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One objection raised is that including this phenomenon as a psychiatric diagnosis identifies gender-variant identity and expression as pathological, even though many gender-variant children do not report emotional distress; rather, distress may be related to the reaction of the social environment to the child's gender variance.
Coming out can be a very difficult process. Kitts RL. However, given that the youths in the current sample were no more consistent in their sexual identity than lesbian and bisexual youths recruited from both gay- and non-gay venues Diamond, , we do not believe this to be a major limitation.
However, not all LGB youth have access to such centers or health care professionals; most receive health care from providers in their own community who also provide care to non-LGB youth.