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1) Why LGBTQ+ Identity Language Matters in Mental Health Practice

The words clients use to describe their sexuality, gender, and relationships can carry significant personal meaning. When mental health professionals understand and respectfully use that language, it can strengthen rapport and reduce the amount of emotional energy clients spend explaining or defending their identities. For LGBTQ+ clients, especially adolescents and young adults who may still be exploring how they understand themselves, that sense of safety can make a meaningful difference in therapy.

Language Can Build or Undermine Trust

Using a client’s chosen name, pronouns, and identity terms communicates respect. On the other hand, repeatedly mislabeling someone’s identity, making assumptions about attraction, or questioning whether a term is “real” can quickly damage trust. A client who identifies as spectrasexual, demisexual, nonbinary, or another less familiar identity shouldn’t have to convince their therapist that their experience is valid before meaningful clinical work can begin.

This doesn’t mean clinicians need to memorize every LGBTQ+ term. Language changes, new terms emerge, and people sometimes use the same word in different ways. A better goal is developing enough familiarity to respond with informed curiosity rather than confusion or judgment.

Client Definitions Matter More Than Dictionary Definitions

Knowing basic terminology provides an important foundation, but a glossary can only take a clinician so far. Two people who identify as bisexual may understand that identity differently, just as two nonbinary clients may have completely different relationships with gender.

When a client uses an unfamiliar term, consider asking, “What does that identity mean to you?” This allows the provider to understand the client’s experience without turning the session into a debate over terminology.

Affirming Language Supports Better Assessment

Understanding identity language can also improve clinical assessment. Providers are less likely to mistake sexual orientation for gender identity, assume relationship structures based on a client’s label, or incorrectly attribute mental health concerns to being LGBTQ+.

Ultimately, affirming language is one part of culturally responsive care. The goal isn’t perfect vocabulary. It’s creating a therapeutic environment where clients can describe themselves in their own words and trust that those words will be treated with respect.

2) Glossary of Sexual Orientation, Gender Identity, and Other Identity Language

LGBTQ+ terminology can feel expansive because sexuality and gender are expansive. People may use several terms at the same time, change the language they use as they understand themselves differently, or decide that no available label quite fits. The Trevor Project has documented more than 100 combinations of sexual orientation terms and more than 100 combinations of gender identity terms among LGBTQ+ youth alone, which illustrates why clinicians should think of identity language as flexible rather than as a collection of rigid categories.

For mental health professionals, the goal isn’t to memorize every term a client could possibly use. Instead, clinicians should understand frequently used identities, recognize important distinctions, and know how to respond when a client introduces unfamiliar language. The glossary below provides that foundation.

Sexual Orientation

Sexual orientation refers broadly to patterns of sexual, romantic, or emotional attraction and the language someone uses to describe those experiences. Sexual orientation is distinct from gender identity. Knowing that someone is transgender, for example, tells you nothing about whether that person is gay, straight, bisexual, pansexual, asexual, or another orientation.

Lesbian

Lesbian commonly describes a woman who experiences romantic or sexual attraction to women. Some nonbinary people also identify as lesbians, and individual understandings of the term vary.

Clinicians should avoid assuming that lesbian identity requires a particular appearance, relationship history, or gender expression. Someone can also identify as lesbian even if they haven’t previously dated or had sexual experiences with women.

Gay

Gay commonly refers to someone who experiences attraction to people of the same gender. It is frequently used by men who are attracted to men, although people of other genders may also use gay to describe themselves.

Historically, gay was sometimes used as an umbrella term for the broader LGBTQ+ community. Today, LGBTQ+ or queer may be used more broadly, depending on the preferences of the people involved.

Bisexual

Bisexual generally describes the capacity to experience attraction to more than one gender. One persistent misconception is that bisexuality means attraction exclusively to men and women. Contemporary definitions are broader and can include attraction to people of multiple genders, including nonbinary people. GLAAD notes that bisexual attraction doesn’t have to occur at the same time, in the same way, or to the same degree.

A bisexual person’s current partner doesn’t determine their sexual orientation. A bisexual woman dating a man hasn’t become straight, just as a bisexual man dating another man hasn’t necessarily become gay.

