Last week I posted this story in the Friday Five: 5.6% of American adults say they are LGBTQ. Over half identify as bisexual – The number of LGBTQ Americans coming out and claiming their identity just keeps growing. Digging beyond the headline, a lot of people focused on the generational chart (pictured above): Millennials (folks born between 1981 and 1996) are about four-and-a-half times more likely to identify as queer than Boomers (folks born between 1946-1964), while Gen-Z (folks born after 1996) are nearly eight times more likely than Boomers to identify as something other than heterosexual.

The story was published early in the week and I kept seeing various hot takes on the results. I was a little surprised at just how many people were willing to leap to the conclusion that younger people are only saying that they are queer to be cool.

This ignores several facts that would disproportionately reduce the number of queer people in those less-young generations responding to this survey. Not the least of which is that many of them are literally not alive to respond. Twitter user @mike_i_guess sums up much of what I’d like to say on the matter, though I would use the term “contemporaries” rather than peers:

“The lack of boomer LGBTQ+ people isn’t because it’s ‘more popular now.’ Many were murdered by they peers, died from government inaction during the AIDS crisis, committed suicide due to lack of social supports, or have had to live in the closet due to their peers’ cruelty.”
—@mike_i_guess

I want to unpack that a bit. We don’t really have statistics on hate crimes before the passage of the federal Hate Crime Statistics Act of 1990, and even then crimes against trans people (or those perceived to be trans) weren’t counted until the Matthew Shepard and James Byrd Jr. Hate Crimes Prevention Act of 2010 was signed into law. But queer people have been subject to bashings and murder for decades. The longer one lives, the more opportunities there are to fall victim to such crime.

It’s been known for a long time that queer people, particularly queer children and teens, are far more likely to attempt suicide than their straight contemporaries, and the statistical analysis is that the disparity is entirely due to the stress of homophobic abuse and related issues. Preliminary studies show a slight decrease in those numbers for teens and children since about 2012, as growing acceptance of queer adults in society has given more of them hope of a happy future.

Then there are health care issues. Numerous studies show that queer people are more likely to experience interruptions in health care coverage, are less likely to be forthcoming with their health care providers, and less likely to receive the same quality of health care as their straight contemporaries. It’s a complicated result of both systemic and direct homophobia. Lots of people operate under the mistaken notions that bigotry only exists in a small number of people who actively hate others because of their race, religion, sexual orientation, et cetera, but it’s a lot more subtle than that.

For instance, let’s talk about the bit about interruptions in health care coverage. For years in the U.S. one’s health insurance (if you have it) is provided by your employer. Most people don’t get to choose their coverage, they have to take what’s offered by their employer. Which means if you get laid off or otherwise lose your job, your health coverage goes away. Queer people are disproportionately likely to be let go when a Reduction In Force hits a workplace. They are also less likely to get promotions and more likely to earn less than their straight co-workers who received similar job performance reviews and have similar experience. This is not because most managers are actively homophobic. It is a combination of a lot of unconscious processes.

For example, if a queer person doesn’t feel safe being out in the workplace, they will police themselves constantly to make sure they don’t let telling details of their personal life slip. While straight co-workers will be sharing stories about things they did with the children over the weekend, or a project they worked on with their spouse, or even issues with an ex-spouse or in-laws they don’t get along with, the closeted co-worker remains mum. The closeted working can’t talk about their partner freely or in detail. So they limit themselves to very vague generalities are just politely comment on the other person’s remarks. This is perceived as being unfriendly. Not sharing personal details after another person shares some of theirs is considered anti-social. So the closeted queer employee is perceived as being less of a team player, aloof, and so forth. This has a deleterious effect on every aspect of employment, including as mentioned above an increased likelihood of being one of the people let go if there are lay-offs.

Even more dangerous is the tendency of some health care professionals not to take as seriously symptoms reported by a queer person. I have a very personal example of this. In the very early 1990s I had a series of weird health events. It took over a year for my doctor and two specialists to figure out what the underlying problem was. Before that diagnosis, I had a number of incidents that required me going to an emergency room.

One time, I had been unable to keep any food down. Soon I was running a fever and it reach the point that even trying to sip plain wanter sent me running to the bathroom and left me curled up with horrible pain in my stomach after I threw up the water. Eventually, Ray (my now late-husband) convinced me to let him take me to the hospital.

We had one bit of good luck. As we were checking in, a nurse who just happened to be coming to the front to give the admin person some information related to another patient, noticed how bad I looked. She asked a couple of questions, then pinched my forearm, before telling the admin person, “He’s extremely dehydrated and need to be put on an IV right away.”

I was whisked off, put on an IV, had my vitals taken. Not long after another nurse came in and drew a bunch of blood, asked questions, and finished filling out the admission form. Some time later the initial nurse dropped by to say her shift was ending, but before she left she wanted to see for herself if the fluids they were pumping into me were helping. My fever was down, I felt a lot better, and apparently I looked a lot better.

