This grounded theory study utilized interviews with 16 service providers and 19 lesbian, gay, bisexual, trans, and queer (LGBTQ) youth to develop a substantive theory of resilience processes among LGBTQ youth. The core category, paving pathways through the pain, suggests that LGBTQ youth build on emotional pain inflicted by external adversities to carve out pathways to resilience. Youth employed the following resilience processes: (1) navigating safety across contexts, (2) asserting personal agency, (3) seeking and cultivating meaningful relationships, (4) un‐silencing marginalized identities, and (5) engaging in collective healing and action. Youth focused on particularly painful adversities and engaged intentionally in one or more of the resilience processes related to the origins of their pain.