Transgender people are enduring "some of the worst forms" of societal, political, and institutional discrimination, according to a major Scottish study.
Researchers linked this to gender identity being more outwardly expressed, than sexual orientation, through physical appearance and mannerisms.
This was said to have been exacerbated by the "culture war" narrative around sex and gender in Scotland.
The report, by Glasgow Centre for Population Health (GCPH) notes how "many Indigenous cultures across the planet recognised and admired gender and sexual diversity, long before the arrival of colonialism and its rigid heteronormative constructs."
It discusses how society's adherence to "rigid gender norms" has exacerbated microaggressions, defined as the most frequent, subtle forms of discrimination, often unconscious or unintentional that communicate hostile or derogatory views and messages.
Microaggressions were likened to “death by a thousand cuts” by members of the LGBT+ community who experience them.
The review analysed the findings of around 200 UK studies, to examine the "unmet" health needs of the LGBT+ community.
It found the "pervasive" reach of heteronormativity continues to permeate society and its various facets, including healthcare and this has been linked to poorer health outcomes.
Many healthcare providers and institutions were said to face challenges in embedding LGBT+ inclusive practices and policies, from registration or medical forms that fail to recognise gender diversity.
Most medical education and training is underpinned by heteronormative ideals which rely on "essentialist" understandings of sex, gender, and sexual binary systems (i.e. female or male).
"Based on the findings of this review (and the many, quality, recent UK studies reviewed), it is evident that heteronormative cultures and implicit biases remain in healthcare settings and work is required to redress this issue," researchers said.
Mark Kelvin CEO of Scottish charity LGBT Health and Wellbeing, which contributed to the report, recounted a recent example where he was handed blue and pink forms by a GP surgery receptionist when he enquired about registering himself and his husband.
He described another example when during an intimate examination the doctor remarked that he was aware, "It wasn't very nice to be touched there by a man."
He said: "The report demonstrates what our community has lived with for a long time. It's good to see attention from a mainstream organisation which recognises the lack of equal access and the lack of data.
"Coming just before the Census is interesting for us to see how many people in Scotland identify as LGBT and how that information will be used, either helpfully or unhelpfully.
"My fear at that moment with the culture, particularly leading up to the general election, our community is often used as a political distraction."
Several studies have shown that LGBT+ people are at higher risk of developing certain types of cancer and at a younger age compared to heterosexual people.
They are less likely to take up cancer screening programs with evidence stating this can be linked to prior negative experiences within healthcare settings.
Transgender men and non-binary people assigned female at birth (who have not undergone surgery to remove the cervix) are recommended to undertake cervical screening with the same frequency as cisgender women.
Several studies reviewed linked religious-based intolerance among healthcare staff to adverse outcomes for LGBT+ people.
The study notes that the views of most major religions, including Christianity and Islam, are opposed to LGBT+ people.
However, much of the discrimination was unrelated to the religious background of the clinician or caregiver.
The inclusion of sexual orientation and gender identity questions within the 2021 Scottish census questionnaire was described by researchers as a "landmark" step.
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It will enable the most comprehensive profiling of sexual and gender minorities ever in Scotland and further analysis of health outcomes.
The mental health profile of LGBT+ adolescents was described as "concerning" with studies estimating several-fold increases in depression, anxiety, self-harm and suicidality in comparison to heterosexual and cisgender peers.
Poor mental health can lead to unhealthy coping mechanisms, such as higher rates of drugs and alcohol use which in turn play a part in the evidenced adverse physical health among LGBT+ groups, including increased rates of obesity and cardiovascular disease.
Sexual minority adolescents are more likely to be obese or underweight , have an eating disorder, engage in risky sexual behaviour and use cigarettes and other substances such as alcohol and cannabis than their heterosexual adolescents peers.
The report makes a series of recommendations including the development of national public education campaigns highlighting the discrimination faced by the LGBT+ community.
Chris Harkins, public health programme manager for GCPH, who led the report, said: "There is a narrative that things are getting better for the LGBT+ community.
"We've had same-sex marriages and a ban on conversion therapy in recent years but I think that is a narrative that is complacent.
"It needs laser-like attention and focus if we are to get anywhere near the parity that we are looking for."
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