Background: Researchers have tended to favor scholarship that looks at institutional forms of support for gay, lesbian, bisexual, and transgender students in the context of resource centers specifically tailored to gay, lesbian, bisexual, and transgender students. Our study makes two distinct contributions to the study of gay and lesbian students of color: (1) We move away from resource centers as a focal point of support for students and attempt to explore the role of student health at 11 HBCUs; and (2) We draw attention to the ways in which health administrators challenge the influence of respectability to promote the delivery of healthcare that is attuned to the needs and experiences of sexual minorities, thereby providing evidence that pushes back against dominant narratives that reinforce HBCUs as homogenous communities of conservatism and homophobia. Research Question: This study seeks to answer the following questions--(1) How do student health directors at HBCUs promote policies and practices that are attuned to the health of their gay and lesbian students?; and (2) What conditions are developed to cultivate a student health center that not only addresses students' physical health, but is also "in a position to reaffirm these students" (Edwards, 1994, p. 1)? Participants: Eleven student health directors at 4-year private and public HBCUs. Research Design: The inquiry is situated within the tradition of narrative analyses. Semistructured interviews were conducted with our participants. Data Collection and Analysis: We structured each interview around six broad open-ended questions that offered opportunities for us to tease out unique areas of tension during the interview and to "lead the respondent on a journey, to a frame of mind from which she will understand our "big questions" (Dilley, 2002, p. 133). These questions included perceptions of challenges and successes of campus inclusiveness for sexual minority students, clinical services, sensitivity training for staff, and the presence of same gender loving brochures and messaging. Findings: Our data offers a narrative that illuminates the forces that shape the challenges and opportunities for student health directors (SHDs) to engender change within and outside student health centers and how that ultimately affects the provision of health services to gay and lesbian students. More importantly, it showcases how efforts are made to challenge the influence of respectability to ensure student health and well-being. The findings are organized under the following themes: (a) building trust, (b) partnerships, (c) resistance, and (d) envisioning next steps. Conclusions: We provide an extensive discussion in how student health directors manage the challenges associated with dominant institutional ideologies, as well as critical implications for future research and practice.