ES. An analysis of the demographics and clinical characteristics of transgender and intersex populations in Korea: a retrospective study using HIRA database. J Korean Med Sci. 2023; 38(50):e385. DOI: 10.3346/jkms.2023.38.e385. PMID: 38147835. PMCID: PMC10752747.
54. Crowley F, Mihalopoulos M, Gaglani S, Tewari AK, Tsao CK, Djordjevic M, et al. Prostate cancer in transgender women: considerations for screening, diagnosis and management. Br J Cancer. 2023; 128(2):177–189. DOI: 10.1038/s41416-022-01989-y. PMID: 36261584. PMCID: PMC9902518.
55. Shadid S, Abosi-Appeadu K, De Maertelaere AS, Defreyne J, Veldeman L, Holst JJ, et al. Effects of gender-affirming hormone therapy on insulin sensitivity and incretin responses in transgender people. Diabetes Care. 2020; 43(2):411–417. DOI: 10.2337/dc19-1061. PMID: 31740479.
56. Brown JP, Kathleen Tracy J. Lesbians and cancer: an overlooked health disparity. Cancer Causes Control. 2008; 19(10):1009–1020. DOI: 10.1007/s10552-008-9176-z. PMID: 18551371.
57. National Institutes of Health. Strategic plan to advance research on the health and well-being of sexual and gender minorities. Bethesda: The National Institutes of Health;2016.
58. Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry. 2016; 16:1–9. DOI: 10.1186/s12888-016-0767-z. PMID: 27009565. PMCID: PMC4806482.
59. Ward BW, Dahlhamer JM, Galinsky AM, Joestl SS. Sexual orientation and health among US adults: National Health Interview Survey, 2013. Washington: United States Department of Health and Human Services;2014.
60. Daniel H, Butkus R. Lesbian, gay, bisexual, and transgender health disparities: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2015; 163(2):135–137. DOI: 10.7326/M14-2482. PMID: 25961598.
61. Gibson AW, Gobillot TA, Wang K, Conley E, Coard W, Matsumoto K, et al. A novel curriculum for medical student training in LGBTQ healthcare: a regional pathway experience. J Med Educ Curric Dev. 2020; 7:2382120520965254. DOI: 10.1177/2382120520965254. PMID: 33195802. PMCID: PMC7594215.
62. AMA Foundation. The AMA foundation national LGBTQ+ fellowship program [Internet]. Chicago (IL): AMA Foundation;c2024. [cited 2024 Jan 24]. Available from: https://amafoundation.org/programs/lgbtq-fellowship/.
63. Wight RG, LeBlanc AJ, Lee Badgett MV. Same-sex legal marriage and psychological well-being: findings from the California Health Interview Survey. Am J Public Health. 2013; 103(2):339–346. DOI: 10.2105/AJPH.2012.301113. PMID: 23237155. PMCID: PMC3558785.
64. Sattler FA, Wagner U, Christiansen H. Effects of minority stress, group-level coping, and social support on mental health of German gay men. PLOS ONE. 2016; 11(3):e0150562. DOI: 10.1371/journal.pone.0150562. PMID: 26943785. PMCID: PMC4778907.
65. American Psychiatric Association. APA expresses great disappointment in the Supreme Court Decision to lift the injunctions on the administration’s ban on transgender service members [Internet]. Washington (DC): American Psychiatric Association;c2019. [cited 2024 Jan 23]. Available from: https://www.psychiatry.org/news-room/news-releases/apa-expresses-great-disappointment-in-the-supreme.
66. GLMA: Health Professionals Advancing LGBTQ Equality. GLMA's policies and position statements [Internet]. Washington (DC): GLMA;c2024. [cited 2024 Jan 23]. Available from: https://www.memberleap.com/news_archive_headlines.php?org_id=GLMA&snc=969947#969947.
67. Poushter J, Kent NO. The global divide on homosexuality persists: but increasing acceptance in many countries over past two decades [Internet]. Washington (DC): Pew Research Center;c2020. [cited 2024 Jan 23]. Available from: https://www.pewresearch.org/global/wp-content/uploads/sites/2/2020/06/PG_2020.06.25_Global-Views-Homosexuality_FINAL.pdf.
68. Korea Institute of Public Administration. 2023 Korea social integration survey [Internet]. Seoul (KR): Korea Institute of Public Administration;c2024. [cited 2024 Jan 24]. Available from: https://www.kipa.re.kr/synap/skin/doc.html?fn=FILE_0000000000196070&rs=/convert/result/201512/.
69. Centers for Disease Control and Prevention. Terminology [Internet]. Atlanta (GA): Centers for Disease Control and Prevention;c2022. [cited 2024 Jan 12]. Available from: https://www.cdc.gov/healthyyouth/terminology/sexual-and-gender-identity-terms.htm.
70. Lee H, Operario D, Agénor M, Yi H, Choo S, Kim SS. Internalized homophobia and HIV testing among Korean gay and bisexual men: a study in a high-income country with pervasive HIV/AIDS stigma. AIDS Care. 2023; 35(5):672–677. DOI: 10.1080/09540121.2022.2083056. PMID: 35642248.
71. Lee H, Restar AJ, Operario D, Choo S, Streed CG Jr, Yi H, et al. Transgender-specific COVID-19-related stressors and their association with depressive symptoms among transgender adults: a nationwide cross-sectional survey in South Korea. Int J Transgend Health. 2023; 24(3):334–345. DOI: 10.1080/26895269.2021.1989357. PMID: 37519917. PMCID: PMC10373603.
Full Text Links
  • EMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr