Adolescent patients comprise up to 16% of all emergency department (ED) visits in the United States. Although an exact prevalence is difficult to determine, an estimated 4-17% of youth identify as lesbian, gay, bisexual, transgender, and questioning. Health care providers need to understand gender identity and sexual orientation to provide competent medical care within a clinical setting that is safe for minority youth. Despite the ED presence of lesbian, gay, bisexual, transgender, and questioning teens, many ED providers report a lack of comfort with understanding the health care needs of this patient population. In this article, we aim to review the topics of gender identity, gender presentation, sexual orientation, and pronoun use, and provide practical guidelines for eliciting important information in the care of sexual and gender minority youth.