Sexual Orientation and Gender Identity

Sexual orientation and gender identity/expression are important aspects of a young person’s identity. Understanding and expressing sexual orientation and gender and developing related identities are typical development tasks that vary across children and youth. For example, some youth may be unsure of their sexual orientation, whereas others have been clear about it since childhood and have expressed it since a young age. Expressing and exploring gender identity and roles is a part of normal development. The process of understanding and expressing one’s sexual orientation and gender identity is unique to each individual. It is not a one-time event and personal, cultural, and social factors may influence how one expresses their sexual orientation and gender identity.3

There is currently no universally-accepted acronym inclusive of all youth who are not heterosexual and/or express their gender in diverse ways. The commonly-used acronym — LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity) — refers to the communities included in the “LGBTTTQQIAA” acronym (see Figure 1). This youth topic primarily uses “LGBTQ+” as an inclusive term for simplicity, except when describing research studies explicitly focused on more narrowly-specific communities. 

Young people who identify as LGBTQ+ can experience various challenges because of how others respond to their sexual orientation or gender identity/expression. This is also true for youth who are questioning their sexual orientation or gender identity, or may be perceived as LGBTQ+ or gender variant by others.8 In a 2021 survey of nearly 35,000 LGBTQ+ youth, 75 percent reported having experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime.These negative experiences include high rates of physical and emotional bias and violence; rejection by schools, employment, and communities because of their sexual orientation and/or gender identity/expression.

Research shows that due to these challenges and the associated stress, LGBTQ+ youth are at risk for negative health outcomes and are more likely to attempt suicide, experience homelessness, and use illegal drugs These issues may also contribute to anxiety, depressive symptoms, and feelings of isolation. Youth who express their gender in ways that vary from societal expectations for their perceived sex or gender are at risk for high levels of childhood physical, psychological, and sexual abuse. They are also at risk for school victimization. As a result, they may have poorer well-being than lesbian, gay, and bisexual peers whose gender expression is more closely aligned with societal expectations.

Resiliency and Protective Factors

Research on LGBTQ+ youth has focused on the risk factors and disparities these young people experience compared with youth who are not LGBTQ+. However, more recently there has been research on resiliency and protective factors, which offers a strength-based focus on LGBTQ+ youth well-being. For instance, LGBTQ+ youth who have access to spaces that affirm their sexual orientation and gender identity report lower rates of attempting suicide4 and experiencing supportive environments.5

Several factors that can help improve outcomes for LGBTQ+ young people include:

• Addressing LGBTQ+-related stigma, discrimination, and violence
• Building on the strengths of LGBTQ+ youth
• Fostering supports such as family acceptance and safe, affirming environments in schools and other settings.