This chapter examines the relationship between sexual identity and risk factors related to safety, health, sex, substance use, family and friends, worries, and their desire to talk about these in counseling. It considers the findings from an adolescent self-report questionnaire (Adquest) gathered at intake at the Mount Sinai Adolescent Health Center (AHC). AHC is a comprehensive health and mental health center serving inner-city adolescents in New York City. The chapter discusses self-reported sexual identity is treated as the independent variable; gender as an intervening variable; and risk and behavior items as well as desire to talk as dependent variables. It presents a snapshot of respondent self-identification with one of the sexual orientation categories, and cross-tabulate sexual orientation by age and gender. The chapter considers the gender and sexual identity differences associated with these risks and experiences. It reports on Lesbian, gay, bisexual, and sexual-orientation questioning youth's desire to talk to a counselor about multiple problems.