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
*Corresponding author: Sun Young Lee,
Public Healthcare Center, Seoul National University Hospital, 101, Daehak-ro,
Jongno-gu, Seoul 03080, Korea, E-mail: sy2376@snu.ac.kr
• Received: February 29, 2024 • Revised: April 22, 2024 • Accepted: April 23, 2024
This is an Open-Access article distributed under the terms of the
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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.
Definition and prevalence of sexual and gender minorities
Sexual and gender minorities (SGMs) are individuals or groups whose sexual
orientation or gender identity diverges from that of the societal majority.
Common international terms for SGMs include LGBT, LGBTQ, and LGBTQIA+, which
encompass lesbian, gay, bisexual, transgender, questioning, intersex,
asexual, and other diverse identities (as indicated by the +symbol) [1]. The American Psychiatric Association
(APA) defines sexual orientation refers to an enduring pattern of emotional,
romantic, and/or sexual attractions to men, women, or both sexes [2]. Heterosexual individuals are
attracted to the opposite gender, homosexual people to the same gender, and
bisexual individuals to both genders. The term “lesbian”
describes women who are romantically or sexually attracted to other women,
while “gay” typically refers to men attracted to other men.
Pansexual individuals perceive attraction regardless of gender, and asexual
people experience little or no sexual attraction or interest in sexual
behavior [2]. Additionally, in the
medical context, the term “men who have sex with men” (MSM)
describes men who engage in sexual activities with other men. Gender
identity refers to a person’s internal sense of being male, female or
something else [3]. Transgender and
gender diverse (TGD) individuals are broadly defined as those whose gender
identity does not align with their sex assigned at birth, which can result
in gender dysphoria [4]. This group
includes transmen, who identify as men; transwomen, who identify as women;
and nonbinary transgender individuals, whose identities do not conform to
the male/female binary [4,5]. Intersex individual is person with
variations in physical sex characteristics, including anatomy, hormones,
chromosomes, or other traits, that differ from expectations generally
associated with male or female body (Table
1).
Table 1.
Definitions of sexual and gender minorities
Term
Definition
Lesbian
A woman who experiences emotional,
romantic, or sexual attraction to women
Gay
A man who experiences emotional,
romantic, or sexual attraction to men
Bisexual
A person who is attracted to both
people of their own and other genders
Asexual
A person who does not experience
sexual attraction toward individuals of any gender
Transgender
An individual whose current gender
identity differs from the sex assigned at birth
Nonbinary
An individual who does not
identify as male or female regarding gender
Questioning
For some, the process of exploring
and discovering one’s own sexual orientation, gender
identity, or gender expression
Intersex
A person with variations in
physical sex characteristics, including anatomy, hormones,
chromosomes, or other traits, that differ from expectations
generally associated with male or female bodies
Data from Centers for Disease Control and Prevention [69].
Studies conducted outside of Korea estimate that SGMs comprise 4%–5%
of the total population [6,7]. In the United States, an annual
survey of adults aged 18 years and older found that 7.6% self-identified as
SGM in 2023, an increase from 3.5% in 2012 and 5.6% in 2020 [8]. The proportion was notably higher
among younger generations, with 22.3% of Generation Z (born
1997–2012) and 9.8% of millennials (born 1981–1996)
identifying as SGMs. This contrasts with 4.5% of Generation X (born
1965–1980) and 2.3% of Baby Boomers (born 1946–1964). The
generational difference may reflect a greater visibility and openness about
their identities among younger people. Unlike countries that estimate the
sizes of their SGM populations through national statistics and
questionnaires, Korea lacks such data, as questions about sexual orientation
and gender identity are not collected in national surveys. Applying
international estimates to Korea’s population of 50 million suggests
a population of approximately 2–2.5 million SGM individuals.
