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The chapter next examines contextual influences, such as demographic characteristics and the role of the family. Risk and protective factors and health services are then addressed in turn. The chapter then reviews the research on mental health and then physical health in these youth. This chapter begins with a discussion of the development of sexual orientation and gender identity in LGBT youth. As mentioned in previous chapters, 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 and throughout the life course. While the current state of knowledge regarding the health of LGBT youth is derived from limited research, it is worth noting that much of this research has focused on mental health little research has been conducted on the physical health of LGBT youth because, like most other youth, they generally do not struggle with chronic diseases that impact their physical health.
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These barriers have impeded important developmental research. Moreover, efforts to survey young people about their sexual orientation have been fraught with difficulties at both the institutional review board and community levels. Not long ago, for example, a prevailing notion was that one's sexual identity and orientation did not emerge until late adolescence and that an attraction to people of the same sex was likely a passing phase ( Money, 1990). One of the challenges of discussing the development of children and adolescents who are LGBT is that beliefs and biases have often precluded substantive research. The ability to address these disparities is hampered by our lack of knowledge about LGBT youth. LGBT youth face the same challenges as their heterosexual peers, but also stigma that may contribute to the identified disparities in health status between sexual- and gender-minority youth and heterosexual youth. The developmental changes that occur are complex, particularly with the onset of puberty. During this phase of life, a person, regardless of his or her sexual orientation or gender identity, develops from a child who must be cared for to a self-reliant individual. In this report, childhood and adolescence encompasses the life course through the emergence of adulthood, generally understood by the committee to occur in the early 20s.
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Moreover, transgender youth today have access to early medical intervention to alleviate any gender dysphoria (defined as discomfort with one's sex assigned at birth) they might experience. By contrast, many transgender children and adolescents today have role models (either in the media or in real life), and their gender-variant expression is often sufficient for parents to obtain more information and access existing networks of families with gender-variant children. Likewise, many transgender elders did not even know as children that other transgender people existed, and certainly received little acknowledgment of their transgender feelings. At the same time, young LGBT people searching the Internet and interacting with their peers will be aware of the pervasive negative views of sexual and gender minorities. Today's youth are able to use the Internet to retrieve online information about LGBT issues, providing social networking opportunities and access to knowledge in a way that was not available to older cohorts. Youth growing up today will see changes that earlier generations of lesbians and gay men would never have expected in their lifetimes, including politicians, business leaders, and educators who are openly gay marriage between same-sex couples and an evolving popular and artistic culture that provides many positive portrayals of lesbian and gay characters in movies and plays, on television, and in literature.
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To understand the context of a person's life course, it is critical to understand the age cohort to which that individual belongs.