Stewart L. Adelson, MD, Editor

Nadia L. Dowshen, MD, Editor

Harvey J Makadon, MD, FACP, Editor

Robert Garofalo, MD, MPH, Editor

Nonheterosexual orientations and nonconformity in gender expression are not uncommon in youth, and part of normal development. However, in addition to the normal health and mental health needs they share with all youth, certain aspects of LGBT youths’ development are unique. As LGBT youth are becoming increasingly visible in society, competence in caring for them and families is a core skill that is necessary for all pediatric practitioners.

This issue is framed around key concepts. These include the biopsychosocial model , in which mental and physical health are interconnected and related to social factors, sexuality, and gender during development. There is epidemiologic evidence of special health needs among the pediatric LGBT population, including increased risk for certain illnesses associated with significant morbidity and mortality. In part, this is because LGBT youth are exposed to certain epidemics affecting them, including HIV, and certain substances of abuse. A substantial body of evidence indicates that risk is mediated by others’ reactions to LGBT youth, including stigma that may adversely affect their physical and mental health in a variety of ways. This includes both interpersonal stigma, such as family, peer bullying, violence, or other forms of interpersonal discrimination, and also structural stigma, which may affect equity in health care resources, training, and competence. The concept that stigma mediates adverse health outcomes is known as the minority stress model. The framework of intersectionality described in this issue refers to the way in which sociocultural factors in addition to LGBT-specific ones, including race/ethnicity, related stigma, and economic factors, can interact to influence health.

Although they are exposed to unique risks, LGBT youth also display patterns of strength and resilience that mitigate the likelihood of adverse outcomes. In each youth, a personal profile of vulnerability and strength influences how the individual copes with stressors and other risk exposure. Good clinical practice includes not only addressing risk but also enhancing strength to promote adaptive coping, good physical and mental health, and optimal fulfillment of each youth’s developmental potential.

Clinical practitioners of pediatrics and allied professions have opportunities to promote health and well-being in LGBT youth through a variety of recognized medical interventions ranging from anticipatory guidance to specialized care. These include supporting healthy emotional development and providing comprehensive, inclusive sexual health education, addressing special needs like HIV prevention and treatment and, for transgender youth, appropriately providing gender-affirming care. This issue discusses clinical competence in these and other areas of physical and mental health for LGBT youth.

An increasing evidence base guides best pediatric practice with LGBT youth. This issue refers to that evidence and expert guidelines wherever available. Several articles also point to gaps in the literature where more research is needed. In light of these gaps, clinicians must sometimes generalize limited evidence derived from research settings and existing practice guidelines to novel contexts in primary care and other community settings. Therefore, in addition to using best practice guidelines whenever possible, this issue discusses using informed consent principles when it is not. Where there are controversies about best practice, this issue discusses them transparently. As this series is geared toward those caring for children and adolescents in clinical practice, there is a pragmatic focus on the clinical application of knowledge in the context of community, family, and development, with illustrative case vignettes.

At present, significant barriers exist to addressing the physical and mental health needs of LGBT youth and contribute to significant health inequities in this population. This issue is intended as a tool to help practitioners of pediatrics and allied professions to provide improved care, research, and education to meet these needs.