Sexual and gender minorities and health
In the past, the understanding of SGMs was limited, and these identities were
classified as mental disorders. However, with advances in scientific and
social understanding, diagnostic classifications evolved, and SGM identities
were depathologized. Regarding sexual orientation, homosexuality was listed
in the APA’s Diagnostic and Statistical Manual of Mental Disorders
(DSM)-I in 1952. It was removed from the DSM-II as a mental disorder in
1973, following social movements such as the Stonewall riots in 1969 as well
as a growing understanding of SGMs. In its place, the category
“sexual orientation disturbance” was introduced. By the
publication of the DSM-V in 2013, homosexuality was totally deleted, with
the recognition that variations in sexual orientation are not indicative of
a disorder [9]. In 1998, the APA
officially stated that attempts to change an individual’s sexual
orientation, commonly referred to as conversion therapy, are contraindicated
as they can worsen mental health [9].
In the context of gender identity, “transsexualism” was first
included in the DSM-III in 1980. In the 2013 release of the DSM-V, this term
was replaced with the diagnosis of gender dysphoria, with the manual
clarifying that gender identity is not a disorder. Gender dysphoria is now
used to justify the need for gender-affirming care (GAC) rather than to
label gender identity as a disorder [4].
While SGM identities are no longer classified as mental disorders, these
groups continue to face health disparities in various areas. Gay, lesbian,
and bisexual individuals often experience comparatively poor mental health
outcomes, such as higher rates of depression, anxiety, and suicidal
ideation, as well as an increased prevalence of chronic conditions like
insomnia [10,11]. TGD individuals also experience elevated levels of
depression, anxiety, suicidal ideation, and suicide attempts, along with
higher mortality rates [12,13]. The minority stress model, which
posits that stress stemming from a minority identity and status imposes
additional burdens on top of general stressors, is commonly employed to
explain the poor mental health observed among SGM populations [14,15]. A 2024 review published in The Lancet
indicated that structural stigma—including societal conditions,
cultural norms, and institutional policies—intensifies health
disparities for SGM individuals [16].
Another critical issue for SGM health is GAC for TGD individuals. GAC
includes medical interventions that enable TGD people to live in a manner
consistent with their gender identity, thereby alleviating gender dysphoria
[4]. This care may involve
gender-affirming hormone therapy (GAHT) and gender-affirming surgery. As
part of this process, many TGD individuals are diagnosed with gender
identity disorder (GID, ICD-10 code F64) [4]. Although not all TGD individuals seek medical intervention,
many require varying levels of GAC to relieve their gender dysphoria.
Previous research has shown that GAC can enhance physical and mental health
by reducing gender dysphoria, improving overall quality of life, and
decreasing suicidal ideation among TGD people [17,18].
Consequently, many countries, including the United States and Germany, have
implemented policies to expand access to GAC through public insurance
coverage [19–21].
Health of sexual and gender minorities in Korea
Scientifically, little is known about the health of SGMs in Korea. Despite
the depathologization of SGM identities, their presence has remained largely
invisible within academic research for many years. Apart from acknowledging
MSM as a high-risk group for HIV/acquired immunodeficiency syndrome (AIDS),
research on SGM health in Korea has been limited. A systematic review of
Korean SGM health, conducted in 2014, analyzed 128 papers published up to
that year. This review identified 101 clinical studies and 27 social health
studies [22]. Among the clinical
investigations, 50 case reports pertained to intersex conditions, while 21
studies focused on surgical interventions for intersex and transgender
individuals. Of the social health studies, 13 examined mental health. The
review highlighted a notable shortfall in research on SGM health in Korea
compared to other countries and pointed out the lack of studies on
healthcare accessibility, a crucial social determinant of health [22].
As of 2024, TGD individuals in Korea are required to undergo GAC not only to
alleviate gender dysphoria but also to obtain legal gender recognition
[23]. Per the Supreme
Court’s Family Relations Registration Guidelines No. 550, titled
“Guidelines for Processing Applications for Legal Gender Recognition
of Transgender Individuals,” applicants are typically required to
present a diagnosis of GID and evidence of their inability to reproduce
[23]. Furthermore, TGD
individuals assigned male at birth must receive GAC, including a GID
diagnosis, to qualify for exemption from mandatory military service as
stipulated by Korea’s Military Service Act. In some instances, TGD
individuals may undergo GAC solely for the purposes of legal gender
recognition or military exemption, rather than out of personal necessity.
