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They generally believe that it is determined by biological and environmental factors ; they state that most people's sexual orientation is determined at an early age, and sexual orientation development involves a complex interplay between nature and nurture. There are, however, often significant differences between official policy and real-world enforcement. Archived from the original PDF on 11 March Princeton, NJ: MMWR Morb. The percentage of people who are gay or lesbian and the proportion of people who are in same-sex romantic relationships or have had same-sex sexual experiences are difficult for researchers to estimate reliably for a variety of reasons, including many gay and lesbian people not openly identifying as such due to prejudice or discrimination such as homophobia and heterosexism.

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Dynes and Stephen Donaldson ed. Generally speaking, sexuality in these cultures is considered a more personal aspect of one's identity than it is in the United States. LGBT adoption. Men who have sex with men may not donate blood; Permanent deferral 1.

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