understanding lgbtqia identities

Millions of Americans identify as LGBTQIA+. The acronym stands for lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other orientations that do not fit within these categories.

According to a February 2021 Gallup poll, 5.6% of American adults identify as LGBT — up from 4.5% in a 2017 poll. A September 2020 analysis by the UCLA School of Law’s Williams Institute estimated 9.54% of American youths identified as LGBT.

Kacie Kidd, MD, adolescent medicine fellow, UPMC Children’s Hospital of Pittsburgh, conducted a study on gender diversity in Pittsburgh area public high schools. According to the study, which appeared in the journal Pediatrics in June 2021, almost 10% of the high schoolers surveyed identified as gender diverse.

It is important to respect and honor people’s sexual orientation and gender identity and expression. Doing so helps create an atmosphere of inclusion and respect. The process begins with understanding what it means to be LGBTQ.

UPMC Children’s Hospital of Pittsburgh put together a list of definitions and key concepts for sexual orientation, gender identity, and gender expression. Following are some key terms and resources to help you become better informed.

What Is Sexual Orientation?

Sexual orientation describes to whom a person is sexually attracted. Some people are attracted to people of a particular gender. Others are attracted to people of more than one gender. Some people are not sexually attracted to anyone.

Examples of sexual orientation include:

  • Asexual (ace): No sexual attraction to anyone and/or no desire to act on sexual attraction to anyone. An asexual person may still choose to engage in sex. Asexual people sometimes do experience emotional or romantic attraction.
  • Bisexual (bi): Sexual attraction to one’s own gender and people of other genders. There is a misconception that bisexual people are attracted to anyone and everyone, or that they just haven’t “decided.”
  • Gay: Generally a man who is attracted to other men. This term sometimes also refers to anyone who is attracted to people of the same gender.
  • Lesbian: Generally a woman who is attracted to other women. This term also is used by others within the LGBTQIA+ umbrella.
  • Pansexual (pan): Sexual attraction to people regardless of sex or gender identity. Sometimes also known as “omnisexual.”
  • Polysexual (poly): Sexual attraction to people of many/most genders.
  • Straight: Also known as “heterosexual”, this term refers to someone attracted to people of the opposite binary sex (male and female).

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What Are Gender Expression and Gender Identity?

Although they may seem similar, gender expression and gender identity refer to two different ideas.

Gender identity is a person’s internal sense of self with regard to gender. Gender identity can either match or not match a person’s sex/gender assigned at birth. Gender identity begins to develop in early childhood (from the age of 2, in some cases). It is usually firmly established by the start of puberty.

Gender identity terms include:

  • Cisgender (cis): Someone whose gender identity matches their sex assigned at birth.
  • Gender binary: A gender classification system in which all people are categorized as either male or female. In a binary system, gender identity is expected to align with a person’s sex assigned at birth.
  • Gender dysphoria: A feeling of distress that can happen in people whose gender identity does not match their sex assigned at birth.
  • Genderfluid: Gender identity that varies over time. A genderfluid person’s identity may change regularly, so it’s always best to ask what it is at that moment.
  • Nonbinary: An umbrella term used to describe people who do not identify exclusively as male or female. Some consider themselves as having a mix of masculine and feminine traits. Others have a gender identity that is completely outside the binary gender spectrum.
  • Transgender (trans): Someone whose gender identity differs from their assigned sex at birth. This is used as the primary umbrella term to describe people with a range of gender-diverse identities or expressions, regardless of whether they choose to transition.

Gender expression is the way a person expresses their gender, including:

  • Appearance (clothing, hairstyle, jewelry, makeup, tattoos).
  • Presentation (mannerisms, body language).
  • Social behavior.

Typical gender expression may be based on social or cultural expectations for binary gender roles (masculine or feminine) or may be androgynous/gender-neutral.

Gender expression terms include:

  • Androgyny: A mode or style of expression that combines a mix of masculine and feminine characteristics. It also may lack gender-specific characteristics, such as nongendered (unisex) or gender-neutral clothing.
  • Gender expansive and gender diverse: Applies to someone who gender expression does not conform to binary gender social “norms.” These terms should be used in place of gender nonconforming.
  • Gender transition: The process of changing one’s gender expression or sex characteristics to align with their gender identity. This can include social transitioning — telling other people, changing names or pronouns, or changing appearance (such as clothing). It also can include medical transitioning: taking puberty blockers, using hormone therapy, or undergoing surgery.
  • Pronouns: Common pronouns are the binary she/her/hers or he/him/his, and the nonbinary they/them/theirs. Gender diverse people — especially those who are nonbinary — can have many other pronouns. A person’s pronouns are not optional; if known, use the chosen pronouns.

