He hailed from Chenggao 成皐 (today Xingyang 滎陽, Henan) and was in his youth made a palace attendant (xiao huangmen 小黃門) and then rose to the post of Palace Attendant-in-ordinary (zhongchangshi 中常侍). During the reign of Emperor Ling 漢靈帝 (r. 167-189) he was offered the title of Township Marquis of Duxiang 都鄉侯, but he declined.
In a memorial to the throne he recommended to demote conniving officials and minions, and instead to appoint loyal and virtuous officials. He also suggested lowering taxes and state expenditure, promoting agriculture, and to allow more criticism towards politics. The emperor was very disappointed that Lü was a eunuch and not a regular court official, and could therefore not appointed to a government post.
When the Yellow Turban rebellion 黃巾起義 broke out Lü recommended to amnesty those accused of factionalism (dangren 黨人) and to punish corrupt officials, particularly those in the local administration who had not prevented the large-scale uprising. In order to protect their system of nepotism, powerful families, represented by the court eunuchs Zhao Zhong 趙忠 and Xia Yun 夏惲, fired back and accuse Lü Qiang of embezzlement. He was arrested and commited suicide.
An investigation of all family members of Lü Qiang after his death did not confirm the charge of corruption.