To adequately understand the diversity of child and adolescent homoeroticism, a differential developmental trajectories perspective is proposed that integrates recent research about the development of sexual orientation, sexual behavior, and sexual identity. Only the latter two can be altered therapeutically. Biologic theories of homosexuality are reviewed. Homoerotic youth are shown to be similar and dissimilar to heterosexual youth; more variability occurs within than among sexual orientation groups. Contemporary homoerotic youth recognize their sexuality, self-label, and accept their sexuality at earlier ages than previous generations and many are rejecting traditional identity labels. Clinical recommendations offer ways to assess sexual orientation and help patients to achieve acceptance of their sexuality.