Page numbers printed in boldface type refer to tables and figures.
Acebook,146
ACT UP,87
Addiction.
See Substance use
Adolescents,31–32.
See also Children
asexual,155
communicating with about sexuality,118
with DSD,140
pediatricians and LGBTQ+ teenagers,118
questioning,114
Ag/aggressive,3, 89
Agingbaby boomers and,56
bisexual individuals and,56
gay men and,41–42
questioning and older adults,122–123
transgender individuals and,74–75, 77–78
AIS.
See Androgen insensitivity syndrome
Alcoholics Anonymous,37
Alloromantic,148
Allosexual,145
Allyaddressing anti-LGBTQ+ behavior,182
equality versus equity,184,
185in everyday life,182
LGBTQ+ friendly environment and,183
meaning of term,183
privileges of,178
psychological and cultural context,177–181
self-awareness of,184, 186
support from,180–183
talking about LGBTQ+ issues and,182
5-alpha-reductase deficiency,131
Ambiguous genitalia,129–135
See also Disorders of sex development
Androgen insensitivity syndrome (AIS),131–132
Androgynous,63Aromantic,148
asexual, distinct from,157
patterns of romantic orientation,149Asexualityadolescents and,155
and allosexuality, difference between,145
autism spectrum disorder and,156
categorization of,147–148
as distinct from aromanticity,157
celibacy, confusion with,148
coming out,154, 155
current issues,151–152
dating,155
definitions,63,
115DSM-5 recognition of,147–148
gray-sexual,151
history,145–146
Kinsey sexuality orientation scale,146Storms sexuality orientation scale,147hostility from LGBTQ+ community,152
and HSDD, differences between,147
identification scale items,150mental health and illness,155–156
model of,146,
147overview,145
patterns of romantic orientation,149psychological and cultural context,145–152
research,148–151
romantic relationships and,154
self-identification,152–153
sexual behavior and,156
and sexual dysfunction, difference between,153–154
Asexual Community Survey,151
(A)sexual (2011 documentary),146
Asexual Visibility and EducationNetwork (AVEN),146
AVEN.
See Asexual Visibility and Education Network
Baby boomersaging of,56
coming out,54
BDSM (bondage and sadomasochism)and abuse, differences between,97
definition of,18
participation in,97–98
queer individuals and,91–92, 96–97
Bisexualityaging and,56
in binary and nonbinary terms,161–162
coming out,53–54
definitions,3,
63,
115gender distribution of,51–52, 53
history of,48–50
identity and,52
oppression and,52–53
and pansexuality, differences between,165–167, 175
parenting and families,55–56
psychological and cultural context,47–50
race and intersectionality,54
sexuality and relationships,55
stigma and,57
substance use,54, 57
as umbrella term,166
Bi-curious,3, 6,
115Bi-erasure,51, 57
Bigender,115Biological sex,62, 63.
See also Sex
Bi/panromantic, patterns of romantic orientation,149Bi/pansexual, patterns of romantic orientation,149Biphobia,51, 57
Biromantic,148
Blanchard, Rowan,90
BlaQ,2, 3
BlaQueer,2, 3
BoJack Horseman (TV show),146
Bullyingof gay men,23
of lesbians,9
CAH.
See Congenital adrenal hyperplasia
Case examplesof black midwestern trans identity,102–103
of open relationship,95
of polyamorous relationship,95–96
of rural white queer identity,102
CDC.
See Centers for Disease Control and Prevention
Centers for Disease Control and Prevention (CDC),53
Chicago Consensus,129, 131
Children.
See also Adolescents; Disorders of sex development
cognitive label as “boy” or “girl,”130
coming out,10
communication about sexuality,117
gay behavior among,31–32
genetically XY,130
questioning sexuality,117
same-sex parents and,13
sex assignment of neonates,131
Chromosomal sex,62, 63
Cisgender,3, 18, 61
62cisnormativity,89
cis women,5–6
pronouns and,92
Clinic, LGBTQ+ friendly,183
COLAGE,13
Coming outas an ally,182
asexual individuals and,154, 155
baby boomers and,54
bisexual individuals and,53–54
children of LGBTQ+ parents,10
as gay,24, 26, 32–33
as lesbian,5, 9–10
process of,53–54
safety and,120
as transgender,75–76
Communication.
