Background <p>Very little is known about the practice of compensated dating among LGBTQA + youth in Japan. This is a critical gap in research, as compensated dating (<i>enjo kōsai</i>) is more commonly reported among young people experiencing economic hardship, social exclusion, or housing instability. LGBTQA + youth in Japan are disproportionately affected by structural vulnerabilities, yet their experiences remain underexamined in national data. This study examines the prevalence and correlates of compensated dating among LGBTQA + youth, and whether it is associated with indicators of social and mental health disparities.</p> Methods <p>We conducted a national online survey of 5,323 LGBTQA + youth aged 15–25 across Japan. Prevalence and patterns of compensated dating were assessed, and multivariable logistic regression was used to examine demographic and psychosocial correlates.</p> Results <p>One in twenty participants (5.0%) reported engaging in compensated dating in the past 12 months. It was more common among those who had experienced homelessness, economic hardship, self-harm, and sexuality or gender identity-based marginalisation. Cisgender men were more likely to engage in compensated dating than cisgender women or trans and gender diverse youth, and gay youth more than asexual respondents.</p> Conclusions <p>While compensated dating is often portrayed through moralistic or heteronormative narratives in East Asia, our findings suggest that it is shaped by intersecting forms of social and economic vulnerability. Associations between compensated dating and key risk factors including homelessness, discrimination, exclusion, and self-harm. These results call for rights-based, harm reduction approaches in public health responses, including LGBTQA+-inclusive mental health services and housing protections, grounded in care rather than criminalisation.</p>