How to Handle Lesbian, Gay, Bisexual, and Transgender Health Issues

This guide equips prevention professionals, healthcare providers, and educators with information on current health issues among lesbian, gay, bisexual, and transgender (LGBT) populations. Includes an overview of terms related to gender identity and sexual expression.

This guide is designed for a wide-range of organizations and individuals that serve LGBT populations across the country. These include prevention specialists working in State, Territorial, and Tribal community-based organizations; behavioral healthcare providers; medical and other allied health professionals; health educators, technical assistance providers; and LGBT individuals. This guide may be used by individuals or groups in educational outreach programs to raise awareness of the physical and behavioral health status and needs of LGBT populations.

For many, the acronym LGBT reflects a community of individuals who, in some way, are attracted to members of the same sex. However, many people fail to realize that the “T” in the acronym does not relate to sexual attraction at all; rather, it refers to a person’s sense of gender (referred to as gender identity).

The Formation and Role of Gender Identity

There are several schools of thought or theories about how a person develops, accepts, and expresses their gender identity. These include, but are not limited to, psychoanalytic theories, gender essentialism, cognitive development theories, and gender schema theories, among many others. While not exhaustive, the following is a brief overview of some of these perspectives.

Before the 19th century, the terms gender and sex were synonymous, as these were based on an exclusive binary paradigm (i.e., male/female). Until then, the only determinant of gender was a person’s assigned sex at birth. However, in the mid-1920s, German sexologist Magnus Hirschfeld published an article making the first differentiation between the desire for same-sex acts and the desire to live and/or dress as the opposite sex.

It wasn’t until the 1950s that the concepts and theories about gender, gender roles, and gender identity were introduced and defined in the literature. Psychologists, such as Jerome Kagan and John Money, initially believed that gender identity was the extent to which a person felt masculine or feminine.

During the mid-1960s to early 1980s, researchers such as Richard Green, Robert Stoller, Harry Benjamin, and Sandra Bem furthered the understanding of gender and gender identity. The ongoing work of these and other pioneer researchers in the field of gender identity development raised awareness that gender is not exclusively determined by a person’s by an assigned sex at birth, but also by their choices of sense, belief, and expression of self.

A 2011 study by psychiatrist Robert Spitze suggests that some people who are highly motivated may be able to change their sexual orientation. Some results were that 200 individuals surveyed through a telephone interview claim to have changed their sexual orientation.

Prevention specialists and healthcare providers should be aware that beliefs around gender can, and often do, affect and even create many gender-related aspects of life. These beliefs can manifest in a number of areas ranging from reactions toward clothing individuals wear to the pronouns used during clinical assessments. It is important for providers to demonstrate sensitivity to all clients, regardless of perceived gender, when communicating to and/or about clients.

The full kit may be downloaded or ordered at Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).