Understanding 2SLGBTQI+: A Plain-Language Guide

Updated February 12, 2025 5 min read

Illustrative photo of a diverse Canadian care team in a staff training discussion circle

This acronym is confusing. We get it. It’s long, it keeps changing, and nobody wants to be the person who says it wrong in front of others. So let’s take the pressure off: you don’t have to memorize it. You just have to understand what it’s for and be willing to learn.

Here’s why it exists, what each part means in plain language, and how to use it in your day-to-day work — with real examples from care settings.

Why the acronym exists (and why it’s so long)

The acronym grew because one word never covered everyone. “Gay” left out lesbians. “Gay and lesbian” left out bisexual people. Add “transgender” and you’ve still left out queer, questioning, intersex, and Two-Spirit people. Each letter was added because real people were being missed.

In Canada, the “2S” at the front is intentional. Two-Spirit is a specific identity held by some Indigenous people, and placing it first recognizes that Indigenous 2SLGBTQI+ people were here before the colonial language that came later. It’s a sign of respect — and a reminder that this isn’t one-size-fits-all.

The “+” is the important part

The plus sign means “and anyone else whose identity isn’t captured by these letters.” Language will keep evolving, and the plus makes room for that. You don’t need to chase every new term — you just need to respect the person in front of you.

What each letter means — in plain language

Here’s the breakdown. For each one, you’ll see what it stands for, a plain-language explanation, what it might look like in a care setting, and when you’d use the term.

Two-Spirit

A specific identity held by some Indigenous people that encompasses sexual, gender, and spiritual diversity. It’s a role and identity rooted in Indigenous cultures — not a synonym for LGBTQ.

In a care setting

An Indigenous resident may identify as Two-Spirit and want that term used, not “trans” or “gay.” They may also want their cultural and spiritual practices honoured alongside their care.

When to use it: Use it only for people who identify as Two-Spirit, and always as its own term — never as a catch-all. If you’re unsure, ask the resident how they describe themselves.

Lesbian

A woman who is attracted to other women. It’s about who a person is drawn to, not how they present or identify in terms of gender.

In a care setting

A resident may mention a female partner of 40 years. Using “partner” or “spouse” — and welcoming that partner as family — tells her she’s safe here.

When to use it: When a woman specifically uses this word for herself. Otherwise, “partner” or “spouse” is a warm, neutral default until you know.

Gay

A person attracted to people of the same gender — most often used by men attracted to men, but some women use it too.

In a care setting

A male resident refers to his husband. Using “husband” (his word) and including him in care conversations affirms the relationship without making it a story.

When to use it: When someone uses it for themselves. As a default, “partner” works until you know the person’s own words.

Bisexual

A person attracted to more than one gender. It doesn’t mean someone is confused or “halfway” — it’s a complete identity on its own.

In a care setting

A resident may have been married to a person of a different gender earlier in life and now have a same-gender partner. Both relationships are real; neither cancels the other out.

When to use it: When someone shares it. You rarely need to name it in care — just respect whoever the resident tells you matters to them now.

Transgender

A person whose gender identity (their internal sense of self) differs from the sex they were assumed to be at birth. “Trans” is a common short form. This is about identity, not about bodies or surgery.

In a care setting

A resident was recorded as male at birth but lives as a woman. She uses “she/her” and a chosen name. Using both, consistently and without fuss, is the single most affirming thing you can do.

When to use it: When someone tells you they’re trans. Use their chosen name and pronouns always — in conversation, charts, signage, and handover.

Queer / Questioning

“Queer” is a word many people now use proudly as a broad umbrella for not-straight or not-cisgender. “Questioning” means someone is exploring their identity. Both are valid.

In a care setting

A resident might describe themselves as “just queer” rather than picking a specific label. Use their word. If someone is questioning, give them space — no pressure to decide.

When to use it: When someone uses “queer” for themselves (some older adults still find it painful, so never apply it to someone who hasn’t claimed it). For questioning, simply be patient and open.

