This paper documents the experiences of health care access among gay, lesbian, bisexual and Two-Spirit (glbt-s) people in Canada. In particular, it addresses the importance of coming out as glbt-s to the development of good health and appropriate care. The paper reflects upon the impact of hiding one's sexual orientation on glbt-s people's experience of and use of health care resources and the responsibility of health care institutions to address homophobia and create supportive environments in order to facilitate the coming out process in health care settings. The central role of health care policy makers with regard to the articulation of gay-positive policy and practice in health care institutions is highlighted.