What We Lose When We “Don’t Say Gay”: Generational Shifts in Sexual Identity and Gender

Abstract

At a time when anti-LGBTQ+ legislation is on the rise in more than a dozen states across the United States, social work providers and researchers must be acutely aware of the ways in which their practice may unintentionally invalidate the identities of LGBTQ+ youth. Concurrently, language used in the LGBTQ+ youth community to describe both sexual identity and gender has moved away from monosexual and binary labels toward nonmonosexual and nonbinary descriptions. The adoption of such language, in practice and in research, is a simple step toward combatting invalidation in the social work field. This commentary explores the expansion of identity labels through the lens of a study conducted across four leading LGBTQ+ agencies in New York and New Jersey with youth and staff. Authors review data that demonstrate the evolution of labels and argue that adopting these terms in practice and research will have fruitful and affirming effects on access to care, treatment attrition, and the design and quality of research in and for the LGBTQ+ community. This shift in language must be comprehensively addressed to ensure that practice and research continue to adopt and advocate for ways to affirm LGBTQ+ people, particularly given the recent onslaught of anti-LGBTQ+ legislation.

Agrowing body of research indicates that LGBTQ+ youth are more frequently rejecting binary descriptions of their sexual (i.e., monosexual terms such as gay or lesbian) and gender (i.e., man or woman) identities (Bates et al., 2019; Callis, 2014). As a result, LGBTQ+ youth have shifted away from labels tied to gender of partners, or those that indicate attraction based on gender, toward a more expansive, individualized conception of identity that may or may not consider attraction based on gender and/or sex assigned at birth (Bochicchio, 2020; Watson et al., 2020). This has resulted in the increased use of nonmonosexual labels such as bisexual or pansexual. Similarly, a desire for terms to reflect the diversity of gender (we use the term “gender” instead of “gender identity” to affirm that being transgender or gender diverse [TGD] is not an identity but a gender) speaks to the increased use of nonbinary gender labels (e.g., genderqueer, gender-fluid).

Alongside these trends, LGBTQ+ youth and adults have once again come under attack by a spate of anti-LGBTQ+ legislative initiatives across the United States (American Civil Liberties Union, 2022; Movement Advancement Project, n.d.). In the state of Florida, for example, Parental Rights in Education (HB 1557) actively prohibits discussion about LGBTQ+ identities and issues in the classroom. Minority stress theory posits that disparities stem from a combination of distal (e.g., structural stigma, societal discrimination) and proximal (e.g., internalized homophobia) stressors related to identifying as a sexual or gender minority in a society marked by heterosexism and cissexism (Brooks, 1981; Meyer, 2003; Toomey, 2021; Toomey et al., 2017). Indeed, anti-LGBTQ+ legislation runs the risk of widespread heightening of stigma and discrimination for all LGBTQ+ youth, both within impacted states and beyond, because simply being exposed to ads or campaign messages related to anti-LGBTQ+ legislation or thinking about the bills can have negative impacts on well-being (Flores et al., 2018; Frost & Fingerhut, 2016; Hughes et al., 2022; Paceley et al., 2021). Given the chronic, recurring, and pervasive nature of these stressors, there is a need for social work providers and researchers to create affirming environments to avoid inadvertently reinforcing messages and attitudes that may threaten the well-being of LGBTQ+ people.

The creation of affirming, culturally competent environments is not only a critical consideration for social workers providing clinical care or conducting research with LGBTQ+ populations, but also an ethical imperative. The National Association of Social Workers’ (NASW, 2021) Code of Ethics details social workers’ responsibilities to clients, including the evolving practice of cultural competence. This can be enacted through demonstrating simultaneous awareness and humility, and by participating in ongoing training that showcases understanding of diversity and social oppression (NASW, 2021). Placing the onus of learning on social workers reduces the oft-omnipresent burden felt by LGBTQ+ clients to explain their identities.

