Not only are lesbians, gay men, bisexual women and men, and transgender people distinct populations, but each of these groups is itself a diverse population whose members vary widely in age, race and ethnicity, geographic location, social background, religiosity, and other demographic characteristics. Since many of these variables are centrally related to health status, health concerns, and access to care, this report explicitly considers a few key subgroupings of the LGBT population in each chapter:
Age cohort—One’s age influences one’s experiences and needs. Bisexual adolescents who are wrestling with coming out in a nonsupportive environment have different health needs than gay adult men who lack access to health insurance or older lesbians who are unable to find appropriate grief counseling services. In addition, development does not follow the same course for people of all ages. An older adult who comes out as gay in his 50s may not experience the developmental process in the same fashion as a self-identified “queer” youth who comes out during her teenage years. Similarly, as discussed further below, experiences across the life course differ according to the time period in which individuals are born. For example, an adolescent coming out in 2010 would do so in a different environment than an adolescent coming out in the 1960s. Moreover, some people experience changes in their sexual attractions and relationships over the course of their life. Some transgender people, for example, are visibly gender role nonconforming in childhood and come out at an early age, whereas others are able to conform and may not come out until much later in life.
Race and ethnicity—Concepts of community, traditional roles, religiosity, and cultural influences associated with race and ethnicity shape an LGBT individual’s experiences. The racial and ethnic communities to which one belongs affect self-identification, the process of coming out, available support, the extent to which one identifies with the LGBT community, affirmation of gender-variant expression, and other factors that ultimately influence health outcomes. Members of racial and ethnic minority groups may have profoundly different experiences than non-Hispanic white LGBT individuals.
Educational level and socioeconomic status—An LGBT individual’s experience in society varies depending on his or her educational level and socioeconomic status. As higher educational levels tend to be associated with higher income levels, members of the community who are more educated may live in better neighborhoods with