Navigating one’s sexual and/or gender identity can be a difficult and complex process for Christian LGBT+ youth, leaving many of them at high risk for poor mental health outcomes and self-harming thoughts and behaviors. Seventh-day Adventist families and congregations are just beginning to grapple with how they should respond to their LGBT+ children. This survey of 310 Seventh-day Adventist adult Millennials explored perceived levels of their families’ acceptance or rejection of their sexual orientation or gender identity during their teen years. Other variables included recent levels of self-esteem, social support, depression, substance abuse, high-risk sexual activity, and suicidal thinking or attempts. Findings showed generally low levels of family acceptance and support, as well as elevated rates of depression and at-risk thoughts and behaviors. A high proportion of respondents have retained strong spiritual commitment and moderate church involvement. We conclude with recommendations for parents, family, church members, and friends who have LGBT+ loved ones.