Recent studies and research findings suggest that genetics, ancestral exposures, and prenatal exposure to certain hormones, primarily testosterone, might play a role in determining sexual orientation or gender identity. The DES community has long discussed the possible role that prenatal exposure to synthetic hormones could have played in gender and sex identity, noting a significantly higher percentage of LGBTQ+ members than the general population.

A January 2020 research study conducted by the National Institute of Health DES cohort found that prenatal exposure to DES may increase the likelihood of being gay among DES Sons, while DES Daughters seem less likely to be lesbians than unexposed women.

However, the study's findings were imprecise and compatible with chance, and it could not address the question of gender identity due to the small number of transgender participants. Researchers will need to continue investigating the relationship between sexual orientation, gender identity, and prenatal DES exposure.