Pansexual

Pansexual generally describes someone who can experience attraction to people across genders. Some pansexual people describe themselves as experiencing attraction regardless of gender, while others simply use the term because gender doesn’t create a boundary around whom they might find attractive.

Pansexuality and bisexuality can overlap considerably. One isn’t a more inclusive or more evolved version of the other. The Trevor Project emphasizes that identity labels can help people make sense of their experiences, but people ultimately determine which terminology feels right for them.

Omnisexual

Omnisexual generally refers to the capacity for attraction to people of all genders, while gender may still influence how attraction is experienced.

Someone who identifies as omnisexual might say that they could potentially be attracted to someone of any gender but notice differences in the ways they experience attraction toward men, women, or nonbinary people. That distinction is sometimes used to differentiate omnisexuality from pansexuality, although individual definitions can vary.

Polysexual

Polysexual typically describes attraction to people of multiple genders, but not necessarily all genders.

For instance, someone might experience attraction toward women and several nonbinary genders but not toward men. Polysexual is part of a larger group of orientations describing attraction beyond one gender.

Spectrasexual

Spectrasexual generally refers to romantic or sexual attraction to people across a range or spectrum of genders, sexes, or gender identities, without necessarily experiencing attraction toward all genders. It is sometimes closely associated with polysexuality.

The spectrasexual meaning is particularly useful for clinicians to understand because a client may choose the term precisely because broader labels don’t capture their pattern of attraction. For example, someone might experience attraction toward several genders while noticing that gender remains relevant to whom they’re attracted to.

Rather than responding, “Isn’t that just bisexual?” a clinician can ask:

“What does being spectrasexual mean to you?”

That question allows the client to explain why the identity resonates without positioning the therapist as the authority on the client’s sexuality.

Asexual

Asexual, frequently shortened to ace, generally describes someone who experiences little or no sexual attraction. Asexuality exists across a spectrum, and being asexual doesn’t tell you whether someone wants romantic relationships, experiences physical arousal, masturbates, has sex, enjoys affection, or desires partnership. GLAAD distinguishes asexuality from aromanticism, which concerns romantic rather than sexual attraction.

This distinction can be particularly important in mental health settings. Asexuality shouldn’t automatically be interpreted as sexual dysfunction, avoidance, trauma response, or a symptom requiring treatment.

Demisexual

Demisexual generally describes someone who experiences sexual attraction after developing a significant emotional connection with another person. It is commonly understood as part of the asexual spectrum.

Demisexuality isn’t simply a preference for waiting to have sex. Someone can feel immediate sexual attraction and still choose not to act on it. A demisexual person, by contrast, may not experience sexual attraction in the first place until a meaningful emotional bond develops.

Graysexual or Gray-Asexual

Graysexual, gray-asexual, or gray-ace refers to experiences that fall somewhere between asexuality and more frequent sexual attraction.

A graysexual person might experience sexual attraction very rarely, only in particular circumstances, or in ways that feel significantly different from how sexual attraction is commonly described.

Sexually Fluid

Sexually fluid may describe someone whose attractions, identity, or patterns of attraction shift over time.

Sexual fluidity doesn’t mean someone is confused or incapable of choosing an identity. For some people, change itself is an accurate description of their experience.

Sapphic

Sapphic is an umbrella term often used by women and some nonbinary people who experience attraction to women. A person might identify as lesbian, bisexual, pansexual, queer, or another orientation while also using sapphic.

For example, a bisexual woman may use sapphic when discussing her attraction to or relationships with women without suggesting that women are the only people she can be attracted to.

Achillean

Achillean is a comparable umbrella term commonly used for men and some nonbinary people who experience attraction to men. Someone can identify as gay, bisexual, pansexual, queer, or another orientation and also describe themselves as achillean.

Romantic Orientation

Sexual attraction and romantic attraction aren’t always experienced in the same way. For this reason, some clients use separate terms for their sexual orientation and romantic orientation.

A person might be bisexual and aromantic, asexual and panromantic, or demisexual and biromantic.

Aromantic

Aromantic, often shortened to aro, generally describes someone who experiences little or no romantic attraction.