Unfortunately, intentionally or otherwise, social work researchers, research guidelines, and clinical practitioners lag in adopting newer terminology and may ignore, silence, or inadvertently invalidate the experiences of LGBTQ+ individuals. Yet there are demonstrated negative implications of nonaffirming behaviors in clinical environments (e.g., treatment attrition and/or avoidance) that may further exacerbate existing health disparities among LGBTQ+ individuals, particularly given increased anti-LGBTQ+ legislation (Perron et al., 2017; Shelton & Delgado-Romero, 2013; Spengler et al., 2016). One way to create an affirming environment is for social work providers and researchers to use the language communities have adopted in practice. With an increased understanding of identity labels, social workers will be better equipped to serve the LGBTQ+ community, thus taking steps to ensure micro interactions do not mimic invalidation present in macro policy decisions.

This article presents study data and then integrates our data and recent literature to offer recommendations for LGBTQ+ affirmative research and practice—recommendations that are even more urgent in the face of recent anti-LGBTQ+ legislation. Although always a clinical and research imperative, per NASW’s Code of Ethics, the current cultural context emphasizes the importance of ensuring that providers and researchers use language that matches the language communities use for themselves. This includes adopting evolving sexual identity and gender labels. After all, affirmation of identities creates space for inclusive service provision, and the opportunity for social work research to uplift communities particularly in the face of codified discrimination and stigma (American Psychological Association [APA], 2017, 2021; Dean et al., 2016; Westbrook & Saperstein, 2015).

SUMMARY OF METHODOLOGY

While conducting a qualitative study on affirmative practice guidelines for LGBTQ+ youth across four leading LGBTQ+ agencies in New York and New Jersey, it became evident that youth’s descriptions of their identities differed from language previously used by older LGBTQ+ community members (Bochicchio, 2020). The study included 30 LGBTQ+ youth and 12 agency staff who participated in focus groups and interviews to understand their perspectives on LGBTQ+ affirmative care beyond current practice guidelines. Agency staff recruited youth through word of mouth and informational flyers, and agency leadership nominated agency staff to participate in focus groups/interviews. Youth ranged in age from 13 to 26 (corresponding to LGBTQ+ organizations’ definition of youth) and agency staff ranged in age from 20 to 50, with the majority falling between the ages of 25 and 30. Most youth who participated identified as Black (n = 9) or White (n = 7), and the majority of providers identified as White (n = 6; see Table 1 and Table 2). As part of the larger study, demographic information was collected through questionnaires and included two open-ended questions asking participants to describe their sexual identities and gender in their own words. The interview guide was constructed and pilot tested in consultation with multiple social work researchers and informed by both minority stress theory (Bochicchio, 2020; Brooks, 1981; Meyer, 2003) and research on the same topic. Informed by recent literature on best practices for questionnaire design, demographic information (e.g., sexual identity, age, race, and ethnicity) was collected on completion of interviews/focus groups to reduce the potential for bias (Lietz, 2010). Questions regarding sexual identity and gender were open-ended, ensuring that participants could utilize their own language to identify themselves. Although not a study inclusion criterion, all agency staff also identified as LGBTQ+. All study procedures were approved by the Columbia University–Morningside institutional review board.

Table 1:

Youth Sample Characteristics (n = 30)

Demographic	n	%
Age (years)
12–15	1	3
15–18	8	27
18–21	9	30
21–24	10	33
<24	2	7
Gender
Male	12	40
Female	6	20
Trans man	3	10
Trans woman	3	10
Nonbinary/genderqueer	6	20
Sexual identity
Straight	5	17
Lesbian	0	0
Gay	5	17
Bisexual	8	27
Pansexual	7	23
Queer	4	13
Questioning	1	3
Race/ethnicity
Latinx/White	3	10
Latinx/Black	3	10
Latinx/other	1	3
Latinx	2	7
Black	9	30
American Indian/Alaska Native	3	10
Asian/Pacific Islander	1	3
White	7	23

Table 2:

Staff Sample Characteristics (n = 12)

Demographic	n	%
Age (years)
20–25	1	8
25–30	5	42
30–35	3	25
35–40	1	8
<40	2	17
Gender
Male	5	42
Female	3	25
Trans man	1	8
Trans woman	0	0
Nonbinary/genderqueer	3	25
Sexual identity
Straight	0	0
Lesbian	0	0
Gay	4	33
Bisexual	2	17
Pansexual	2	17
Queer	4	33
Questioning	0	0
Race/ethnicity
Latinx/White	0	0
Latinx/Black	2	17
Latinx/other	0	0
Black	2	17
American Indian/Alaska Native	0	0
Asian/Pacific Islander	1	8
White	6	50
Multiracial	1	8