See also Language
as an ally,180–181, 182
and parents of questioning children,117
judgment-free,15
Congenital adrenal hyperplasia (CAH),131, 139
Consensual non-monogamous relationships,95
Conversion therapy,26, 37–38, 81, 101
Countertransferencepansexual individuals and,168–170
transgender individuals and,81–82
Crystal meth (methamphetamine),37
Cyrus, Miley,164
Datingasexual individuals and,155
transgender community and,76–77
Demiromantic,6
Demisexual,3–4
Diagnostic and Statistical Manual of Mental Disorders (DSM)diagnostic criteria for disorders of sex development,63
diagnostic criteria for gender dysphoria,66
diagnostic criteria for homosexuality,38
diagnostic criteria for intersex,63
diagnostic criteria for paraphilic disorder,97
homosexuality described in,38, 90
recognition of asexuality,147–148
removal of homosexuality from,38, 123
Dietrich, Marlene,173
Differences of sex development.
See Disorders of sex development
Discriminationagainst gay men,2
institutionalized heterosexism,186
against lesbians,15
against transgender individuals,74
Disorder of sex development (DSD).
See also Intersex
in adolescents,140
androgen insensitivity syndrome (AIS),131–132
biological, psychological, and cultural context,130–132
congenital adrenal hyperplasia (CAH),131, 139
as condition versus characteristic,132–133
diagnosis of,137–138, 140–141
DSM-5 diagnostic criteria for,63
evolution of clinical understanding of,129–130
fertility and,138–139
gender identity and sexual orientation,137
gender transitioning,134–135
groupings of,131
history of,128–129
incidence of,131–132
in neonates,142
nomenclature of,134–135, 141–142
nongendered language,135–136
overview,127–128
patient-centered approach to,142
psychoeducation about,136–137
public awareness of,132
self-identification of,138
sex assignment of neonates,131, 142
sex development and,136
transgender, confusion with,135
Dopamine,151
Double minority status,40
Down low (DL),x, 19, 54
Drugs.
See also Substance use
lack of sexual desire as side effect,155–156
DSD.
See Disorder of sex development
DSD-LIFE study,135
DSM. See Diagnostic and Statistical Manual of Mental DisordersFalse self phenomenon,23
Familybisexuals and,55–56
of choice,42, 75, 78
conflict between queer individuals and,103
DSD and,138–139
intersex children and,135–136
lesbians and,11
queer individuals and,94–95
transgender individuals and,77–78
Family Equality,13
Female to male (FTM),64
Femininity,63Femme,4, 6, 19
Fertility, DSD and,138–139
Foucault, Michael,48
Freud, Sigmundon homosexuality,47, 49–50, 51
on identity,49–50
on questioning sexuality,110
Friend of Dorothy,19, 22
Fryer, John (Dr. H. Anonymous),38
FTM.
See Female to male
Garland, Judy,22
Gay-affirming therapy,38
Gay civil rights movement,22, 33, 50
Gay menaging and,41–42
body image and,34–35
bullying and,23
in childhood and adolescence,31–32
gay civil rights movement and,22, 33, 50
coming out,24, 26, 32–33
conversion therapy,26, 37–38
definitions,4, 19,
115discrimination against,2, 28
family of choice and,42
gay-affirming therapy,38
gender identity,18, 24
health care and,30–31
history of,17, 21–23
HIV/AIDS and,27, 35–36
internalized homophobia and,30
labeling of,36–37
marriage and,29
mental illness and substance use,29–30
oppression and,30
as parents,28, 39–40
PrEP use,27–28, 36
promiscuity and,27
psychological and cultural context,17–21, 23–24
race and,40–41
religion and,26–27, 38–39
sexual behavior,28–29, 33–34
sexual orientation,24, 25–26
spirituality and,38–39
substance use,36–37
terminology,18–21
visual stereotypes,26
Gay-related immune deficiency (GRID),22, 35.
See also HIV/AIDS
Gender.
