Health Provider Checklist for Adolescent and Young Adult Males

Sexual and Reproductive Health

Sexual Orientation and Gender Identity

Methods, Tools and Resources

In April 2013 The Society for Adolescent Health and Medicine issued the following recommendations for serving LGBT youth:

  • Health care providers should understand that the majority of LGBT young people are healthy and well-adjusted teenagers and young adults. The high-risk behaviors exhibited by some LGBT teens more often reflect reactions to social stigma and non-acceptance by peers and society.
  • Sexual orientation and gender identity are dynamic constructs. Health care providers, educators, policy makers, and researchers should be cautious in assigning labels to an adolescent's sexual orientation, because this may evolve over time. Providers should ask adolescents how they self-identify and should be guided by the youth's language and self-concept.
  • Family connectedness and support are important protective factors against depression, drug use, and high-risk sexual behavior in LGBT adolescents. However, practitioners also should understand that not all LGBT adolescents may be ready to disclose their sexuality to their family. When LGBT teens decide to disclose their sexuality or gender identity, providers should aim to assist families with acceptance of their LGBT teenagers.
  • Lesbian, gay, bisexual, or transgendered youth may be at increased risk of bullying and victimization by peers and adults, including teachers, coaches, and family members; such victimization is associated with an increased risk for depression and suicide. Healthcare providers should be comfortable discussing these issues with their LGBT patients and should take an active role in educating the schools and community on prevention efforts to prevent and stop victimization. The Society for Adolescent Health and Medicine believes that sexual minority adolescents should have full and appropriate legal protection from victimization under both local and federal laws.
  • Because victimized LGBT youth are at increased risk of depression and suicidality, providers should screen for these mental health issues and intervene as appropriate.
  • Antidiscrimination policies should be implemented to protect LGBT youth in foster care settings. Municipalities should disseminate policy guidelines to ensure appropriate care for LGBT youth in out-of-home venues.
  • For youth who are struggling with sexual orientation or gender identity, affirmative therapeutic approaches can help adolescents explore their identities in a healthy manner. Reparative “therapy,” which attempts to change one's sexual orientation or gender identity, is inherently coercive and inconsistent with current standards of medical care.

Gay males are not all sexually active, and of those who are, not all have anal intercourse. Erroneously, some teens get the idea that they cannot really be gay unless they have anal intercourse. Unprotected anal intercourse puts the teen at risk for HIV, parasites, human papillomavirus (HPV), and hepatitis A, B and C. Gay males should be assessed for their risk of STIs.1

With all adolescents, sexual history should be done in a gender-neutral manner. Asking, ‘Is there anyone you are romantically interested in?’ and ‘Have you ever had sex with anyone?’ gives any teen more latitude in his or her answers, and provides a subtle acknowledgement that there are many possible answers. Another good question to ask any teen is ‘When you think of people to whom you are sexually attracted, are they men, women, both, neither or are you not sure yet?’. The occasional patient who is insulted by this question can be educated about sexual orientation.  Many physicians receive little training in talking to teens about sex and sexual orientation. Many still address these issues; however, the clinician who is uncomfortable talking about these issues should consider transferring their adolescent patients to another physician.2

Discussing Sexual Orientation

All Adolescent Males: Address confidentiality.  Ask patient about attractions to same/opposite gender, personal relationships, and sexual experience.  Make sure to assess number of lifetime sexual partners, their genders, and type of intercourse pt has engaged in.  Inquire about bullying/harassment based on actual or perceived sexual orientation, and mental health concerns including suicidality.  If applicable, discuss importance of accepting one’s self and one’s decision to “come out” if safe to do so.    

Early Adolescents (about 11-14 years old): Patient may be more comfortable if you start by inquiring about what patient already knows about sex and sexual orientation.  You can also ask questions about behaviors of their peer groups, then address the pt’s personal sexual experiences.  Provide reassurance that bisexual attractions can be normative during adolescence. 

Middle Adolescents (about 14-18 years old): Patients in this age group may define “sex” differently, so it is advised that you have a discussion about what “sex” means to the patient.
Late Adolescents (about 18-21 years old):Include further discussion on transition to college/employment, and how it may be affected by sexual orientation.  Inquire about future aspirations with relationships, starting a family, etc.  Pt should be aware of how alcohol and substances increases sexual risks, including assault.  Discuss intimate partner violence and continue to assess mental health concerns.


Specific Recommendations for Working With Transgender and Sexual Minority Youth3

If one does not feel comfortable providing high-quality care to sexual minorities or transgender youth, one should refer the youth to a health care provider in their community who can.

Be prepared to respond to questions or concerns about disclosing or “coming out” to family and/or friends. Discuss the timing and approach to disclosure as well as the potential repercussions. Be a support for both the parents and the adolescent.

Evaluate or refer for evaluation gender nonconforming youth, inclusive of the possibility of transitioning to the desired gender.

1 Adolescent Health Committee Adolescent sexual orientation Paediatr Child Health. 2008.

2 Ibid

3 David L. Bell, David J. Breland and Mary A. Ott. Adolescent and Young Adult Male Health: A ReviewPediatrics; originally published online August 12, 2013.