It Chapter Two features a brutal depiction of a homophobic hate crime, highlighting societal prejudice. However, the film's primary LGBTQ+ narrative centers on Richie Tozier's deeply empathetic and complex character arc, exploring his hidden gay identity and unrequited love. This portrayal ultimately affirms the worth and dignity of his feelings, contributing to a net positive impact.

The film features Adrian Mellon, a character implied to be transsexual, whose identity is primarily a source of extreme violence and tragedy. His brutal murder by a hate group and Pennywise serves as a plot device to establish the horror, without offering any affirming portrayal or complexity beyond victimhood, leading to a negative net impact.