Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Asexual (LGBTIQA+) people with intellectual disability face unique challenges in asserting their identities. We aim to understand how Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals with intellectual disability exercise self-determination within disability services. Eight LGBTQ adults with intellectual disability who used disability services participated in qualitative interviews. Fifteen key informants, representing government policy makers, disability service organisations, gender and sexuality educators, and senior leaders of LGBTQ organisations were also interviewed. We found that LGBTQ people with intellectual disability navigate barriers to self-determination: making autonomous decisions about their sexualities or gender identities; coming out and being recognised as LGBTQ; and gaining a sense of belonging in both disability and LGBTQ spaces. We suggest organisational-level actions including: (1) building organisational awareness; (2) including sexuality and gender identities in person centred support planning; and (3) increasing access to positive visual representations and experiences of pride.