LGBT youth experience disproportionate rates of mental health diagnoses, including depression and anxiety. Using qualitative interviews of LGBT youth (n = 14) and primary care providers (n = 12), we sought to identify whether mental health discussions with a primary care provider were perceived as overall beneficial. Most LGBT youth felt comfortable being asked about depression, anxiety, or other mental health conditions by their primary care provider. All felt it appropriate to provide this information by survey or tablet. However, youth participants' comfort depended on feeling connected with and accepted by their provider. Those that did feel comfortable, perceived a benefit when these conversations did happen. Providers unanimously described wanting to address mental health needs in LGBT youth, either in terms of societal advancement, or clinic-based changes. Both LGBT youth and primary care providers appeared to want more mental health discussions during visits. However, more connectedness may be needed to improve willingness to engage in care; and providers may require specific support to successfully fill this need.