Aromantic people may still want companionship, intimacy, committed relationships, sexual relationships, or close emotional connections. Romantic attraction shouldn’t be treated as a requirement for a meaningful life or healthy relationships.

Demiromantic

Demiromantic describes someone who generally experiences romantic attraction after developing a meaningful emotional connection.

As with demisexuality, the distinction involves attraction itself rather than a person’s decision to move slowly in relationships.

Biromantic

Biromantic generally refers to romantic attraction toward people of more than one gender.

Someone could identify as asexual and biromantic if they experience romantic attraction toward multiple genders while experiencing little or no sexual attraction.

Panromantic

Panromantic generally refers to the capacity for romantic attraction to people across genders.

Someone may identify as panromantic but use a different term for their sexual orientation.

Gender Identity

Gender identity refers to someone’s internal understanding or experience of their gender. It isn’t necessarily visible to other people and is different from sexual orientation and gender expression. GLAAD emphasizes that everyone has a gender identity, whether that identity is cisgender, transgender, nonbinary, or described using another term.

Cisgender

Cisgender, often shortened to cis, describes someone whose gender identity corresponds with the sex they were assigned at birth.

For example, someone assigned female at birth who identifies as a woman may describe herself as cisgender.

Transgender

Transgender, frequently shortened to trans, is an umbrella term for people whose gender identity differs from the sex they were assigned at birth. Being transgender doesn’t depend on appearance, medical treatment, hormones, surgery, or any particular transition process.

Some transgender people identify as men or women. Others identify as nonbinary, genderfluid, agender, or another gender.

Transgender is an adjective. Phrases such as “a transgender person” or “a trans woman” are appropriate. Referring to someone as “a transgender” is generally inappropriate.

Nonbinary

Nonbinary describes gender identities that aren’t exclusively man or woman. Some people experience their gender somewhere between those categories, while others experience gender in ways that exist outside them entirely.

Nonbinary can function as a specific identity or as an umbrella term encompassing identities such as genderfluid, agender, bigender, and genderqueer.

Not every nonbinary person identifies as transgender, although many do.

Genderfluid

Genderfluid generally describes someone whose experience of gender changes or shifts over time.

A genderfluid person might sometimes identify more strongly with masculinity, femininity, both, neither, or another gender experience. These shifts don’t have to follow a predictable schedule.

Genderqueer

Genderqueer is an identity used by some people whose gender exists outside traditional expectations of manhood and womanhood.

Genderqueer and nonbinary may overlap, but they aren’t interchangeable for everyone. If a client uses one term, clinicians shouldn’t automatically replace it with the other.

Agender

Agender generally describes someone who experiences themselves as having no gender, having a minimal relationship with gender, or existing outside conventional ideas of gender.

People who identify as agender may use they/them, he/him, she/her, neopronouns, or another set of pronouns.

Bigender

Bigender generally describes someone who experiences two genders. Those genders might be experienced simultaneously or at different times.

They also don’t necessarily have to be man and woman. A person could experience two nonbinary genders, for example.

Demigirl and Demiboy

Demigirl typically describes someone who feels a partial connection to being a girl or woman without identifying completely as one.

Demiboy similarly describes someone who feels a partial connection to being a boy or man.

The remaining part of the person’s gender may be another gender, multiple genders, or no particular gender.

Transmasculine

Transmasculine is an umbrella term sometimes used by people assigned female at birth whose gender identity or expression moves toward masculinity.

A transmasculine person may identify as a man, nonbinary, genderqueer, or another identity.

Transfeminine

Transfeminine is commonly used by people assigned male at birth whose gender identity or expression moves toward femininity.

As with transmasculine, the term doesn’t automatically mean someone identifies exclusively as a woman.

Gender Nonconforming

Gender nonconforming, sometimes shortened to GNC, describes people whose gender expression or presentation doesn’t align with cultural expectations associated with their gender.

Gender nonconformity isn’t necessarily a gender identity. A cisgender man who enjoys clothing culturally considered feminine could be gender nonconforming while still identifying as a man.

Gender Expression

Gender expression refers to the outward ways someone presents or communicates gender through clothing, hairstyle, voice, behavior, name, mannerisms, or other characteristics. What cultures consider masculine or feminine also changes across time and place.