See also Transgender individuals
expression of,7
gender neutrality and queer individuals,89
pansexual individuals and,168
society’s understanding of,x
Gender affirmation,64
hormone replacement therapy,66–67
surgeries,73–74
treatments,66–67
Gender dysphoria,65–66
diagnosis of,67
distinction between assigned and identified gender,83
DSD and,134–135
DSM-5 diagnostic criteria for,66
Gender expression,63, 64
Gender identity,62, 64, 88,
115, 133, 178
definitions,63–64, 92
DSD and,137–138
fluidity of,64, 67, 77
and gender presentation, distinction between,94
importance of for health care,68
nonbinary,135
pansexual individuals and,168
and sexual orientation, in intersex individuals,5, 24, 75, 137–138
social learning theory of,128–129
sociocultural relationships and,137
Gender pronouns,65, 68,
66Genderqueer,3, 62, 64,
115, 166
Gittings, Barbara,38
Goodridge v. Department of Public Health,22–23
Gray-sexual,151.
See also Asexual
GRID (gay-related immunedeficiency),22, 35.
See also HIV-AIDS
Health careasexual individuals and,155–156
gay men and,30–31, 43
LGBTQ+ individuals and,31, 74
transgender individuals and,70–71, 79, 80
Heteroflexible,6, 19
Heteronormativity,184, 186
Heteroromantic, patterns of romantic orientation,149Heterosexual,63patterns of romantic orientation,149HIF model,112
HIV/AIDS,35–36.
See also Pre-exposure prophylaxis
gay men and,27, 35–36
emergence of epidemic,22
stigma about,35–36
transgender individuals and,78–79
treatment for,35
Homonormativity,89
Homophobia,19, 118
internalized,20, 30, 43
Homoromantic,148
patterns of romantic orientation,149Homosexuality,9,
63DSM description of,90
DSM diagnostic criteria for,38
Freud on,47
negative attitudes toward,39
as offensive term,89–90
patterns of romantic orientation,149removal of terminology from DSM,123
Hormone replacement therapy (HRT)age at which to start therapy,71
contraindications for,72
effects and side effects,71–72, 83
role of psychiatrist in care of transgender individuals 69for treatment of gender affirmation,66–67
HRT.
See Hormone replacement therapy
HSDD.
See Hypoactive sexual desire disorder
Hypoactive sexual desire disorder (HSDD),147.
See also Asexual
Identityand bisexuality,52
challenges of,87
Freud on,49–50
health implications of questioning,116–117
Intergender,115Internalized homophobia,20, 24, 30, 43
Internalized queerphobia,100
Intersectionality,14, 54, 80, 82, 102, 136, 141
Intersex.
See also Disorder of sex development
ambiguous genitalia and,129–135
biological, psychological, and cultural context,130–132
description of,63
DSD diagnosis,139–141
DSM diagnostic criteria for,63
evolution of clinical understanding in DSD,129–130
family and,135–136
fertility, relationships, and family,138–139
flag,133gender dysphoria and,134–135
gender identity and,137–138
history of,128–129
John/Joan case,128, 130
negative connotations of,133
overview,127–128
psychoeducation about,136–137
psychological and cultural context,127–132
self-identity as,133
sex development,136–137
sexual orientation,137–138
shame, coping with,139–140
terminology,132–134, 135–136
Intersex Awareness Day,132
Intersex Day of Remembrance,132
Intersex Human Rights Australia,132,
133Jennings, Jazz,164
John/Joan case,128, 130
Kameny, Frank,38
Kink,20
in queer relationships,96, 97
Kinsey, Alfred,145–146,
146on bisexuality,50, 57
Kinsey scale,111Kiyoko, Hayley,5
Klein Sexual Orientation Grid,110–111
Klinefelter syndrome,138
Language.
See also Communication
derogatory,8
gender pronouns,65,
66, 68
nongendered,135–136
queer as pronoun versus noun,91, 92
respectful,8
Legal issuessame-sex couples’ right to marry,12
transgender individuals and,73, 79
Lesbiansaddiction and,8
bullying and,9
coming out,5, 9–10
death and dying,10–11
definition of,115discrimination against,15
end-of-life issues for,10–11
family and,11
gender expression,7
identity label,2
identity terms,6
interpersonal violence and,11–12
legal issues and,12
origin of word,2
psychological and cultural context,1–4
race and,5, 14
religion and spirituality,13
right to marry,12
same-sex parenting,13
sexual orientation and gender identity,5–6, 7
stress and,12
suicide and,14
support for,7–8
terminology,3–4
women of color,14
LGBT History Month,116
LGBTQ+ communityasexual individuals and,152
fitting in,116
pansexual individuals and,171, 173–174
stereotypes of,116
LGBTQ2IA identity,ix
LGBTQ+ individualsdiscrimination and,179
health care and,74, 31, 179–180
history of,2
living in the closet,x
parental rights of,28
in the community,76
risks for mental health problems,82, 178
safety risks and,179
terminology,62–
63Male to female (MTF),64
dating challenges of,77
Marriageamong gay men,29
same sex,1–2, 12, 22–23
Masculinity,63Mental healthof asexual individuals,155–156
culturally competent care for queer individuals,105
comorbidities in transgender care,70, 83
of gay men,29–30
of transgender individuals,79–80
Mercury, Freddie,173
Methamphetamine (crystal meth),21, 37
Minority stress model,54, 70, 118–119, 170–172
Monáe, Janelle,90, 164
Monogamybisexual individuals and,55
pansexual individuals and,167
Morales, Natalie,90
MTF.
