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Depression and Suicidality Over the past decade, an increasing number of studies based on large probability samples have consistently found that LGB youth and youth who report same-sex romantic attraction are at increased risk for suicidal ideation and attempts, as well as depressive symptoms, in comparison with their heterosexual counterparts.

Obesity Childhood obesity rates have risen dramatically in the United States in the past few decades Ogden et al. Transgender-Specific Physical Health Status Although some literature addresses the process of gender identity development among transgender youth, little of this literature is supported by empirical evidence or longitudinal data.

Risk Factors Risk factors affecting the health of LGBT youth examined in the literature include harassment, victimization, and violence; substance use; homelessness; and childhood abuse. Harassment, Victimization, and Violence Compared with heterosexual youth, LGBT youth report experiencing higher levels of harassment, victimization, and violence, including verbal, physical, and sexual abuse.

Substance Use Disparities in rates of substance use exist between LGB and heterosexual youth, with sexual minority youth reporting increased substance use and initiation of use at younger ages Corliss et al. Homelessness Lesbian , gay, and bisexual youth are disproportionately represented among the homeless youth population.

Protective Factors While some may view the absence of risk factors as protective, there is, as noted earlier, a paucity of data on specific protective factors that affect the health of LGBT youth. Access and Utilization With the recent implementation of health care reform, access to health services has increased for many youth since they can now be covered under their parents' insurance until age Quality of Care Studies utilizing convenience samples of LGBT youth show that they value the same health provider characteristics as other youth. Sociodemographic Factors Few recent population-based studies have published substantive sociodemographic findings on LGBT youth.

Familial Factors Although connections to family have been shown to be protective against major health risk behaviors, the literature on LGB youth and families has been very limited in scope and quantity, and has focused mainly on negative aspects of the relationships between LGB youth and their parents.

Development of Sexual Orientation and Gender Identity As a result of the ongoing process of sexual development and awareness among adolescents, self-identification of sexual orientation and the sex of sexual partners may change over time and may not necessarily be congruent.

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Some research examining sexual identity development among ethnically diverse sexual-minority adolescents suggests that the process may differ as adolescents negotiate both ethnic and sexual orientation identity. A relatively small percentage of gender-variant children may develop an adult transgender identity. Gender-variant children may have more difficulties with peer relationships and behavioral problems than non-gender-variant children. Mental Health Status LGB youth are at increased risk for suicidal ideation, attempted suicide, and depression.

This increased risk appears to be consistent across age group, gender, race, and self-identified orientation.

A few studies with small nonprobability samples suggest the same is true for transgender youth. Potential risk factors for increased rates of suicidal ideation and suicide attempts specific to LGB youth include sexual-minority status, homophobic victimization and stress, and family rejection. A few studies show that LGB youth may demonstrate higher rates of disordered eating than heterosexual youth. Physical Health Status Pregnancy rates may be the same or possibly even higher for lesbian and bisexual girls than for heterosexual girls.

Self-identified sexual-minority females may have elevated BMIs relative to their heterosexual peers. While GnRH analogs may be used to alleviate gender dysphoria among adolescents, a paucity of empirical data exists concerning how these medical interventions affect overall physical health and well-being. The burden of HIV infection falls disproportionately on young men who have sex with men, particularly young black men who have sex with men.

These racial disparities are likely due to the intersection of race, sexual orientation, and other social determinants. Additionally, interventions are lacking for this group of LGBT youth. Limited studies suggest that male-to-female transgender youth may face a risk for HIV similar to or even higher than that faced by young men who have sex with men. Risk and Protective Factors LGBT youth report experiencing elevated levels of harassment, victimization, and violence. School-based victimization due to known or perceived identity has been documented, although very little literature exists on violence experienced by young lesbians, bisexual women, or transgender people.

Compared with other students, sexual-minority youth may be more likely to report feeling unsafe at school, being offered weaker support by school staff, and receiving lower grades. Rates of substance use, including smoking and alcohol consumption, may be higher among LGB than heterosexual youth.

Few interventions have been developed to address these disparities. The homeless youth population comprises a disproportionate number of LGB youth. Some research suggests that young transgender women are also at significant risk for homelessness. There are almost no data on homelessness among young transgender men.

