Sexual orientation and gender 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.1 Expressing and exploring gender identity and roles is also a part of normal development.2 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
Unfortunately, lesbian, gay, bisexual, and transgender (LGBT) youth 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 LGBT or gender variant by others.4 A landmark 2011 Institute of Medicine (IOM) report reviewed research on the health of LGBT individuals, including youth. Although this research is limited, the IOM report found that “the disparities in both mental and physical health that are seen between LGBT and heterosexual and non-gender-variant youth are influenced largely by their experiences of stigma and discrimination during the development of their sexual orientation and gender identity.”5 These negative experiences include high rates of physical and emotional bias and violence; rejection by families and peers; and inadequate supports in schools, employment, and communities because of their sexual orientation and gender identity/expression.
Stress associated with these experiences can put LGBT young people at risk for negative health outcomes. Research shows that due to these environmental challenges, LGBT youth are at risk for negative health outcomes and are more likely to attempt suicide, experience homelessness, and use illegal drugs.6 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.7 They are also at risk for school victimization.8 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.9
To date, most research on LGBT youth has focused on the risk factors and disparities they experience compared with youth who are not LGBT. However, emerging research on resiliency and protective factors offers a strength-based focus on LGBT youth well-being. Addressing LGBT-related stigma, discrimination, and violence; building on the strengths of LGBT youth; and fostering supports such as family acceptance and safe, affirming environments in schools and other settings will help improve outcomes for LGBT young people. Federal and local policies and practices increasingly acknowledge and focus on the experiences and needs of LGBT youth. Numerous national advocacy and other organizations are also giving greater attention to LGBT youth in their work.10 Fostering safe, affirming communities and youth-serving settings such as schools for all youth requires efforts to address the challenges described here. At the same time, it is also important to acknowledge and build on the strengths, resilience, and factors that protect LGBT youth from risk, such as connection to caring adults and peers and family acceptance.
1 Institute of Medicine, 2011; Poirier, Fisher, Hunt, & Bearse, 2014
2 Institute of Medicine, 2011; Poirier, Fisher, Hunt, & Bearse, 2014
3 Poirier, Fisher, Hunt, & Bearse, 2014
4 Gender variant youth are not necessarily LGBT. In fact, any youth who does not fit typical social expectations for his or her mannerisms, behavior, or choice of clothing based on birth-assigned gender, for example, can be considered “gender variant.” This does not mean the youth is lesbian, gay, or bisexual—or identifies as a gender different from what he or she was assigned at birth (i.e., transgender).
5 Institute of Medicine, 2011, p. 142
6 Hunter & Schaecher, 1987; Reis, 1999; Reis & Saewyc, 1999; Ray, 2006; Ryan, Huebner, Diaz, & Sanchez, 2009; SAMHSA, 2014
7 Roberts, Rosario, Corliss, Koenen, & Austin, 2012
8 Toomey, Ryan, Diaz, & Russell, 2010
9 Rieger & Savin-Williams, 2012
10 American Association of School Administrators et al., n.d.; National Association of School Nurses, 2003; National Association of School Psychologists, 2006