Elementary features LGBTQ+ characters, including Joan Watson and Ms. Hudson, whose identities are portrayed with dignity and normalcy. The show integrates queer identity into its narrative without sensationalism or harmful stereotypes, presenting it as an ordinary aspect of its characters' lives. The net impact is affirming, as these depictions contribute to a respectful and validating portrayal.

The series features Dr. Aris Lovell, a trans woman, portrayed as a competent professional. While her past transition is central to a blackmail plot, the show frames prejudice as an external negative force. The main characters treat her identity with respect, and she is ultimately cleared of any wrongdoing, contributing to a net positive portrayal.

The show features Dr. Joan Watson and Professor Jamie Moriarty, both major characters who were canonically established as male (Dr. John Watson and Professor James Moriarty) in the source material, now portrayed as female.

Dr. Watson, a character canonically established as a white male in the Sherlock Holmes stories, is portrayed as a female of Asian descent in "Elementary," constituting a race swap.