Intersex

A person born with variations in sex characteristics (chromosomes, hormones, or anatomy) that don’t fit typical definitions of male or female. It’s about biology, not identity or orientation.

In a care setting

An intersex resident may have specific health or personal-care needs and may be private about their history. Follow their lead, protect their privacy, and never share their status unnecessarily.

When to use it: Rarely in conversation — it’s medical and personal. The key is privacy and respect: chart only what’s needed for care, and keep it confidential.

Plus

Everyone else whose identity isn’t captured by the letters above — including asexual, pansexual, non-binary, and other identities. It’s the acronym’s way of saying “and whoever else.”

In a care setting

A resident might identify as non-binary (neither a man nor a woman) and use “they/them.” The plus makes room for them. Use their name and pronouns exactly as given.

When to use it: You don’t say “plus” out loud — it’s part of the written acronym. In person, just use each resident’s own words for themselves.

Common questions (the ones people are too shy to ask)

Do I have to memorize all this?

No. You don’t need to recite the acronym. You need to use each resident’s name and pronouns, treat their relationships as real, and ask respectfully when you’re unsure. That’s it. The acronym is a map, not a test.

What if I get it wrong?

Correct yourself briefly and move on: “Sorry — she. As I was saying…” Don’t make it a big moment or over-apologize. What matters is that you keep trying. Residents notice the effort far more than the occasional slip.

Can I just say LGBTQ?

You can, and many people still do. In Canada, 2SLGBTQI+ is the more inclusive form because it names Two-Spirit and intersex people. Using the fuller version signals respect — but if you slip back to LGBTQ, no one will be upset as long as you’re respectful in person.

Why is it so long?

Because real people kept getting left out, and each addition made the umbrella wider. It’s a sign of progress, not bureaucracy. The plus means it doesn’t have to be perfect — it just has to make room.

Does this apply to my workplace?

Yes — if you serve older adults in Canada, you serve 2SLGBTQI+ older adults, whether you know it or not. Many are not out. The same respect you show every resident applies here, with a little more awareness.

A simple way to remember it

If the whole acronym feels like too much, hold onto this: every letter is a person who wants to be seen and respected for who they are. You don’t need the vocabulary perfect. You need the posture right — curious, kind, and willing to use someone’s own words.

You don’t need to be perfect

You just need to be respectful and willing to learn. That’s the whole thing. The residents in your care will feel the difference — not because you knew every term, but because you treated them as a person worth getting right.

Quick check-in

Let’s reinforce what you just read. This isn’t graded — it’s just a friendly way to let the ideas settle. There’s no wrong answer, only learning.

Quick check-in (not graded — just for fun)

1. A resident tells you their name is different from the one on their chart. What do you do?

2. What does the “2S” in 2SLGBTQI+ stand for, and why is it first?

3. You accidentally use the wrong pronoun for a resident. What’s the best response?

4. A resident mentions a partner your intake form didn’t capture. What do you say?

Keep learning

You’ve just taken a real step by reading this. That curiosity is exactly what good care is built on. Here’s where to go next:

Your start-here pathway

A moment to reflect

What’s one new thing you learned about 2SLGBTQI+ people today?

No need to write it down — just sit with it for a moment.

Downloadable one-pager

2SLGBTQI+ Quick Reference

A printable cheat sheet with what each letter stands for, a plain-language definition, a care-setting example, and when to use it — keep it at the nursing station.

Open & print

Frequently asked questions:

Do I really have to memorize the whole acronym?+

No. You need to use each resident’s name and pronouns, respect their relationships, and ask kindly when unsure. The acronym is a map, not a test — the “+” means there’s always room to learn more.

Is it okay to just say LGBTQ?+

Many people still do. In Canada, 2SLGBTQI+ is more inclusive because it names Two-Spirit and intersex people. Using the fuller version signals respect, but what matters most is how you treat the person in front of you.

What’s the difference between sexual orientation and gender identity?+

Sexual orientation is about who you’re drawn to. Gender identity is about who you know yourself to be. They’re separate things — a trans woman might be attracted to men, women, both, or neither, just like anyone else.