Do Ask, Do Tell


LGBT People: An Overview

Who Are LGBT People?

Understanding Sexual Orientation and Gender Identity

This section introduces basic concepts and terms that may be helpful in developing common understandings and good communication with LGBT people. These concepts will also help you understand how patients may answer SO/GI questions posed in an EHR. Additional terms are included in a glossary at the end of this section.

Terms and Definitions

“LGBT” stands for lesbian, gay, bisexual, and transgender. This umbrella term includes two concepts: sexual orientation and gender identity. All people have a sexual orientation and a gender identity. But sexual orientation and gender identity are not the same thing.

Below, we describe various terms that are frequently used to describe sexual orientation and gender identity. Later in this Tool Kit, we will also learn how to let LGBT people describe themselves using language they prefer. This freedom of expression is important, particularly when communicating with people who may want to use terms other than those that are included in the acronym “LGBT.”

Sexual orientation tells you about a person’s sexual and romantic attractions. Common words to describe sexual orientation are:

  • Heterosexual (straight) describes someone who is attracted to people of a different sex. For example: a man who is attracted to women; or a woman attracted to men.
  • Gay describes someone who is attracted to people of the same sex. Gay is usually used for men who are attracted to men.
  • Lesbian describes a woman who is attracted to other women.
  • Bisexual describes someone who is attracted to both men and women.

Some people describe their sexual orientation in other ways. For example, younger people may use the term “queer” instead of lesbian, gay, or bisexual, and the term “same-gender-loving” is used in many African American communities.

Some people are attracted to and have relationships with people of the same sex, but prefer to call themselves heterosexual. This may be because they fear a negative reaction from others, because their culture does not recognize gay or lesbian sexual orientations, because they do not wish to claim terms such as “gay,” “lesbian,” or “bisexual” as an identity for themselves, or for other personal reasons.

It’s also important to keep in mind that some people desire to be with someone of the same sex, but have not acted on this desire, and may want to discuss their feelings.

Sometimes health care or research professionals do not use terms like “gay” or “lesbian” to describe people, but focus instead on their sexual behavior. They use terms like “men who have sex with men,” abbreviated as MSM, or “women who have sex with women” (WSW).

Gender identity describes the deep, innate understanding that each person has of their individual identity as a man, a woman, or in some cases, another gender. Most people know their gender identity is the same as the sex they were assigned at birth—for example, a person whose original birth certificate says “male” and identifies as a man. But some people know that their gender identity is not the same as the sex they were assigned at birth—for example, a person assigned male at birth may know her gender identity is female and may identify as a woman, or a person assigned female at birth may know his gender identity is male and may identify as a man. We use the term transgender to describe these individuals.

It’s very important to know that, when talking about a transgender person, we always use terms such as “man” or “woman” to describe the individual’s gender identity, not the sex they were assigned at birth. Similarly, the appropriate gender pronouns—such as “he/him” and “she/her,” as well as terms such as “sir” or “ma’am”—to use for a transgender person are those that align with their gender identity, not the sex they were assigned at birth. Some transgender people may use pronouns that have no gender, such as “they/them.” In cases in which you’re not sure which pronoun to use, it’s best to just politely ask and then make sure to always use the appropriate pronoun in future conversations and correspondence.

The term “transgender” is broad and can be used to describe a variety of gendered expressions of individual identity:

  • A transgender man is someone who was assigned the female sex at birth but identifies as a man (some use the term female-to-male or FTM).
  • A transgender woman is someone who was assigned the male sex at birth but identifies as a woman (some use the term male-to-female or MTF).
  • Other people reject thinking of themselves as either man or woman, and may identify themselves as something else, such as “genderqueer.
  • Transgender people can have any sexual orientation. For example, a transgender woman can be attracted to men, and might therefore consider herself straight or heterosexual. Another transgender woman can be attracted to women, in which case she might think of herself as lesbian.

An important part of affirming and expressing gender identity for many transgender people is a process of “transition” from one gender to another. Note that these terms are themselves sensitive; some transgender people consider “transitioning” to be disrespectful, since they are not really changing themselves, only making their appearance consistent with the person they know they are. “Affirming” is a term that may be helpful in such cases. As part of transition, transgender people may change their name, clothes, hair style, mannerisms, or other social markers of gender. They may also take cross-sex hormones and/or undergo surgeries to align their physical body with their gender identity. Many transgender people do not take hormones or have surgery, however, so it is important not to make assumptions from a patient’s appearance alone.

Hormones and surgeries involved in transition/affirmation can be costly and difficult to find, and these treatments take time to complete. Whether you see a person after their transition/affirmation is complete, or in the middle of the process, it is important to be respectful and not to let your curiosity interfere with your professional relationship with any patient. Maintain a calm and welcoming personality at all times, do not express surprise or stare at the patient, and—most importantly—only ask questions related to their health care needs, never to satisfy your own curiosity.

Definitions of terms such as “lesbian,” “gay,” “bisexual,” and “transgender” are important concepts to learn. But, more important is recognizing that everyone is unique and deserves to be respected as the person they are. In addition, many non-LGBT people have LGBT family members and may feel hurt if their family members are not respected. Making LGBT people and their families feel safe and welcome can lead to a more trusting relationship between them and their health care providers, and improved communication about their unique needs for care.


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