Adolescence is an acutely significant period of development, and sexual and gender minority youth (SGMY) experience unique stressors which contribute to elevated rates of substance use, mood disorders, suicidal ideation and attempts, and other health outcomes when compared with their heterosexual, cisgender peers. Family is often the context in which SGMY navigate these stressors and manage their health. Family rejection and support have each been linked to health outcomes among SGMY, including depression and substance use. More globally, family connectedness is beneficial to adolescent’s health but is an understudied construct within SGMY research. Limited research has examined how these family processes converge to influence SGMY health. In an effort to capture nuance in family process and SGMY health, this study examined the relationship between experiences of family support, rejection, and connection among SGMY and their depressive symptoms and substance use. Findings have implications for research and practice with families.