Despite these mandates, GAC in Korea is not covered by the National Health
Insurance (NHI) service, and very few healthcare facilities offer these
services. Research is scarce regarding the current availability and impact
of GAC for TGD individuals in Korea.
Objectives
This study aims to review existing research on the health of Korean SGMs and to
propose strategies for healthcare professionals to improve their health outcomes
and access to medical care.
Methods
Ethics statement
As this is a literature review study, it does not require approval from an
institutional review board or individual consent.
Study design
The present study is a narrative review of peer-reviewed quantitative studies
obtained through a web-based database search.
Literature search
We reviewed quantitative studies on SGM health that were published in
peer-reviewed international journals after 2000s, the year marked the
depathologization of SGM identities and their increased visibility within Korean
society.
Inclusion and exclusion criteria
As a 2014 systematic review focused on theses and Korean domestic journals [22], our study was limited to quantitative
research published in peer-reviewed international journals. We excluded PhD
theses, review papers, qualitative studies, validation studies for assessment
tools, and studies of surgical techniques. Additionally, research that
considered SGMs within the context of HIV/AIDS risk groups was not included in
our analysis.
Information source and search strategy
The following search terms were used in PubMed, combining terms related to SGMs
with “Korea” [16]:
(Korea) AND {(bisexual [tiab]) OR (bisexuality [MESH terms]) OR (gay [tiab]) OR
(homosexuality, female [MESH terms]) OR (homosexuality, male [MESH terms]) OR
(lesbian [tiab]) OR (LGB [tiab]) OR (LGBT [tiab]) OR (sexual and gender
minorities [MESH terms]) OR (sexual behavior [MESH terms]) OR (sexual
orientation [tiab]) OR (sexuality [MESH terms]) OR (transgender persons [MESH
terms])}
As of February 29, 2024, the titles and abstracts of all identified papers were
reviewed. Additional studies by the same authors and cited references were also
examined. This led to the analysis of 33 studies that focused on Korean SGMs and
included health-related variables as independent or outcome measures.
Results
The selected papers were analyzed, which involved categorizing them based on their
focus on either sexual minority or gender minority health. Key aspects such as the
publication year, study methods, and topics were examined, and the critical findings
from each paper were reviewed.
Studies of the health of sexual minorities
Within the category of sexual minority health, a total of 17 studies were
identified (Table 2). Seven studies (41%)
utilized data from online surveys conducted in 2016 among gay, lesbian, and
bisexual individuals. Four articles (24%) employed data from the Youth Risk
Behavior Survey, which included questions regarding the sex of sexual partners.
Two studies used data from online surveys of lesbian and bisexual women
conducted in 2017, and two studies used data from online surveys of gay and
bisexual men (that is, MSM) conducted in 2022.
Table 2.
List of 17 articles on the health of sexual minorities
No
Year
Authors
Primary exposure or measure
Outcome assessment
Method
Sample characteristics
Main result and significant effect
association indicating adverse health effects
MSM, men who have sex with men; LGB, lesbian, gay, and bisexual; LB,
lesbian and bisexual; HRQoL, health-related quality of life;
SF-36v2, 36-item Short Form Health Survey version 2.0; GB, gay and
bisexual; HIV, human immunodeficiency virus; SOGE, sexual
orientation and gender identity; COVID-19, coronavirus disease-19;
PLWH, people living with HIV.
The topic most frequently addressed was mental health, with six studies (35%)
investigating depression, anxiety symptoms, and suicidal ideation, plans, and
attempts among sexual minorities. Four studies (24%) examined health-related
behaviors, including alcohol consumption and smoking. Additionally, two studies
explored health-related quality of life. One study each investigated disordered
eating behaviors, cervical cancer screening and HPV vaccination, HIV testing,
avoidance or delay in seeking healthcare, sleep health, coronavirus disease
(COVID-19) vaccination, and physical distancing from people living with HIV
(PLWH).
