LGBT stands for lesbian, gay, bisexual, and transgender and encompasses sexual and gender minorities. Homosexual individuals are attracted sexually to individuals of same sex. In the cases of males, they are commonly referred to as gays, and in the cases of females, gays or lesbians. Bisexual individuals are attracted sexually to individuals of both sexes. Transgender individuals have a gender identity that does not match their anatomical sex.
Homosexuality is not an illness. It is well recognized as a normal variant of human sexuality and many have normal mental health. Gender identity is usually established in toddlerhood and matches their biological sex most of the time. Many children exhibit gender-nonconforming behaviors that are thought to be part of normal development. A few, however, may develop strong discomfort with their natal sex and feel a persistent desire to become a different sex. Though controversial, DSM-5 includes criteria for gender dysphoria in children, adolescents, and adults.
How to diagnose/assess it?
The primary method to assess sexuality and gender identity is to interview the youths in an age-appropriate manner. Because family and community support may be variable, confidentiality is particularly important. LGBT individuals experience unique stressors which may explain increased risks for depression, anxiety, substance use, and suicide, and they should be screened regularly using validated measures. It is common for them to be bullied. Some may feel socially isolated and engage in high risk behaviors which may include risk of contracting HIV and other sexually transmitted illnesses.
What causes it?
The cause(s) of homosexuality, bisexuality, or gender dysphoria are not fully understood but evidence suggests strong biological factors. A person’s sexual orientation and gender identity are not matters of choice. Neither parenting behaviors nor caregivers’ sexual orientation/gender identity have been shown to be influential.
When to Refer/Seek Help
The goal is to nurture healthy psychosexual development in these youths. The integrated identity formation and adaptive functioning are the keys for healthy development. There is no evidence that sexual orientation can be changed through therapy or other types of treatment. Attempts to do so may be harmful.
When screening for depression, anxiety, substance use, and other high risk behaviors yield positive results, they should be addressed promptly. If they require significant care or have suicidal ideation, referral to mental health providers who are familiar with and comfortable treating those with sexual and gender minorities is helpful.
To find local providers, on the Find A Provider page of our Kid Catch website, we have a category under the Issues search filter for LGBT. Click on this filter to return search results of clinicians who advertise themselves as working with this population. Kid Catch cannot guarantee that clinicians who advertise themselves this way are truly expert with this group.
Youth with gender dysphoria require multi-disciplinary assessment and treatment that may include primary care, endocrinologists, urologists, gynecologists, surgeons, therapists and psychiatrists. Coordination of care is key.
For transgender issues, the World Professional Association for Transgender Health has information on a range of issues in the free Standards of Care which is available online http://www.wpath.org.
Additional Resources for Providers
A Practitioners Resource Guide: Helping Families to Support Their LGBT Children is a 15-page guide free from SAMHSA. It is not written in highly technical language and also be useful for parents. It can be downloaded at the bottom of this page.
AACAP Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents
AAP Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth
Additional Resources for Youths and Families
AACAP Facts for Families: Gay, Lesbian, and Bisexual Adolescents
AAP Gay, Lesbian, and Bisexual Teens: Facts for Teens and Their Parents
Parents, Families and Friends of Lesbians and Gays (PFLAG)
TransKids Purple Rainbow
Family Acceptance Project
- Updated July 24, 2019