Body image, sexual orientation and gender identity

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While people who identify as lesbian, gay, bisexual and transgender (LGBT) experience body image concerns in ways that are generally similar to people who identify as heterosexual, their experience and relationship with their body is likely to differ in specific ways.   

How does body image vary across the LGBT community?

Heterosexual men have been found to report higher levels of body appreciation than gay and bisexual men (123,124).

Some research suggests that sexual minority men may be more likely to internalise an appearance ideal that is centred around looking athletic (124) and that there may be a greater emphasis on physical appearance in the gay community, which can negatively affect body image (125) through pressure to match this ideal.

One review of the research (126) found that gay men are more likely than their heterosexual counterparts to experience a desire to be thin, and this can sometimes manifest in higher levels of eating disorder symptoms. As in the wider research, studies focused on gay and bisexual men have found a connection between higher levels of body dissatisfaction, an increased likelihood of experiencing depressive symptoms and increased sexual anxiety and poorer sexual self-efficacy (123). 

There is some research to suggest that lesbian women have a similar level of concern around their body image as heterosexual women (127,128), though research is mixed on this point. One study suggested a small difference, finding that lesbian women may be slightly more satisfied with their bodies than heterosexual women (129). However, other studies find a similar level of concern between heterosexual and lesbian women regarding the perceptions of their bodies and their perceptions of what an ‘ideal’ body looks like (128). A similar pattern was found for women who identify as bisexual (130).  

In our survey, a higher proportion of individuals who identified as gay, lesbian or bisexual reported feelings of anxiety and depression because of their body image. Among adults who identified as gay, lesbian, bisexual or other, 53% felt anxious and 56% felt depressed because of their body image compared to one third (33%) of the adults who identified as heterosexual. 

Similarly, in our survey, one third (33%) of adults who identified as gay, lesbian, bisexual or other reported experiencing suicidal thoughts or feelings because of concerns about their body image, compared to 11% of the adults who identified as heterosexual.  

 

Transgender people

Transgender people may experience distress resulting from the incongruity between their biological sex and their gender identity. This can have an effect on their body image, and research suggests that levels of body dissatisfaction in transgender people tend to be higher prior to undergoing gender confirmation treatments (131).

Feelings around one’s body can differ depending on the stage at which a person is on their transition journey (132). It should be noted that transitioning does not just refer to medical intervention, which is something that not all transgender people want or are able to have. It refers to the steps a person takes to live in the gender with which they identify, which could include things like telling friends and family or dressing differently.

There is a much larger body of literature around gender dysphoria and the psychological and physical effects of transitioning that is beyond the scope of the current report. Further information about, and support around, transitioning is available from organisations like the LGBT Foundation, Consortium and TransUnite.  

Stigma and discrimination

The stigma, prejudice and discrimination that LGBT people can face often leads to higher levels of stress (133). This ‘minority stress’, which not only encompasses experiences of discrimination, harassment and victimisation, but also more internalised feelings like shame, may be a contributing factor to the mental health problems reported within the LGBT community (133).  

This ‘minority stress’ may also be linked to body image. For young men who have sex with men, one study found that internalised negative attitudes towards homosexuality and sexual orientation predicted overall body dissatisfaction, muscularity dissatisfaction and body fat dissatisfaction (134). Another recent study looking at body image of non-binary and binary transgender people found that harassment or rejection was associated with lower levels of body appreciation by reducing self-esteem and satisfaction with life (135). This was reflected in our survey, where 40% of the adults who identified as gay, lesbian, bisexual or other said they felt shame because of their body image, compared to 18% of the heterosexual adults. Similarly, 54% of adults who identified as gay, lesbian, bisexual or other felt their self-esteem was negatively affected by their body image in the past year, compared to 37% of the adults who identified as heterosexual. 

Next: How can we protect, promote, and maintain body image?
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References

123. Blashill AJ, Tomassilli J, Biello K, O’Cleirigh C, Safren SA, Mayer KH. Body Dissatisfaction Among Sexual Minority Men: Psychological and Sexual Health Outcomes. Arch Sex Behav. 2016 Jul 8;45(5):1241–7.  
124. Alleva JM, Paraskeva N, Craddock N, Diedrichs PC. Body appreciation in British men: Correlates and variation across sexual orientation. Body Image. 2018 Dec;27:169–78.  
125. Jankowski GS, Diedrichs PC, Halliwell E. Can appearance conversations explain differences between gay and heterosexual men’s body dissatisfaction? Psychol Men Masculinity. 2014 Jan;15(1):68–77.  
126. McCreary DR, Hildebrandt TB, Heinberg LJ, Boroughs M, Thompson JK. A review of body image influences on men’s fitness goals and supplement use. American Journal of Men’s Health. 2007;1(1):307–16.  
127. Kelly L. Lesbian body image perceptions: The context of body silence. Qual Health Res. 2007 Sep;17(7):873–83.  
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130. Smith ML, Telford E, Tree JJ. Body image and sexual orientation: The experiences of lesbian and bisexual women. J Health Psychol. 2017 Feb 1  
131. Owen-Smith AA, Gerth J, Sineath RC, Barzilay J, Becerra-Culqui TA, Getahun D, et al. Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction, and Mental Health in a Cohort of Transgender Individuals. J Sex Med. 2018 Apr;15(4):591–600.  
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133. Meyer IH. Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological Bulletin. 2003;129(1):674–97.  
134. Siconolfi DE, Kapadia F, Moeller RW, Eddy JA, Kupprat SA, Kingdon MJ, et al. Body Dissatisfaction in a Diverse Sample of Young Men Who Have Sex With Men: The P18 Cohort Study. Arch Sex Behav. 2016 Jul 14;45(5):1227–39.  
135. Tabaac A, Perrin PB, Benotsch EG. Discrimination, mental health, and body image among transgender and gender-non-binary individuals: Constructing a multiple mediational path model. J Gay Lesbian Soc Serv. 2018 Jan 2;30(1):1–16