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.

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 This youth topic primarily uses “LGBTQ+” as an inclusive term for simplicity, except when describing research studies explicitly focused on more narrowly specific communities. to learn more about each of these communities.


Family acceptance and support are significant factors that promote well-being and protection from risks for all youth, including LGBT youth. The meaning of family varies by personal, cultural, and other factors and can include individuals who are not biologically or legally related to a youth (i.e., families of choice). Family responses to expressions of gender and sexual identity by youth may vary. Although some families are supportive, accepting, and even celebratory, others may respond and behave in ways that have negative consequences and result in trauma to the youth. Research demonstrates a strong link between family rejection of LGBT youth and negative physical and mental health outcomes for them. In contrast, family acceptance can serve as a protective factor against depression, substance use, and suicidal ideation and attempts. Research has found that compared with LGBT youth who experienced little or no parental/caregiver rejection, those LGBT youth who were highly rejected were

  • more than eight times as likely to attempt suicide.
  • almost six times as likely to report high levels of depression.
  • more than three times as likely to use illegal drugs; and
  • more than three times as likely to be at high risk for HIV and sexually transmitted diseases.

A recent report of findings from a survey of more than 10,000 LGBT youth ages 13 to 17 (using a convenience sample, which may not be representative of all LGBT youth) also found that approximately one in four identified nonaccepting families as the most important challenge in their lives. These findings illustrate the importance of family acceptance and support in the lives of LGBT youth.

Youth-serving organizations and systems can build awareness about and encourage family behaviors that research has shown can affect outcomes for LGBT youth. Examples of behaviors that should be avoided and discouraged include

  • blocking access to LGBT friends, events, and resources.
  • blaming youth when they are discriminated against because of their LGBT identity; and
  • pressuring youth to be more (or less) “masculine” or “feminine” - and keeping their ­­­LGBT identity a “secret.”

Rather, it is important for families to express support through such behaviors as

  • talking with youth about their LGBT identity in an affirming manner.
  • communicating that their young person can have a happy future as an LGBT adult.
  • working to ensure that other family members respect the young person.
  • talking with clergy and help their faith community support LGBT individuals; and
  • advocating for youth if they are mistreated because of their identity

It is also important for youth-serving agencies and communities to enhance their cultural competence in working with LGBT-headed families, which are increasing in number. Youth who are not LGBT but have an LGBT caregiver may also experience bias and other negative outcomes because of reactions to their caregiver’s LGBT identity.

Key Terms and Concepts

Currently, there is no universally accepted acronym for the community or communities of youth who are not heterosexual and/or express their gender in diverse ways. Lesbian, gay, bisexual, transgender, queer or questioning, or another diverse identity (LGBTQ+) youth each represent distinct populations with particular and unique experiences. This youth topic primarily uses “LGBTQ+” as an inclusive term. Also, it is important to remember that sexual orientation and gender identity intersect with cultural and other aspects of a young person’s identity, such as faith/spirituality and race and ethnicity, and can also change over time.

Below are some of the key concepts and terms related to sexual orientation and gender identity/expression:

2/Two-Spirit: An inclusive term created specifically by and used by some Native American communities. It refers to American Indian/Alaskan Native individuals who express their gender, sexual orientation, and/or sex/gender roles in Indigenous, non-Western ways, using tribal terms and concepts, and/or who define themselves as LGBTQ+, questioning, and intersex in a Native context. Often a person’s spiritual experiences or cultural beliefs are core to the formation of their two-spirit identity.

Agender: Individuals who do not identify as any gender.

Ally: A term relating generally to individuals who support marginalized groups. In the LGBTQ+ community, this term is used to describe someone who is supportive of LGBTQ+ individuals and the community, either personally or as an advocate. Allies include heterosexual and cisgender individuals (i.e., those who identify with the sex assigned to them at birth)

Asexual: Individuals who do not experience sexual attraction. An individual can also be aromantic, meaning that they do not experience romantic attraction.