See Male to female
Obergefell v. Hodges,12, 23
Omnisexual,6, 89
Oppressionof bisexual individuals,52–53
of gay men,29–30
Oxytocin,151
Pansexualityacceptance of,164
attraction to others,167–168
and bisexuality, differences between,165–167, 175
celebrities identifying as pansexual,164
community support for,164
countertransference,168–170
definitions,4,
63, 159–160, 162–163
gender and,168
generation Z and,164
icons of,173
meanings of,163
millennials and,164
minority stress and,170–172
misconceptions about,164–165
monogamy and,167
nonbinary terms,161–162
overview,160
partners’ concerns,173
psychological and cultural context,159–160
rejection by LGBTQ+ community,171, 173–174
relationships and invisibility,172–174
sexual behavior,167
in therapy,173
Panromantic, patterns of romantic orientation,149Pansexual Day of Visibility,174
Pansexual Pride Day,174
Paraphilic disorder, DSM diagnostic criteria for,97
Parentsbisexuals as,55–56
gay men as,28, 39–40
of asexual children,154
of intersex children,133–134
same-sex,13, 40
Phalloplasty,73
Placental aromatase deficiency,131
Polyamory,55
Poppers,20, 37
Pre-exposure prophylaxis (PrEP),27–28, 36.
See also HIV/AIDS
PrEP.
See Pre-exposure prophylaxis
Pride,20, 122
Pride Generation,122
Psychiatrist.
See also Doctor-patient relationship
queer clinicians,90–91
reason for transgender individual to see,69
role in transgender care,69
self-disclosure to patients,98–99
sexual identity of,169
transference and countertransferencewith pansexual individuals,168–170
with transgender individuals,81–82
Psychoeducationabout DSD,136–137
about fluidity of gender and sexuality,172
QPR.
See Queer/quasiplatonic relationship
Queeras adjective versus noun,91
alienation,99–100
barriers to health care,89–90
case examplesblack midwestern trans identity,102–103
open relationship,95
polyamorous relationship,95–96
rural white queer identity,102
definitions,4, 20,
115familial conflict and chosen families,103
family,94–95
fears of being pathologized,101
gender neutrality of,89
history of,87–88, 104
identity,91–93
compared with gay, lesbian, or bisexual identity,88–89, 91–92
compared with transgender identity,92
femme and masc,94
internalized queer phobia,100
intersecting identities and discrimination,89, 102–103
kink community,96–98
pronouns for,92
psychological and cultural context,87–91
public figures,90–91
“queer enough,”99
relationships,93–96
sexuality and intimacy,96
shame about sexuality,100–101
therapist’s self-disclosure,98–99
use of term,91
Queerphobia,100
Queer/quasiplatonic relationship (QPR),154
Questioningdescription of,109–114
determining sexual orientation,116
evolving concept of,109–110
health implications,116–117
milestones in processing sexuality,113older adults and,122–123
overview,109
psychological and cultural context,109–114, 116–117
psychotherapy and,118–119
race and,121–122
research,112–113
risks of harm when questioning sexuality,120–121
sex and sexual identity,116
support for,114, 117, 118
terminology for sexual identity and sexual attraction,115theoryFreud,110
Homosexual Identity Formation (HIF) stage model,111–112
Kinsey scale,110,
111Klein Sexual Orientation Grid,110
therapy,118–123
Racebisexual individuals and,54
case examplesblack Midwestern trans identity,102–103
rural white queer identity,102
gay men and,39–40
lesbians and,5, 14
minority stress model,54
questioning sexuality and,121–122
Reimer, David,130
Relationshipsasexual individuals and,154, 155
case examplesopen relationship,95
polyamorous relationship,95–96
consensual non-monogamies,95
dating in the transgender community,76–77
doctor-patient relationship,81–82
DSD and,138–139
pansexual individuals and,172–174
queer individuals and,93–95
relationship status,52
Religiongay men and,26–27, 38–39
lesbians and,13
transgender individuals and,81
Same gender loving,4, 6, 89, 90
Sappho,2
School, creating inclusive environment for,183
Sex, definition of,159.