Gender expression doesn’t reliably tell you someone’s identity.

A masculine-presenting woman may be cisgender or transgender. She may be straight, lesbian, bisexual, pansexual, or asexual. A person who appears androgynous may identify as nonbinary, or they may identify as a man or woman.

Clinically, appearance is a poor substitute for asking.

Intersex

Intersex refers broadly to people born with variations in sex characteristics that don’t fit typical definitions of male or female bodies. These variations can involve chromosomes, reproductive anatomy, hormones, gonads, or secondary sex characteristics.

Intersex is important to include in LGBTQIA+ terminology, but it isn’t itself a sexual orientation or gender identity. An intersex person can be cisgender, transgender, nonbinary, straight, gay, bisexual, asexual, or any other identity.

Clinicians should also avoid assuming an intersex person knows about their intersex variation. Some individuals learn about it during childhood, while others discover it during puberty, fertility evaluations, medical procedures, or adulthood.

Two-Spirit

Two-Spirit is a culturally specific term used by some Indigenous people and communities. It may encompass gender, sexuality, spirituality, cultural identity, and traditional community roles.

Two-Spirit shouldn’t be treated as simply another synonym for gay, bisexual, transgender, or nonbinary. The Indian Health Service notes that Two-Spirit roles and meanings vary substantially across Native cultures and that many Indigenous communities have their own language and traditions describing gender-diverse roles.

Because of that cultural context, non-Indigenous people shouldn’t adopt Two-Spirit as a general LGBTQ+ identity label. Clinicians also shouldn’t assume every LGBTQ+ Indigenous client identifies as Two-Spirit.

Queer

Queer is an umbrella term used by many people whose sexual orientation, gender identity, or relationships exist outside heterosexual or cisgender norms. Some people prefer queer because more specific categories don’t fully describe their experiences.

However, queer has also historically been used as a slur. Many people have reclaimed it proudly, while others remain uncomfortable with it.

The safest clinical practice is simple: use queer for someone when they use it for themselves rather than automatically applying it to every LGBTQ+ client.

Questioning

Questioning describes someone who is exploring or considering their sexual orientation, gender identity, or both.

Questioning shouldn’t be viewed as a problem that therapy needs to solve. Particularly with adolescents and young adults, clinicians may feel pressure to help clients “figure out what they are.” A more affirming approach creates room for uncertainty.

A client can explore attraction or gender without selecting a permanent label.

Coming Out

Coming out generally refers to the process of recognizing or sharing one’s sexual orientation or gender identity with others.

Importantly, coming out is rarely one event. A person may be out with friends but not family, out at college but not at work, or open with certain healthcare professionals while remaining private in other environments.

Mental health providers should avoid assuming that coming out is always the healthiest next step. Disclosure can affect safety, housing, finances, employment, education, family relationships, or community membership.

The question isn’t simply, “When will you come out?”

A more clinically useful question might be, “What would you want to consider before deciding whether to share this with them?”

Closeted

Closeted generally refers to someone who hasn’t disclosed their LGBTQ+ identity to some or all people in their life.

Some people use the term comfortably, while others prefer language such as “private about my identity” or “not out.”

Being closeted shouldn’t automatically be interpreted as shame or denial. Sometimes privacy is a thoughtful response to a person’s environment.

Outing

Outing means revealing another person’s LGBTQ+ identity without that person’s permission.

This distinction is especially important for mental health professionals working with youth. A client telling a therapist about their sexual orientation or gender identity doesn’t automatically mean parents, caregivers, teachers, or other professionals know.

Clinicians need to consider confidentiality, applicable laws, ethical obligations, documentation practices, and the client’s safety before sharing identity information with others.

Chosen Name

A chosen name is the name a person uses that may differ from the name assigned to them at birth or the name appearing on legal documents.

Chosen names are especially common among transgender and nonbinary people, although anyone may use one.

When clinical or billing systems require a legal name, providers should still consider whether records can display the person’s chosen name prominently so staff don’t repeatedly use the wrong one.

Deadname

A deadname is a previous name that a transgender or nonbinary person no longer uses.