Then we just waited. I don’t know how long I laid there. Ray got very impatient and went to ask when someone was going to check on us. I think I was on my third unit of fluid at that point. A doctor showed up, asked a bunch of questions, checked a few things, and told us they were still waiting for a couple of the blood tests to come in. Some time after that the doctor reappeared, alone with a nurse who changed out the fluid bag again. The doctor explained that the blood tests were inconclusive, but he suspected I had a rare form of ulcer that his caused by a particular kind of infection of the stomach lining, so he was prescribing some pills that would help with that. He said that as soon as I was rehydrated enough that I had to go to the bathroom, I’d been discharged. I should keep taking the pills for the rest of the weekend (it was a Saturday night), and see my regular doctor on Monday.

I fell asleep on the drive home. And pretty much slept through all of Sunday. I was able to keep broth, plain water, and tea down, so I thought the pills were helping.

The next morning, I left a message with my boss saying I was sick and hoping to see my doctor that day. I had just hung up and was going to look up my doctor’s phone number when the doctor’s office called us. They’d gotten the information from the hospital and my regular doctor was not happy. They wanted me to come right away, bring all of the paperwork the hospital had given me, “And if you haven’t taken any of those pills today, don’t take any more!”

My doctor wasn’t just unhappy, he was royally pissed. The pills I had been given had nothing to do with ulcers or infections of any kind. They were tranquilizers. Among the notes from the ER doctor was the phrase, “Gay male patient claims he doesn’t have AIDS.” His diagnosis was that I was probably just overreacting to “unremarkable symptoms.”

My doctor wanted to know why I had gone to that hospital instead of one that was much closer to my home (where he happened to be a resident, and would have been called as soon as I was admitted, instead of him finding it out when they pulled faxes off the machine Monday morning). I explained that my employer had recently changed our insurance plan and there was exactly one ER in the city that was considered in network. He explained that the particular hospital I had gone to had a number of doctors like this one guy who 1) assumed every gay male patient was infected with the virus that causes AIDS, and 2) there isn’t anything you can do for AIDS patients, anyway, so don’t waste a lot of time on them.

The blood tests that came back before they admitted me clearly indicated that in addition to the fever and other symptoms I did have some kind of serious infection. But the medicine prescribed wouldn’t treat any infections. Tests results that had come back after they let me go gave my doctor a good guess as to what kind of infection I did have, and he prescribed something that actually would work against. Then my doctor walked me through the process of filing a formal complaint. Which he was also doing.

The upshot was that I received a partial refund from the hospital of my out-of-pocket for the ER visit. My doctor pried a letter out of my insurance company saying that the hospital close to my house would be covered as in-network. But just to be sure, my doctor also got a letter from that hospital saying that if my insurance billed me as out-of-network they would cover the cost of the difference in out-of-pocket.

The initial incident happened in the city of Seattle, which most people think of as an extremely liberal city where virtually no one is homophobic. I was lucky that I had as my primary physician a guy who was ready to fight for his patients. Who know what would have happened if I hadn’t had him in my corner? And the doctor who sent me home with tranquilizers was simply appalled that anyone would think that he had allowed any sort of prejudice guide his decision to lie to me about his diagnosis and send me home with medicine that would just make sure I was too sleepy to do anything for a few days.

I bet to this day he would swear that he doesn’t have a homophobic bone in his body. Homophobia isn’t limited to people scream slurs while they beat you.

The takeaway: for many reasons queers are less likely to get consistent, quality health care. They are disproportionately less likely to experience good health care outcomes. Therefore, more likely to die younger than their straight contemporaries. And that doesn’t even include the hundreds of thousands of queer men in the U.S. who died starting in 1979 due to the AIDS epidemic (which is still ongoing, but the availability of multi-drug anti-viral cocktails beginning in the mid-1990s have met it is no long a death sentence, even though there is still no cure).

Then there is the phenomenon of people so deeply afraid of being outed that even on an anonymous survey they will not identify as anything other than straight. Any reasonably friendly out gay man who has ever logged into a hookup app, a gay chat site, or similar forum will have many stories of getting hit up on by men who are married to women (usually with kids), and desperately want to have sex with other men, but only if you can be discreet and guarantee that no one will ever know. If you can get them to talk about it, they will admit that they have wanted to have sex with other men since they were teens (or even earlier), but have always been afraid to be out, and they are convinced that their lives will end if their wife and family ever found out they were anything but 100 percent straight.

I remember one particularly heart-wrenching conversation with a guy who felt he was super lucky precisely because his first (and only) child was a son, so that his super conservative and religious parents and in-laws were all happy, and he was able to just stop having sex with his wife at all after the arrival of the first baby. And significantly, his wife was perfectly happy that he supposedly hadn’t been interested in sex at all for the next about 30 years (at the time I talked to him). He had been having lots and lots and lots of sex for all those years—it was just furtive, downlow sex with other men. And I have little doubt that if he happened to be surveyed by Gallup, that without hesitation he would describe himself as straight

Now while I have met a few younger men like him, the vast majority of these downlow closet cases I run into online now are middle aged or older.

It’s more accurate to conclude from Gallup’s generational information that younger people currently feel less fear to admit their orientation. We hope that, going forward, they will also experience fewer of the issues that have caused earlier generations of queers to die before their time.