See also Biological sex
Sex assignment,142.
See also Disorders of sex development
Sexual attraction, terminology for,115Sexual behaviorasexuality and sexual dysfunction,153–154
of asexual individuals,156
bisexual relationships and,55
of gay men,27–29, 33–34
of lesbians,6–7
of pansexual individuals,167
of queer individuals,96
shame about,100–101
of transgender individuals,80
Sexual identitydefinition of,21
diversity and,x
pansexual individuals and,168
terminology for,115Sexualitybinary,160–161
categorization of,88
conversations about questioning,117–118
discussion of with health professionals,34
evolving understanding of,109–112
fluidity of,152, 163, 172, 173
milestones,113nonbinary,161–162
older adults and,122–123
patient’s understanding of,121
race and questioning,113, 121–122
in Western culture,48–50
Sexually transmitted diseases (STDs),80
Sexual orientationchanges over lifespan,57
definition of,63description of,64
determination of,116
diversity of sexual identity and,x
DSD and,137–138
identity terms,6
questioning,5
sexual behavior and,117
society’s understanding of,x
Shadowhunters (TV show),146
Silenced Generation,122
Societytransgender individuals and,76, 78
understanding of gender and sexual orientation,x
“Somewhere Over the Rainbow” (song),19
Spiritualitygay men and,38–39
lesbians and,13
transgender individuals and,81
Spironolactone,71.
See also Hormone replacement therapy
Split attraction model,148
STDs.
See Sexually transmitted diseases
Stenberg, Amandla,1
Stigmabisexuals and,57
gay men and,29–30
about HIV/AIDS,35–36
Stonewall Riots,x, 21, 22, 33
Storms sexuality orientation scale,146,
147Stresslesbians and,12
model of,12, 40–41
pansexual individuals and,170–172
Stud,2, 4, 89
Substance use.
See also Drugs
bisexual individuals and,54, 57
gay men and,29–30, 36–37
lesbians and,8
as method of coping with minority stress,54
Suicide and suicide attempts,9, 11, 12, 14, 23–24, 26, 30, 42, 70, 74, 78, 80, 101, 120, 178
Suicidal ideation,14, 24, 30, 69, 117
Surgery, for gender affirmation,73–74
TDF.
See Testes-determining factor
Teenagers.
See Adolescents
Testes-determining factor (TDF),136
Tobia, Jacob,90
Transference and countertransferencecisgender therapists and,183
transgender individuals and,81–82
Transgender binary,62Transgender individuals.
See also Hormone replacement therapy (HRT)
aging and,74–75
biological underpinnings,68–69
case example,102–103
coming out,75–76
community support,75
comorbidities in mental health care,70, 83
countertransference and,81–82
dating,76–77
definition of,115family and,77–78
finances and,78
gender affirmation treatments,66–67, 71–72, 73–74
gender dysphoria,65–66
health care of,70–71, 74
HIV/AIDS and,78–79
incongruence between assigned gender and identified gender,64
legal issues and,73, 79
mental health and illness,79–80
pronouns for,68
psychiatric interview and,74–82
dating as topic of,76–77
family as topic of,77–78
sex as topic of,80
psychological and cultural context,61–67
reasons for seeing a psychiatrist,69
religion and spirituality,81
roles of medical personnel in care for,69, 70–71
sexual behavior and,80
sexual orientation of,65
stress and,70
terminology,61–65
transference and countertransference,81–82
Transgender nonbinary,62Trevor Project,151
U.S. Transgender Survey,90
Vaginoplasty,66, 73–74, 77, 130
Vasopressin,151
The Wizard of Oz (film),19
World Professional Association for Transgender Health (WPATH),67, 73
WPATH.
See World Professional Association for Transgender Health