Bigender: Individuals who identify as a person whose gender identity encompasses two genders (often man and woman, but not exclusively), or is moving between two genders

Bisexual: An individual who has the capacity to form enduring physical, romantic, and/or emotional attractions to those of the same gender or to those of another gender

Coming Out: The process through which youth identify, acknowledge, express, and share with others information about their sexual orientation and gender identity. This experience can be an affirming one, resulting in a sense of belonging, but it can also create stress in the life of youth and put them at risk for negative outcomes as a result of LGBTQ+ -related stigma and the responses and behaviors of others. This process includes coming out over time to oneself, to friends and other peers, at school, to family, at work, and in one’s community.

Gay: Individuals whose enduring physical, romantic, and/or emotional attractions are to people of the same sex.

Gender Identity: Our internal sense of being male, female, or another identity. Because gender identity is internal, it is not necessarily visible to others. “Cisgender” describes youth whose gender identity/expression does not differ from that typically associated with their assigned sex at birth. For example, a young person who was born as male and identifies as a man may be considered cisgender. In contrast, “transgender” (or “trans”) describes people whose gender identity/expression is different from that typically associated with their assigned sex at birth. A relatively small percentage of gender-variant children develop an adult transgender identity, but most adolescents with a gender-variant identity develop an adult transgender identity.

Gender Expression: How youth represent their gender to others. For example, individuals may express their gender through mannerisms, clothes, and personal interests. Our understanding of gender and what it means to be “masculine” and “feminine” is influenced by how we were socialized. For example, families, schools, and the media influence our understanding of gender. Research shows that children as young as two years old can identify a person’s sex based on how they present their gender, that by age three they can begin to see themselves as either male or female, and that around age nine they understand gender roles. For most youth, internal gender identity is reinforced by the reactions that others have to our gender expression. Other terms are sometimes used to describe one’s gender. For example, “gender fluid” or “gender creative” reflect a more flexible range of gender expression.

Genderqueer: Individuals who experience their gender identity and/or gender expression as falling outside the categories of man and woman.

Gender Variant: Individuals who do not follow gender stereotypes.

Intersex: An umbrella term used to describe people with differences in reproductive anatomy, chromosomes or hormones that don't fit typical definitions of male and female.

Lesbian: A woman who has romantic and/or sexual orientation toward women. Some nonbinary individuals also identify with this term.

Nonbinary: Individuals who experience their gender identity and/or gender expression as outside of the male-female gender binary.

Pangender: An individual whose gender identity and/or gender expression is numerous, either fixed (many at once) or fluid (moving from one to another, often more than two).

Pansexual: An individual who experiences sexual, romantic, physical, and/or spiritual attraction for members of all gender identities/expressions.

Queer: Historically, this has been a pejorative term used to describe LGBTQ+ people, but is now used by some people, particularly younger people, whose sexual orientation is not exclusively heterosexual. Some people may use queer, or more commonly genderqueer, to describe their gender identity and/or gender expression

Questioning: A term used to describe young people who are unsure about their sexual and/or gender identity.

Sex: Genetic and anatomical characteristics with which youth are born, typically labeled “male” or “female.” Some youth are born with a reproductive/sexual anatomy that does not fit typical definitions of “male” or “female.” This is sometimes referred to as “intersex.” Many medical and some advocacy communities now use the term “disorder” (or sometimes, “differences”) of sex development (DSD).

Sexual Orientation: A youth’s emotional, sexual, and/or relational attraction to others. For some, this attraction is to people of the opposite sex/gender (heterosexual), the same sex/gender (gay/lesbian), or both sexes/genders (bisexual) or to people in general independent of their sex/gender (pansexual or omnisexual). The term can also refer to low or non-existent attraction to any sex/gender (asexual).

Transgender: People whose gender identity differs from the sex they were assigned at birth. Many transgender people will transition to align their gender expression with their gender identity; however, a person does not have to transition to be transgender

Transsexual: An older term that was developed in the medical and psychological communities to describe individuals whose gender identity is different from the sex they were assigned at birth.

Transitioning: Transgender youth “transition” to express their gender identity through various changes, such as wearing clothes and adopting a physical appearance that aligns with their internal sense of gender. Transitioning may or may not include medical or surgical treatment and depends on a variety of factors, including age, access to and affordability of services, overall health, and personal choice. For transgender youth, transitioning is an important part of affirming their identity.