The research findings indicated that homosexual adolescents, compared to their
heterosexual counterparts, faced a higher risk of engaging in health-risk
behaviors such as alcohol consumption and smoking. They also experienced higher
rates of suicidal ideation, plans, and attempts [24,25]. Bisexual adolescents
were more likely than homosexual adolescents to engage in disordered weight
control behaviors and exhibited higher frequencies of alcohol consumption [26,27]. Among adults, gay, lesbians, and bisexuals reported poorer
self-rated health, more musculoskeletal pain, higher levels of depression, and
elevated risks of suicidal ideation and attempts compared to the general
population [11,28]. Studies that focused exclusively on gays, lesbians,
and bisexuals revealed that those with higher levels of internalized homophobia,
experiences of discrimination due to sexual orientation, or experiences of
bullying related to sexual orientation during adolescence were more likely to
report depression [29–31]. Higher levels of internalized
homophobia, experiences of sexual orientation change efforts, and experiences of
bullying related to sexual orientation during adolescence were also associated
with higher rates of suicidal ideation and attempts [29,31,32]. Individuals who perceived a risk of
rejection because of their sexual orientation were more likely to avoid or delay
seeking healthcare, and those who experienced discrimination based on sexual
orientation reported poorer sleep health [33,34].
Studies focusing on lesbian and bisexual women have shown that although their
physical health-related quality of life is comparable to that of the general
population, their mental health-related quality of life is lower [35]. Furthermore, rates of cervical cancer
screening and HPV vaccination differ based on the sex of sexual partners, with
lesbian and bisexual women who have sex exclusively with female partners tending
to receive fewer screenings and vaccinations [36].
Research involving gay and bisexual men has shown that PLWH experienced higher
rates of COVID-19 infection. Additionally, individuals who had PLWH as friends
or acquaintances were less likely to maintain physical distancing from them,
compared to those who did not had PLWH as friends or acquaintances [37,38].
Studies of the health of gender minorities
Regarding the health of gender minorities, a total of 16 studies were identified
(Table 3). The earliest study,
published in 2006, utilized survey data from the Military Manpower
Administration. Seven studies (44%) used data from online surveys of TGD
individuals conducted in 2017, while four studies (25%) used data from online
surveys of this population conducted in 2020, with 1 year of follow-up. Three
studies utilized hospital medical records, and one study used administrative
data from the Health Insurance Review and Assessment Service. The majority of
the studies (12 of 16, or 75%) were based on surveys of TGD individuals.
Table 3.
List of 16 articles on the health of gender minorities
No
Year
Authors
Primary exposure or measure
Outcome assessment
Sample design
Sample characteristics
Significant main effect association
indicating adverse health effects of LGB
Barrier: cost, negative experiences in
healthcare settings, lack of specialized healthcare
professionals and facilities, and social stigma against
TGD.
30% TGD-specific COVID-19 related
stressor experience and more depressive symptoms. Barrier to
gender affirming care: economic hardship, limited access to
hospital.
53.7% experienced anti-transgender
discrimination at initial and one year follow up survey, and
they experienced more non-transition-related healthcare
avoidance and delay.
Mean age of onset of GI was 10.6 years
(29% before age 6, 61% before age 12, and 87% before age 15),
TGD lived with GI for almost 14 years before gender affirming
hormone therapy.
TGD, transgender and gender diverse; BDI, Beck's Depression
Inventory; SADS, Social Avoidance and Distress Scale; SES,
Self-Esteem Scale; FACES, Family Adaptability and Cohesion
Evaluation Scale; PTSD, post-traumatic stress disorder; COVID-19,
coronavirus disease-19; HIRA, Health Insurance Review and Assessment
Service.
The most frequently researched topic was mental health, with nine studies (56%)
exploring issues such as depression, anxiety symptoms, and suicidal ideation,
plans, and attempts among TGD individuals. Three clinical studies focused on TGD
patients who underwent GAC at a single institution; these studies reported on
the detail of GAC, the physical effects of GAHT, and the time elapsed between
recognizing gender dysphoria and initiating GAHT. Two studies investigated the
tendency of TGD individuals to avoid or delay seeking necessary healthcare,
while another study explored the barriers they faced in accessing GAC.
