In recent years, `state-centered' LGBT (lesbian, gay, bisexual, and transgendered) health advocacy has emerged as a distinctive form of health activism in the United States. These advocates seek the inclusion of lesbians, gay men, bisexuals, and transgendered persons as subjects and objects of biomedical research. Much of their attention has focused on changing the policies, practices, and priorities of agencies of the US Department of Health and Human Services, including the National Institutes of Health. This emphasis has developed out of the convergence of two trajectories: the histories of specific activist movements that show an increasing willingness to engage directly with the state; and the adoption by the state of a `policy paradigm' for including `special populations' within the concerns of federal health agencies. The impact of state-centered LGBT health advocacy can be traced in a number of specific domains. However, the partial successes of these efforts raise troubling questions about the medicalization of LGBT identities and the limitations of biomedical citizenship.