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Interventions designed to decrease homelessness are lacking, and limited research on the specific health needs of homeless LGBT youth has been conducted. The prevalence of childhood abuse may be higher among sexual-minority youth compared with their heterosexual peers. The few studies that have examined protective factors for LGBT youth suggest that family connectedness and school safety are two possible areas for intervention research.

Limited studies evaluating the impact of school polices on the experiences of LGB students indicate that students attending schools with antiharassment policies report that they feel safer and are less likely to be harassed. Family acceptance among LGBT youth may be a protective factor against depression, substance use, and suicidal ideation and attempts.

Small studies suggest that many LGB youth have not disclosed their sexual orientation to their physician. Similarly, there appears to be some unease among physicians about addressing sexual orientation with their adolescent patients.

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Studies with small samples suggest that sociodemographic factors, including race, ethnicity, geography, religion, and socioeconomic status, play a role in the lives of LGBT youth. While research on families suggests that family support may be protective, most research has focused on negative interactions with families. Results of this research suggest that family rejection may be associated with negative mental health outcomes. Research Opportunities Research on all adolescents, regardless of their sexual orientation or gender identity, is limited.

These parameters could be brought to bear in research in the following areas: Demographic and descriptive information , including the percentage of adolescents who are LGBT and how that percentage varies by demographic characteristics such as race, ethnicity, socioeconomic status, geography, and religion; also, the general experiences and health status of LGBT adolescents and how these vary by demographic characteristics.

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Family and interpersonal relations , including the family life of LGBT youth from diverse backgrounds e. Health services , including barriers to access particularly related to identity disclosure and interactions with providers , utilization rates, and quality of care received. Mental health , including the diagnosis of disorders among LGBT youth, their rates of suicidal behavior and suicidality, identity-related issues and experiences of stigma and discrimination, and eating disorders.

Physical health , including obesity and substance use including smoking and alcohol use. Sexual and reproductive health , including sexual development, sexual health, reproductive health, risk behaviors, pregnancy, STIs, and HIV rates and interventions with a focus on natural history studies of high-risk groups.

Transgender -specific health care , including the effects, benefits, and risks of puberty-delaying hormone therapy. Sexual behaviors and risks among bisexually- and gay-identified young Latino men. Adolescent health care experience of gay, lesbian, and bisexual young adults. Journal of Adolescent Health. Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation.

PMC ] [ PubMed: Health care needs of the homosexual population AMA policy regarding sexual orientation. American Psychiatric Association. Therapies focused on attempts to change sexual orientation reparative or conversion therapies: Position statement. Washington, DC: American Psychiatric Association; American Psychological Association. Report of the task force on appropriate therapeutic responses to sexual orientation.

American Psychological Association; Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Sexual orientation, weight concerns, and eating-disordered behaviors in adolescent girls and boys. American Journal of Public Health. Sexual orientation disparities in purging and binge eating from early to late adolescence. Sexual orientation disparities in weight status in adolescence: Findings from a prospective study.

Benestad EEP. Addressing the disturbed, like ripples in water: Intervention with the social networks of children who transe. Sexual and Relationship Therapy. LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay-sensitive HIV instruction in schools.

Bockting WO, Ehrbar R. Gender variance, dissonance, or identity disorder.

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    Homosexual identity formation: A theoretical model. Morbidity and Mortality Weekly Report. Sexual and reproductive health of persons aged 10—24 years—United States, — Child Welfare League of America. Out of the margins: A report on regional listening forums highlighting the experiences of lesbian, gay, bisexual and transgender youth in care.

    Child Welfare League of America; Substance use, substance choice, and unprotected anal intercourse among young Asian American and Pacific Islander men who have sex with men. Homelessness and drug abuse among young men who have sex with men in New York City: A preliminary epidemiological trajectory. Journal of Adolescence. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Challenges faced by homeless sexual minorities: Comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts.

    Sex reassignment of adolescent transsexuals: A follow-up study.

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    Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. Journal of Abnormal Child Psychology. The treatment of adolescent transsexuals: Changing insights. The Journal of Sexual Medicine. The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health. Age of minority sexual orientation development and risk of childhood maltreatment and suicide attempts in women.

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