Additionally, two studies—one using online survey data and the other
analyzing administrative data—examined the demographic characteristics of
the TGD population in Korea.
The research findings indicated that transgender individuals experienced higher
levels of psychological distress and stress, along with lower self-esteem,
compared to their non-transgender counterparts. Additionally, they faced
increased risks of depression and suicidal ideation relative to the general
population [39,40]. An examination of medical records revealed that 20% of
TGD individuals who underwent GAC had a mental health diagnosis other than
gender dysphoria [41]. Results from an
online survey showed that over half (53.7%) of TGD individuals had faced
discrimination due to their gender identity. Those who encountered such
discrimination were more likely to avoid or postpone seeking GAC or other
healthcare services [42,43]. Among TGD individuals, higher levels
of internalized transphobia, stress associated with using public bathrooms,
experiences of gender identity change efforts, and discrimination based on
gender identity were associated with greater depression [44–47].
Higher levels of internalized transphobia and experiences of gender identity
change efforts were linked to increased suicidal ideation and attempts [44,45]. TGD individuals who faced discrimination due to their gender
identity reported worse sleep health. Additionally, those who avoided public
bathrooms, job-seeking activities, or healthcare services because of their
gender identity experienced higher levels of anxiety symptoms [48,49]. TGD individuals identified several significant barriers to
accessing GAC, including costs, negative experiences in healthcare settings, a
scarcity of healthcare providers and facilities with expertise in GAC, and
societal stigma [50].
A study of 337 TGD individuals in Korea who underwent GAC revealed that the
average age at which participants first recognized their gender dysphoria was
10.6 years (SD, 5.1 years), with 29% recognizing it before the age of 6 and 61%
before age 12. Based on the median age of initiating GAHT, which is 23 years,
these individuals lived with gender dysphoria for an average of approximately 14
years before beginning GAHT [51]. A study
of transgender women undergoing GAHT observed physical changes that included an
increase in fat mass, a decrease in hand grip strength, and a shift toward a
more “feminized” body fat distribution when compared to the
pre-treatment period [52].
A study utilizing Health Insurance Review and Assessment Service data found that,
between 2007 and 2021, 8,602 individuals received a diagnosis of GID (ICD-10
code, F64), with an annual rate of approximately 500–600 diagnoses and an
increasing trend over the years [53].
Discussion
Interpretation
Between 2000 and 2024, only 33 quantitative studies focusing on the health of
Korean SGMs were published in peer-reviewed international journals. Although the
number of studies has gradually increased, with one study published between
2000–2010, 13 studies from 2011–2020, and 19 studies from
2021–2024, research on this topic is still relatively limited. Starting
in 2017, surveys have been conducted of Korean gay, lesbian, bisexual, and TGD
individuals, contributing to the growth in published research on the health of
Korean SGMs. Gay, lesbian, and bisexual Koreans have reported higher rates of
depression, anxiety symptoms, suicidal ideation, and suicide attempts, as well
as a lower health-related quality of life. Those with internalized homophobia,
who have experienced coercive attempts to change their sexual orientation, or
who have faced discrimination due to their sexual orientation are more likely to
experience poor mental health and sleep issues and to avoid or delay seeking
medical care. Similarly, TGD individuals report relatively high rates of
depression, anxiety symptoms, suicidal thoughts, and suicide attempts. Those
with greater internalized transphobia, who have encountered discrimination based
on their gender identity, or who have avoided daily activities due to their
gender identity are relatively likely to experience worse mental health and to
avoid or delay using healthcare services.
Suggestions for improving the health of sexual and gender minorities
Based on these research findings, the following changes are needed to improve the
health of the vulnerable SGM population in Korea and to increase their access to
medical care:
First, more research is required on the health of Korean SGMs. While
international studies encompass a wide range of topics, including chronic
disease management, cancer incidence, and the long-term effects of GAC for TGD
individuals, research on the health of Korean SGMs remains limited in scope. To
improve the health of SGMs and to develop strategies for suitable healthcare
access, it is imperative to expand the breadth of studies within the Korean
healthcare system [54–56].