Other Important Terms and Concepts

  • Coming out: The process of acknowledging a person’s sexual orientation and/or gender identity or expression to themselves or to other people.
  • Queer: Historically a derogatory term, this label has been reclaimed by some (especially younger) LGBTQIA+ individuals. It is an umbrella term that embraces an array of sexual preferences, gender identities, and expressions/habits that are not of the heterosexual, heteronormative, or binary-gender majority. This term can be considered offensive when used by people who are not part of the LGBTQ+ community, especially older members.
  • Questioning: A person who may be unsure of, seeking to understand, reconsidering, or choosing to hold off identifying their sexual orientation, gender identity, or gender expression.

What Is an LGBTQ Ally?

Even with the growing numbers of people who identify as LGBTQIA+, discrimination still exists. Homophobia, biphobia, and transphobia refer to the fear and hatred people express to gay, bisexual, and transgender people.

Members of the LGBTQ community are at risk of experiencing hate crimes. According to an FBI report, sexual orientation was the basis for 16.7% of hate crimes in 2019. Gender identity was the basis for 2.7% of hate crimes.

LGBTQ youths consider and attempt suicide at higher rates than heterosexual youths, according to the Trevor Project.

Respecting and supporting people who are LGBTQ is important for creating a more inclusive society. Allies are those who support the LGBTQIA+ community (attending Pride events, assisting in advocacy/education, etc.). Some allies are also activists, sometimes called “accomplices.” Accomplices work to change the cultural norms and laws that marginalize and oppress the LGBTQIA+ community.

It is vital that allies take their lead from those with lived experiences in order to keep the focus on the community and its causes.

GLAAD (previously the Gay & Lesbian Alliance Against Defamation) outlines 10 ways to be a good ally. Examples include being a good listener, being open-minded and willing to talk, and speaking out and/or acting when you see or hear discriminatory behavior.

Part of being a good ally is recognizing that everyone is different. Others may not conform to the same behaviors as you, and that’s OK. Do your best to create an inclusive environment by treating everyone with dignity.

Something as simple as using someone’s pronouns lets them know you respect their identity. Transgender and nonbinary youths who reported that their pronouns were respected attempted suicide at half the rate of those whose pronouns were not, according to a Trevor Project survey.

Resources for LGBTQIA+ Patients and Caregivers

UPMC is committed to providing an inclusive, welcoming environment for everyone in our communities. That includes providing easy, equal access to care and to resources that can help them in their patient journeys.

The Human Rights Campaign has recognized more than 20 UPMC hospitals for LGBTQ health care equality. We offer many different services and support for LGBTQIA+ patients and their caregivers.

For more information about our services or to get connected, email LGBTQHealth@upmc.edu or visit us online. The Gender and Sexual Development Program at UPMC Children’s Hospital of Pittsburgh has resources for both parents and youths.

If you are experiencing an emergency, call 911 or go to your nearest Emergency Department. If you are an Allegheny County resident experiencing a behavioral health crisis, call resolve Crisis Services at 1-888-796-8226 (1-888-7-YOU CAN).

Sources

Kerith J. Conron, UCLA School of Law Williams Institute, LGBT Youth Population in the United States. Link

GLAAD, 10 Ways to Be an Ally and a Friend. Link

Human Rights Campaign, Glossary of Terms. Link

Human Rights Campaign, New FBI Hate Crimes Report Shows Increases in Anti-LGBTQ Attacks. Link

Jeffrey M. Jones, Gallup, LGBT Identification Rises to 5.6% in Latest U.S. Estimate. Link

The Trevor Project, Facts About Suicide. Link

The Trevor Project, National Survey on LGBTQ Youth Mental Health 2020. Link

Laurel Wamsley, NPR, A Guide to Gender Identity Terms. Link

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 700 doctors’ offices and outpatient centers, with locations in central and western Pennsylvania, Maryland, New York, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals.