I think he's addicted to the attention. The dumbest part of all is that he doesn't need to bully or shit on other people to get attention -- but that's what reliably keeps him in the spotlight, so that's what he does.
The whole 'personal responsibility' angle is a way to shit on poor people, addicts, immigrants, etc. The sad part being that he was a addict, and had the money to get treated privately, got treatment, and instead of it humbling him and leading him to realize that anyone can fall down the hole into substance abuse, he uses it to look down on people who need help and don't have the money or assets to pay for that help out of pocket.
I have no idea why he cares about how the LGBTQ+ segment of society lives. What other people do with their junk is anyone else's business, least of all him. It seems like him and his followers are afraid of being attracted to a person that don't have the 'correct' genitals.