Based on the comparatively poor health outcomes demonstrated, many countries are
actively supporting research to enhance the health of SGMs. For instance, in
2015, the US National Institutes of Health established the Sexual &
Gender Minority Research Office, which developed a strategic plan to advance
research on the health and well-being of SGMs [57]. Research on SGM health must be promoted, both to identify the
population-level factors that contribute to their vulnerability and to
scientifically explore ways to improve their health outcomes. Additionally,
national-level statistics are essential for gaining a more accurate
understanding of the lives and health of SGMs. Following the examples of the
United States and the United Kingdom, incorporating questions about sexual
orientation and gender identity into national surveys, such as the National
Health and Nutrition Examination Survey and the Community Health Survey, would
represent a key first step. This would provide baseline statistics on the size
and status of the SGM population, which could inform our understanding of their
health in Korea [58,59].
Second, LGBTQ-friendly healthcare providers are essential for improving
healthcare access for SGMs. Due to their identities, many SGM individuals face
discrimination in their daily lives, which often leads to delays in seeking
necessary medical care. Additionally, TGD individuals report a lack of competent
healthcare providers and facilities as a significant barrier to GAC [50]. To develop LGBTQ-friendly healthcare
providers, education and training on SGM health must be integrated into medical
school curricula and residency training programs. In 2015, the American College
of Physicians emphasized that training healthcare providers in knowledge,
experience, cultural competency, and sensitivity to human rights regarding SGMs
is vital for promoting SGM health and reducing health disparities [60]. While international medical schools
such as Harvard University and the University of Washington offer educational
programs on SGM health, and the American Medical Association provides an SGM
health fellowship, educational programs on SGM health in Korea are still in
their infancy [61,62]. In 2021, Seoul National University College of Medicine
introduced an elective course on SGM health for second-year medical students,
and in 2022, mandatory course began for all students. The need exists for a
standardized curriculum on SGM health, which should be disseminated to all
medical schools and training institutions nationwide. This would serve as a
critical first step in training healthcare professionals who are knowledgeable
about SGM health vulnerabilities and who actively participate in addressing
them.
Third, research and policy efforts are needed to implement programs that have
been demonstrated to enhance the health of SGMs. Social support and the
legalization of same-sex marriage have been shown to improve the mental health
of homosexual and bisexual individuals [63,64]. Increasing access to
GAC for TGD individuals is another notable example, with many studies
demonstrating its positive effects. Although systematic reviews have highlighted
the beneficial impacts of GAC, and the 8th edition of the international
Standards of Care for the Health of Transgender and Gender Diverse People was
published in 2022, knowledge is still limited regarding the health outcomes of
TGD individuals receiving GAC in Korea.
Within Korea, TGD individuals encounter barriers to accessing GAC, including
prohibitive costs, a lack of competent providers and facilities, and social
stigma [50]. In 2014, Soonchunhyang
University Seoul Hospital opened a gender clinic within its Department of
Obstetrics and Gynecology, becoming the first tertiary hospital in Korea to
specialize in GAHT. Subsequently, in 2021, the LGBTQ+ Clinic at Kangdong Sacred
Heart Hospital—through collaboration among the Department of Plastic
Surgery, the Department of Psychiatry, and other multidisciplinary
services—and the Gender Clinic of Korea University Anam Hospital’s
Department of Plastic Surgery opened their doors to provide gender-affirming
surgery. Additionally, several primary care clinics (such as the Salim Clinic,
which has administered GAHT to over 3,000 TGD individuals since 2012) have begun
offering GAC, with a growing number of providers. Despite these advancements,
GAC is still not accessible as a universal healthcare service. More
LGBTQ-friendly healthcare facilities, capable of providing GAC rooted in current
knowledge and cultural competency, are needed. Moreover, it is crucial to assess
the present state of GAC in Korea and to evaluate its impact, forming the
foundation for new strategies that enhance access to these services. In 2023,
eight LGBTQ-friendly healthcare facilities and researchers specializing in SGM
health initiated the KITE: Korean Initiative for Transgender hEalth project, a
cohort study focused on the health of Korean TGD individuals. Gathering
scientific evidence on the health of the Korean TGD population and the effects
of GAC is imperative. These findings can then inform societal discussions about
the inclusion of GAC in the coverage provided by the NHI system.
