Body image, sexual identity, sexual well-being, and gender identity interact in complex ways in youths’ lives. While separate concepts, they inherently intertwine as each affects the other socially, emotionally, developmentally, and physically. Gender-diverse youth must navigate the development of their gender and sexual identities in a social environment that often stigmatizes them while also confronting gender dysphoria that can harm their body image. Disruptions in the development of gender and sexual identities and negative body image can lead to reduced levels of sexual well-being, which can negatively impact gender-diverse youths’ overall well-being. This chapter reviews literature regarding body image, sexual and gender identity development, and sexual well-being among gender-diverse youth, with a focus on how the four aspects of gender-diverse youths’ lives intersect. It concludes with recommendations for social work practice, education, and research so that social workers can be better attuned to gender-diverse youths’ complex gender-, sexuality-, and body image-based needs.