Intentionally using someone’s deadname after knowing their chosen name can be invalidating. Accidental mistakes can happen, particularly when clinicians have known someone for years. When they do, a brief correction is usually more helpful than an extended apology that shifts emotional attention back onto the clinician.

Pronouns

Pronouns are words used to refer to someone without repeating their name. Common pronouns include:

• She/her
• He/him
• They/them

Some people use more than one set, such as she/they or he/they, and some use neopronouns.

Pronouns and gender identity are related, but one doesn’t automatically determine the other. A nonbinary person might use they/them, she/her, he/him, or another set of pronouns.

Rather than trying to infer pronouns based on appearance, ask when it’s relevant and normalize the question across clients.

Assigned Female at Birth and Assigned Male at Birth

Assigned female at birth, often abbreviated AFAB, and assigned male at birth, often abbreviated AMAB, describe the sex designation given to someone when they were born.

These terms may occasionally be clinically relevant, particularly when discussing reproductive or medical concerns. They shouldn’t become substitutes for someone’s actual gender.

For example, referring to a transgender man primarily as “an AFAB person” when his assigned sex isn’t relevant can unnecessarily center information he may not want emphasized.

Transition

Transition describes the processes someone may undertake to live in greater alignment with their gender identity.

Transition can involve different combinations of:

• Changing a name or pronouns
• Changing clothing or gender presentation
• Coming out to others
• Updating identity documents
• Hormone therapy
• Voice-related services
• Gender-affirming procedures or surgeries
• Changes at school or work

There is no universal transition pathway. Some transgender and nonbinary people pursue medical interventions, while others don’t want them, can’t access them, or don’t need them.

A person doesn’t need to complete any specific step to establish the legitimacy of their gender identity.

Ally

An ally is someone who actively supports LGBTQ+ people and works against discrimination, prejudice, and inequity.

From a clinical perspective, affirming practice requires more than privately considering yourself supportive. It may involve examining forms, documentation practices, office policies, assumptions, language, confidentiality procedures, referral networks, and gaps in professional education.

No Label or Prefer Not to Label

Finally, some people intentionally choose no identity label at all.

That preference deserves the same respect as selecting a very specific term.

Labels can provide community, language, validation, and a way to make sense of one’s experiences. For another person, those same labels may feel restrictive.

Mental health professionals don’t need to help every client arrive at a final category. Sometimes “I’m attracted to who I’m attracted to,” “I’m still figuring it out,” or “I don’t really use labels” is a complete answer.

The Most Important Rule for Using LGBTQ+ Identity Language

A glossary can teach clinicians what spectrasexual, pansexual, demisexual, nonbinary, Two-Spirit, queer, and dozens of other terms generally mean. It can’t tell you exactly what any one of those identities means in the life of the client sitting in front of you.

That’s where clinical curiosity comes in.

When appropriate, ask questions such as:

• “What does that identity mean to you?”
• “How long have you been using that term for yourself?”
• “Who in your life knows about this part of your identity?”
• “How supported do you feel?”
• “Are there situations where you don’t feel safe sharing this?”
• “Is there language you’d like me to use or avoid?”
• “Has the way you understand your identity changed over time?”

The goal isn’t to interrogate the client’s identity. It’s to understand the parts of it that are relevant to their well-being, relationships, environment, and treatment.

Language evolves, and clients will eventually use terms that aren’t included in this guide. A clinician who knows how to respond respectfully when that happens is far more prepared than one who has simply memorized the longest glossary.

► Learn more about the Agents of Change Continuing Education here: https://agentsofchangetraining.com

About the Lead Instructor, Dr. Meagan Mitchell: Meagan is a Licensed Clinical Social Worker and has been providing Continuing Education for Social Workers, Counselors, and Mental Health Professionals for more than 10 years. From all of this experience helping others, she created Agents of Change Continuing Education to help Social Workers, Counselors, and Mental Health Professionals stay up-to-date on the latest trends, research, and techniques.

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Disclaimer: This content has been made available for informational and educational purposes only. This content is not intended to be a substitute for professional medical or clinical advice, diagnosis, or treatment

Note: Certain images used in this post were generated with the help of artificial intelligence.