Fourth, healthcare professionals should advocate for changes in social
perceptions and institutional policies related to SGM health. Studies in Korea
have shown that internalized stigma, harassment, discrimination, and exclusion
due to SGM identities are associated with worsened mental health and increases
in suicidal ideation and attempts [29,30,33,34,44]. To promote SGM health, the American
College of Physicians recommends that healthcare professionals advocate for the
rights to same-sex marriage, institutional guarantees of GAC for TGD
individuals, and the inclusion of sexual orientation and gender identity as
protected categories against discrimination [60].
Healthcare professionals should serve as authorities in correcting misconceptions
about SGMs and spearheading institutional reforms that are closely linked to SGM
health. For example, the APA has published an official statement denouncing
discrimination against transgender individuals. Similarly, GLMA: Health
Professionals Advancing LGBTQ+ Equality, a coalition of healthcare providers
advocating for SGM equality, has consistently issued statements in favor of
same-sex marriage and partnership laws, the protection of transgender
individuals’ healthcare rights against discrimination, and the provision
of support for SGM youth in educational settings [65,66]. In a 2019
international survey, only 44% of Koreans agreed that homosexuality should be
accepted by society, a figure markedly lower than those reported in Sweden
(94%), the Netherlands (92%), and the United States (72%). The 2023 Social
Integration Survey further indicated that Koreans exhibit a high tendency to
exclude sexual minorities from societal acceptance (52.3%), ranking just below
their inclination to exclude ex-convicts (72.1%) [67,68]. In Korea,
same-sex marriage remains illegal, GAC for TGD individuals is not covered by the
NHI, and no anti-discrimination laws yet exist that encompass SGM identities.
Given this context, there is much work for healthcare professionals to do to
promote SGM health.
Conclusion
This study aimed to propose a role for healthcare professionals in improving the
health and healthcare access of Korean SGMs through a narrative review of
quantitative studies on SGM health. Korean SGM individuals have been found to
experience higher rates of depression, anxiety, suicidal ideation, and suicide
attempts, with the risks being even greater for those subjected to
discrimination or coercive efforts to alter their SGM identities.
While GAC has been shown to enhance the health and quality of life of TGD
individuals, data are limited regarding the availability and accessibility of
GAC within the Korean TGD population. Despite the acknowledgment that diversity
in sexual orientation and gender identity is not indicative of a disorder, SGMs
in Korea continue to experience poor health outcomes and a diminished
health-related quality of life. Furthermore, scant research has been conducted
on their health status.
In Korean society, where discrimination and hatred against SGMs are rampant, the
discrimination and stigma experienced by SGMs not only worsen their mental
health but also reduce their access to healthcare, further exacerbating their
health vulnerabilities. Healthcare professionals should become active advocates
for SGM health, grounded in a comprehensive understanding of SGMs and their
health-related needs.
Authors' contributions
Project administration: Lee SY
Conceptualization: So H, Kim S, Lee SY
Methodology & data curation: So H, Kim S, Lee SY
Funding acquisition: not applicable
Writing – original draft: So H, Lee SY
Writing – review & editing: So H, Kim S, Lee SY
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
Not applicable.
Data availability
Not applicable.
Acknowledgments
We extend our gratitude to the members of the Korean Association for LGBTQ Medicine
for their assistance in conducting this research. We also thank Hyein Chu from the
Salim Health Welfare Social Cooperative (the Salim Clinic) for reviewing the draft
of this paper and providing valuable advice.
