The Real Housewives of Beverly Hills consistently portrays LGBTQ+ characters and themes in a largely positive and affirming manner. The show features openly gay family members and cast members discussing their same-sex relationships, often participating in LGBTQ+ events like Pride. While drama is inherent to the format, queer identities are generally depicted with dignity and as integral, valued parts of the cast's lives, without being reduced to stereotypes or sources of mockery.

The show has featured transsexual characters and themes, primarily through guest appearances and personal discussions. These portrayals generally avoid negative stereotypes and are handled with respect, but trans identity is not a central narrative focus. The overall impact is neutral, as positive elements are present but incidental, not forming a sustained affirming arc for the series.