EVIDENCE OF GENERATIONAL SHIFT

Several trends emerged in how youth and staff discretely described their sexual identities. Across both groups, 33 percent (n = 14) used monosexual labels (e.g., gay, straight), whereas 64 percent (n = 27) used nonmonosexual labels (e.g., bisexual, pansexual, queer). More specifically, among youth, half (n = 15) used the terms “bisexual” or “pansexual,” 13.3 percent (n = 4) used the term “queer,” 3.3 percent (n = 1) used the term “questioning,” 16.7 percent (n = 5) used the term “gay,” and 16.7 percent (n = 5) used the term “straight.” Among staff members, one-third (n = 4) used the terms “bisexual” or “pansexual,” one-third (n = 4) used the term “queer,” and one-third (n = 4) used the term “gay.” Ultimately, a greater proportion of youth compared with staff used nonmonosexual labels (see Figure 1). Even among staff, younger staff members were more likely to identify using nonmonosexual labels, further highlighting this generational shift. Additionally, of note, the term “lesbian” was not used by any participants; all participants (n = 5) who identified as straight also identified as TGD (e.g., trans man, trans woman, nonbinary, or genderqueer).

Figure 1:

Distributions of Sexual Identities among Youth and Staff

In reference to gender, 62 percent (n = 26) of youth and staff identified as cisgender and 38 percent (n = 16) identified as TGD. Among youth, 60 percent (n = 18) identified as cisgender, and 40 percent (n = 12) identified as TGD, with 10 percent (n = 3) identifying as trans men, 10 percent (n = 3) as trans women, and 20 percent (n = 6) as nonbinary or genderqueer. Among agency staff, 67 percent (n = 8) identified as cisgender, and 33 percent (n = 4) as TGD, with 8 percent (n = 1) identifying as trans men, and 25 percent (n = 3) as nonbinary or genderqueer. Interestingly, of the 26 participants (youth and staff included) who used the words “bisexual,” “pansexual,” and “queer,” almost half (n = 11) also identified as TGD. Overall, a slightly higher percentage of staff identified as cisgender than youth, whereas a slightly higher percentage of youth identified as TGD than staff (see Figure 2).

Figure 2:

Distributions of Gender among Youth and Staff

The terminology used by study participants reflects a generational shift in how LGBTQ+ youth describe sexual identities and gender. Although our sample size is relatively small, this evolution in language is reinforced by several other large-scale national and international studies (Hammack et al., 2021; Jones, 2022; Walton et. al., 2016; Watson et al., 2020; White et al., 2018). Our findings are also consistent with those from a recent Gallup poll (n > 12,000) indicating more people identified as bisexual (57 percent) compared with any other sexual minority identity label (e.g., gay [20.7 percent] or lesbian [13.9 percent]). When broken down across age groups, this corresponded to 15 percent of Generation Z (born 1997–2003) respondents identifying as bisexual versus 6 percent of Millennials (born 1981–1996) and 1.7 percent of Generation X (born 1965–1980; Jones, 2022). A higher proportion of Gen Z respondents also identified as TGD (2.1 percent) compared with respondents from all other generations combined (1.9 percent; Jones, 2022). Similarly, in another national sample of youth (N = 17,112), 24 percent chose more expansive sexual identity and gender labels such as pansexual and nonbinary (Watson et al., 2020). Research by Wilson and Meyer (2021) suggests that 11 percent of LGBTQ adults surveyed identified as nonbinary, supporting claims around label expansion. Taken together, these data suggest that language for identity is evolving and that this shift in language has practical implications for providers and researchers working with LGBTQ+ youth.

CLINICAL IMPLICATIONS AND FUTURE DIRECTIONS

Use of affirming language by both social work providers and researchers can help to reinforce the validity of LGBTQ+ youth identities, particularly in the face of anti-LGBTQ+ legislative initiatives and directives that codify the belief that LGBTQ+ identities are abnormal, invalid, and should not be allowed (American Civil Liberties Union, 2022; APA, 2017, 2021; Bochicchio, 2020; Movement Advancement Project, n.d.). Not only should we “say gay,” but research on the evolution of language within the LGBTQ+ youth community emphasizes the need to use a host of other terminology to validate the diverse identities of LGBTQ+ youth. By failing to incorporate or create space for evolving language, or making assumptions about identity, social work providers and researchers may further silence individual experiences, thereby impacting healthcare access and treatment attrition during this already tumultuous time. Likewise, it may create an obfuscating effect on nuanced research findings, disregarding salient differences within the community (APA, 2017, 2021; Bauer et al., 2009; Dean et al., 2016; Westbrook & Saperstein, 2015). Therefore, it is important to relinquish assumptions of identity and create space for sexual and gender diversity (APA, 2017, 2021; Willging et al., 2006).

