Doogie Kamealoha, M.D. features positive and affirming portrayals of LGBTQ+ characters. Lahela's gay best friend, Alex, has a healthy relationship, and another friend, Steph, explores her bisexuality with sensitivity. The show normalizes queer identities, depicting them with dignity and complexity within its family-oriented narrative.

"Doogie Kamealoha, M.D." features Alex, a recurring character who comes out as a trans boy in Season 2. The show portrays his journey with dignity, complexity, and agency. His family and friends offer supportive and accepting reactions, affirming his identity. The narrative frames his trans identity positively, focusing on personal growth and acceptance rather than ridicule or hardship.

The series is a reimagining of "Doogie Howser, M.D.", where the titular character, originally a male teenage doctor, is now portrayed as a female teenage doctor named Lahela "Doogie" Kameāloha. This constitutes a gender swap for the central character.

The lead character, Lahela "Doogie" Kamealoha, is a reimagining of the original Doogie Howser, who was canonically white. Lahela is portrayed as Hawaiian and Chinese, constituting a race swap for the central character.