The Implications of Self-Labels and Label Changing Among Sexual Minority Adolescents

Introduction: In recent years, the reliance of sexual minority youth (SMY) on strict definitions of their sexual and gender identity (lesbian, gay, bisexual and transgender) has shifted. Youth often reject these sexual identities and instead use labels such as queer or questioning, acknowledging the arbitrariness of these labels. We investigate how SMY recruited from schools and sexual and gender minority-affirming agencies located in a large metropolitan city label themselves through a life history interview. We examine these labels, hoping to inform how label use and label changing may be related to youth’s behaviors and functioning. Additionally, we examine rate of alternative label use (e.g. pansexual, queer) as it may inform health service workers and prevention scientists assessing SMY.

Methods: Fifty-two SMY (aged 14-20; recruited to represent the ethnic diversity of a major urban city) recruited from schools and community agencies spoke with trained interviewers for 90-120 minutes about salient life experiences, memories, and stressors.

Results: Nearly half of youth (44%) stated that their label changed over time (e.g., bisexual to lesbian, pansexual to asexual, lesbian to straight transmale). Approximately one-fifth (21%) did not use typical labels (i.e. gay, lesbian or bisexual) to identify their orientation when asked “how do you identify your sexual identity?” Labels that were used instead include pansexual, queer, asexual, and transgender orientations. Some self-identified queer adolescents felt that “queer” was a more inclusive term which didn’t exclude SMY not identifying as lesbian, gay, or bisexual. Most (74%) of the adolescents who reported changing labels were ever enrolled in counseling/therapy, for reasons including anxiety, depression, eating disorders, and self-harm (e.g. cutting).

Conclusions: These findings have significant implications for intervention, especially as youth seek health services and develop an independent identity. SMY are continuing to change how they label themselves and identify. This study reveals the rates of non-“gay” terms may have increased in recent years, from 15% in 2003 to 21% in this study (2014). The high rate of counseling/therapy consumption among label-ambiguous SMY suggests that this population is within reach of interventionists. Care providers that do not inquire about, or understand, the labels that SMY subscribe to will likely miss opportunities to provide culturally-competent preventive care services. Additionally, our findings show that sexuality and gender labels among this population are often dynamic and may need to be reassessed across time. Care providers may consider assessing behavior in addition to labels when working with sexual and gender minority adolescents.