Moving forward, in both social work practice and research with LGBTQ+ youth, there exists a critical link between the use of affirmative language and a sense of inclusivity. This critical link is reinforced by both social work principles and NASW’s Code of Ethics. A firm grasp on evolving terminology is paramount to the provision of affirmative care and conducting affirmative social work research. To be inclusive and affirming, providers and researchers need to shift how they pose questions related to sexual identity and gender when conducting studies and intake assessments. More explicitly, rather than asking research participants or clients to use preselected terms that may not align with self-perceptions, we recommend offering write-in options for identity labels in research and posing open-ended questions about sexual identity and gender in practice. This approach has the benefit of helping youth feel seen and respected as individuals, which is a key step toward creating an affirming environment in which youth can feel comfortable sharing about themselves with researchers and providers (APA, 2017, 2021; Badgett, 2009; GenIUSS Group, 2014; Hammack et al., 2021). Although asking questions about identity using predefined categories may save time, limiting participants to researcher-designated categories may only further invalidate LGBTQ+ youth, particularly during times when the world is rife with invalidation of LGBTQ+ identities. Further, more accurate social work research findings will be attained with more culturally competent language.

In the face of cultural and societal stress, and with the increased recognition of the fluidity of sexual identity and gender, it is essential that both providers and researchers think holistically about their practice, starting from their use of language, to ensure that communication is affirming for all youth. To avoid identity invalidation, unintentional or otherwise, we recommend continuous training of researchers and providers working with youth around self-awareness, personal positionality (e.g., gender, sexual identity, power, and privilege), evolving conceptions of identity, and relevant terminology (APA, 2017, 2021; Bochicchio, 2020; Boroughs et al., 2015; O’Shaughnessy & Speir, 2018). This can, and should, take several forms, including direct and potentially ongoing discussions with youth about their identities to ensure that terminology used with individuals is consistent with how they identify and parallels the dynamic nature of self-identification. In clinical practice, this has the benefit of creating an environment in which youth feel comfortable disclosing, questioning, and discussing identities over the course of a therapeutic relationship. In research, using affirming language in surveys and interviews can enhance recruitment efforts and improve disclosure of marginalized identities. As identity labels and conceptions of identity will continue to evolve, it is essential that researchers and providers remain aware of, and open to, adopting additional terms and broadening their understanding of how people are experiencing their identities.

Limitations

As this study was conducted in a major urban center, the geographic location may have contributed to the particular language and terminology used by youth and adults. Additionally, given that participants opted into the study, it is possible that those who chose to participate may have had different experiences than those who did not. There was also an uneven number of staff versus youth participants in the study, with more youth participants (n = 30) than staff participants (n = 12). Due to the COVID-19 pandemic, an additional focus group with staff participants was canceled. Finally, the term “lesbian” was not used by any participants. It is unclear if this reflects the lack of lesbian women in the sample or generational differences in the use of the term.

Conclusion and Implications

Certainly, awareness and application of affirmative language can increase the cultural competency of an organization and its providers and researchers. Findings from our study highlight the evolving nature of sexual identity and gender labels and the need for practitioners to respond accordingly. Adopting language that acknowledges evolving sexual identities and genders will facilitate more effective, culturally competent social work practice and research (Boroughs et al., 2015; Hadland et al., 2016). And, of course, that is not enough. Although an essential first step, it is equally important to examine practitioner behavior, organizational policies, and organizational culture. In light of recent anti-LGBTQ+ legislation, it is that much more important that research and practice become tools for identity affirmation, rather than a divisive tool for ostracization and additional minority stress (Brooks, 1981; Heck et al., 2013; Meyer, 2003; Toomey, 2021; Toomey et al., 2017).