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The cost of coming out in biomedicine

News and Views

The cost of coming out in biomedicine

News and Views

Bryce Hughes
Department of Education, Montana State University, USA

National efforts across the United States, United Kingdom and the rest of Europe have taken aim at reducing social inequality through widening participation in undergraduate STEM (science, technology, engineering, and mathematics) fields. These efforts typically focus on redressing the under-representation of women, ethnic minorities, people with disabilities, and people from other groups under-served by these fields (National Academy of Sciences, National Academy of Engineering, and Institute of Medicine, 2011; Thompson, 2019). An emerging body of research has shown that members of the lesbian, gay, bisexual, transgender, and queer1 (LGBTQ) community are also being systematically excluded from full participation in STEM, though limitations in the data collected on participation in STEM until recently has obscured the scope of this problem. Using longitudinal, national data on college students in the United States2, I was able to show that sexual minority (LGBTQ) students are retained in STEM degrees at a significantly lower rate than their heterosexual peers (Hughes, 2018).

Overall, I estimated the retention rate for sexual minority students in STEM to be about 7% lower than that for heterosexual students. What was somewhat surprising was that sexual minority students were more likely to leave STEM despite being about 10% more likely to participate in undergraduate research, one of the most effective experiences to promote persistence to STEM degrees (Graham et al., 2013). This difference persisted even when talent, ability, and interest were accounted for.

Physiology and other medical fields should be especially concerned about LGBTQ participation given how the healthcare system underserves these communities. Negative experiences with providers lead to LGBTQ people not being appropriately evaluated for various diseases, or to avoid seeking healthcare altogether (Parameshwaran et al., 2013). In disaggregating my data to students who majored in the biomedical sciences, I found a starker difference than for STEM overall: 52% of the heterosexual, but only 41% LGBTQ, students were retained in the biomedical sciences after four years. As seen in Table 1, most of the difference appears to be LGBTQ students who switched from the biomedical sciences to other STEM fields, though more than one-third of students in both groups left STEM altogether. About two-thirds of the original LGBTQ biomedicine undergraduate population who remain in STEM keep on track to complete a degree in biomedicine, while the other third may be attracted to other STEM fields offering more task independence for LGBTQ people concerned about disclosing their sexual or gender identity to colleagues (Tilcsik et al., 2015).

What then could be done to bring these numbers closer to parity? It is unclear that undergraduate research experiences make a difference for LGBTQ students in STEM, which could reflect the environment and support established by the faculty mentor. One important recommendation, then, is to provide professional development opportunities to help faculty who would like to be better mentors to feel empowered to do so. Alternatively, it could mean that LGBTQ students may be even less likely to persist in STEM without these undergraduate research experiences. Controlling for other factors, like undergraduate research participation, my estimate of the difference in retention by sexual orientation expanded to 9.5% from 7% (Hughes, 2018). LGBTQ students also continue to experience isolation in STEM, and transgender, nonbinary, and gender nonconforming students face direct stigma when the wrong names or pronouns are used, or when peers express discomfort with their gender expression (Duncan et al., 2018). Organisations like House of STEM in Ireland, oSTEM and NOGLSTP in the United States, and InterEngineering in the United Kingdom are developing networks for LGBTQ STEM students and professionals to find community. Connecting students, faculty, and staff to these organisations, or hosting these types of organisations in academic faculties, can help diminish these feelings of isolation.

Finally, addressing the disparity in retention between LGBTQ and cisgender/heterosexual STEM students has implications for representation in the workplace and in academia. By addressing the climate in STEM and empowering more LGBTQ students to persist in their plans to enter the STEM workforce, future generations of LGBTQ STEM students will have an increased number of role models to look up to as they pursue their own career plans. LGBTQ clients will have access to LGBTQ health providers who can create a more comfortable environment for accessing sensitive and competent health care. I came to this research having been an openly gay engineering undergraduate myself, and I have felt especially encouraged by visibility efforts like 500 Queer Scientists and #LGBTSTEMDay. Society may have shifted rapidly in terms of attitudes toward the LGBTQ community, but the work has not yet finished.

Queer is a formerly derogatory term that has been reclaimed by academics and activists to describe being a sexual or gender minority; academics use it most frequently in reference to queer theory whereas activists tend to use it in political organising.

The sources for these data are the 2011 Freshman Survey and the 2015 College Senior Survey, both administered by the Cooperative Institutional Research Program within the Higher Education Research Institute at UCLA.


Duncan SG et al. (2019). Survey of heteronormative attitudes and tolerance toward gender non-conformity in Mountain West undergraduate students. Frontiers in Psychology 10(793). DOI: 10.3389/fpsyg.2019.00793.

Graham MJ et al. (2013). Increasing persistence of college students in STEM. Science 341(6153), 1455 – 6.

Hughes BE (2018). Coming out in STEM: Factors affecting retention of sexual minority STEM students. Science Advances 4(3), eaao6373.

National Academy of Sciences, National Academy of Engineering, and Institute of Medicine (2011). Expanding underrepresented minority participation: America’s science and technology talent at the crossroads. Washington, DC: The National Academies Press.

Parameshwaran V et al. (2017). Is the lack of specific lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in medical school a cause for concern? Evidence from a survey of knowledge and practice among UK medical students. Journal of Homosexuality 64(3), 367 – 81.

Thompson DW (2019). Widening participation research and practice in the United Kingdom on the twentieth anniversary of the Dearing report: Reflections on a changing landscape. Educational Review 71(2), 182 – 97.

Tilcsik A et al. (2015). Concealable stigma and occupational segregation: Toward a theory of gay and lesbian occupations. Administrative Science Quarterly 60(3), 446 – 81.

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