As a gay songwriter, Alexander has stated in interviews he would like to see greater use of the qualified male pronoun in music. He explained that, whenever he used to write a diary, he would refer to "you and I" because he wanted to hide who he was writing about. Several Years & Years songs feature male pronouns. "It is kind of sad to me that we don't have gay popstars singing about men using a male pronoun," he told Digital Spy, "but that could change hopefully." Though his work with Years & Years openly references his sexuality, Alexander "can't speak for all gay people, because there are so many different issues, and experiences, and different shapes and sizes. But I can speak for myself, and that is what I'm doing if I'm going to be writing songs and giving interviews, I want to be able to speak about something I care about." Years & Years's second studio album titled Palo Santo was released on 6 July 2018 and features hits like "If You're Over Me" and "Sanctify". On 14 August 2018, "If You're Over Me" was certified Gold by the British Phonographic Industry and announced via the band's Twitter account
17 September 2018 saw Years & Years release the official Music video for "All For You", featuring an angelic version of Alexander dancing within an abandoned warehouse before transforming into a demonic version of himself and engaging in dance off with an android.
In September 2018, Alexander won GQ's Award "Live act of the year". The award was presented to him by Héloïse Letissier, and in his acceptance speech, Alexander advocated for the LGBTQ community and Mental Health Awareness Month, particularly in men.
In October 2018, British GQ posted an interview between Alexander and Alastair Campbell where he spoke about his struggles with self harm and eating disorders, his experiences in 2018 with homophobia, his political views on Brexit and Donald Trump.