Affirming Mental Health Care for LGBTQ+ Adults and Teens

Being lesbian, gay, bisexual, transgender, queer, nonbinary, or questioning is not a mental health condition. But stigma, discrimination, rejection, and the strain of concealment, often called minority stress, can contribute to anxiety, depression, substance use, and trauma. Coming out, family conflict, and questions about identity can also bring real distress that deserves thoughtful care.

How our physicians help

Our physicians provide affirming care that treats the anxiety, depression, or other symptoms you came in with, not your identity. We take time to understand your relationships, work or school, and the stress you carry, and offer medication and psychotherapy from the same physician when they help. For teens, we work with parents, with the teen's input, to support connection and understanding at home.

How minority stress can show up

Minority stress is often quiet, and many people do not connect it to how they feel. In adults, it can look like this.

• You scan a room before deciding how much of yourself to show.
• You edit your stories at work or with family, such as leaving out a partner.
• You feel shame picked up from the world around you, even though nothing is wrong with who you are.
• News or public debates about LGBTQ+ people leave you tense, low, or unable to sleep.

What parents and teens may notice

These signs reflect what a teen is up against. They do not mean anything is wrong with who the teen is.

• Avoiding school, gym class, locker rooms, or bathrooms.
• Pulling back from friends, or sadness or irritability that does not lift.
• Big changes in sleep, eating, or grades.
• Saying they feel like a burden or that things will never get better. Take this seriously. If you fear for their safety, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service. If your teen talks about suicide or you fear for their safety, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

What a careful evaluation looks at

We are not evaluating your identity, and we do not assume it is why you came. You may be here for panic attacks or attention problems that have little to do with being queer or trans. Tell us the name and pronouns you use, and where it is safe to use them, and we will follow your lead. Prescriptions and some records may need your legal name.

We ask about mood, sleep, trauma, substance use, and safety so we can tell conditions apart. We also ask about every medication and supplement you take, including any hormones, so that what we suggest fits safely with the rest of your care.

Therapy, medication and what treatment cannot do

Psychotherapy is often central. Cognitive behavioral therapy (CBT) can help you question harsh beliefs absorbed from stigma, and affirming forms of it speak directly to minority stress. Trauma-focused therapy can help after bullying, assault, or family rejection.

Antidepressants are the most common medication for depression, anxiety, and post-traumatic stress disorder (PTSD). Expect to wait several weeks before judging how one is working. Side effects can include changes in sleep, weight, or sexual function. Teens and young adults need close follow-up early on, because some have more suicidal thoughts when starting one.

Treatment cannot remove prejudice or change a relative's mind, so we also look at what supports you, such as friends, partners, and chosen family.

When to reach out, and how to support someone

Reach out if low mood or worry has lasted more than a couple of weeks, if you avoid places because you do not feel safe, or if drinking or drug use is growing.

If someone has come out to you, listen first and thank them for telling you. Ask who else knows before you tell anyone. Steady acceptance from family can make a real difference for a young person.

If you or someone you love is thinking about suicide, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service. Many people who have felt this way go on to feel better with support.

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