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Health of Korean sexual and gender minorities: a narrative review of
quantitative studies
Health of Korean sexual and gender minorities: a narrative review of
quantitative studies
Definitions of sexual and gender minorities
Term
Definition
Lesbian
A woman who experiences emotional,
romantic, or sexual attraction to women
Gay
A man who experiences emotional,
romantic, or sexual attraction to men
Bisexual
A person who is attracted to both
people of their own and other genders
Asexual
A person who does not experience
sexual attraction toward individuals of any gender
Transgender
An individual whose current gender
identity differs from the sex assigned at birth
Nonbinary
An individual who does not
identify as male or female regarding gender
Questioning
For some, the process of exploring
and discovering one’s own sexual orientation, gender
identity, or gender expression
Intersex
A person with variations in
physical sex characteristics, including anatomy, hormones,
chromosomes, or other traits, that differ from expectations
generally associated with male or female bodies
Data from Centers for Disease Control and Prevention [69].
List of 17 articles on the health of sexual minorities
No
Year
Authors
Primary exposure or measure
Outcome assessment
Method
Sample characteristics
Main result and significant effect
association indicating adverse health effects
MSM, men who have sex with men; LGB, lesbian, gay, and bisexual; LB,
lesbian and bisexual; HRQoL, health-related quality of life;
SF-36v2, 36-item Short Form Health Survey version 2.0; GB, gay and
bisexual; HIV, human immunodeficiency virus; SOGE, sexual
orientation and gender identity; COVID-19, coronavirus disease-19;
PLWH, people living with HIV.
List of 16 articles on the health of gender minorities
No
Year
Authors
Primary exposure or measure
Outcome assessment
Sample design
Sample characteristics
Significant main effect association
indicating adverse health effects of LGB
Experiences of and barriers to
transition-related healthcare
Gender affirming care
RCP2* online survey
TGD, N=278
Barrier: cost, negative experiences in
healthcare settings, lack of specialized healthcare
professionals and facilities, and social stigma against
TGD.
30% TGD-specific COVID-19 related
stressor experience and more depressive symptoms. Barrier to
gender affirming care: economic hardship, limited access to
hospital.
53.7% experienced anti-transgender
discrimination at initial and one year follow up survey, and
they experienced more non-transition-related healthcare
avoidance and delay.
Mean age of onset of GI was 10.6 years
(29% before age 6, 61% before age 12, and 87% before age 15),
TGD lived with GI for almost 14 years before gender affirming
hormone therapy.
TGD, transgender and gender diverse; BDI, Beck's Depression
Inventory; SADS, Social Avoidance and Distress Scale; SES,
Self-Esteem Scale; FACES, Family Adaptability and Cohesion
Evaluation Scale; PTSD, post-traumatic stress disorder; COVID-19,
coronavirus disease-19; HIRA, Health Insurance Review and Assessment
Service.
Table 1.
Definitions of sexual and gender minorities
Data from Centers for Disease Control and Prevention [69].
Table 2.
List of 17 articles on the health of sexual minorities
Youth online survey: Korea Youth Risk Behavior Web-based Survey.
RCP1 online survey: rainbow connection project 1.
MSM, men who have sex with men; LGB, lesbian, gay, and bisexual; LB,
lesbian and bisexual; HRQoL, health-related quality of life;
SF-36v2, 36-item Short Form Health Survey version 2.0; GB, gay and
bisexual; HIV, human immunodeficiency virus; SOGE, sexual
orientation and gender identity; COVID-19, coronavirus disease-19;
PLWH, people living with HIV.
Table 3.
List of 16 articles on the health of gender minorities
RCP2 online survey: rainbow connection project 2.
RCP3 online survey: rainbow connection project 3.
TGD, transgender and gender diverse; BDI, Beck's Depression
Inventory; SADS, Social Avoidance and Distress Scale; SES,
Self-Esteem Scale; FACES, Family Adaptability and Cohesion
Evaluation Scale; PTSD, post-traumatic stress disorder; COVID-19,
coronavirus disease-19; HIRA, Health Insurance Review and Assessment
Service.
