FAQ: What Gay Men Actually Ask About Therapy

The Mental Health Stuff Nobody Talks About

Why do gay men have higher depression rates?

Yeah, it's true. The numbers don't lie, but the reasons aren't what most people think.

It's not because being gay is inherently depressing. It's because growing up gay in a straight world rewires your brain for survival mode. You learn to read rooms before you enter them. You develop radar for who's safe and who isn't. You master the art of code-switching so seamlessly you don't even realize you're doing it.

That hypervigilance? It's exhausting. Your nervous system doesn't care that you're just at dinner with coworkers - it's still scanning for threats because that's what kept you safe for decades.

Most gay men I work with are shocked when I explain this. They thought their anxiety was just... them. Personal weakness. Bad genes. They never connected it to years of having to hide core parts of themselves.

The depression and anxiety aren't character flaws. They're what happens when you spend your developmental years learning that authenticity might not be safe.

What's this perfectionism thing about? I keep hearing gay men struggle with this.

Perfectionism in gay men isn't about being Type A or having high standards. It's trauma dressed up as achievement.

When you're a kid and you realize you're different in a way that might make people reject you, you look for ways to compensate. Maybe if you're the smartest kid in class, the gayness won't matter. Maybe if you're the funniest, the most helpful, the most successful - maybe then you'll be worthy of love despite this fundamental "flaw."

Except it never works. There's no level of perfect that erases the fear of rejection. So you keep pushing, keep achieving, keep proving your worth through external validation.

I see this constantly. Gay men who've built impressive lives but feel empty inside. Who can't enjoy their successes because nothing ever feels good enough. Who burn out trying to maintain impossible standards they set for themselves decades ago.

The gay community's emphasis on success and looking perfect doesn't help. Instagram makes it worse. Everyone's supposed to be thriving, traveling, looking amazing, living their best life. But behind all that performance, a lot of guys are struggling.

Coming Out (And Why It Doesn't Fix Everything)

Why do I still feel weird about being gay sometimes?

Because coming out and self-acceptance are two completely different processes, and everyone acts like they're the same thing.

Coming out is external - telling other people. Self-acceptance is internal - actually believing you're okay as you are. You can come out at 15 and still be working on truly accepting yourself at 35.

I call it the "post-coming-out hangover." You expect this rush of relief and authenticity, and instead you realize that announcing your sexuality doesn't automatically undo years of internalized shame. Your nervous system is still running programs from when hiding was necessary for survival.

Plus, coming out isn't a one-time event. You're constantly deciding whether to be open in new situations. New job, new friend group, new dentist - each interaction requires a split-second calculation about safety and authenticity.

The guys who struggle most are often the ones who came out to great acceptance. They feel guilty for still having issues when they "should" be grateful for their supportive families and friends.

How do I know if I have internalized homophobia?

Internalized homophobia is sneaky. It doesn't announce itself by making you attend anti-gay rallies.

It shows up in smaller ways. Feeling embarrassed when your boyfriend is "too gay" in public. Preferring straight-passing friends. Rolling your eyes at Pride parades. Feeling uncomfortable with drag queens or anyone who's too flamboyant.

Sometimes it appears in your sex life - anxiety, shame or disgust during intimate moments that doesn't match your intellectual beliefs. Or in relationships, where you find yourself attracted to guys who are emotionally unavailable or treat you poorly.

The trickiest part is that you can intellectually support LGBTQ+ rights while still carrying unconscious negative associations about your own sexuality. You can donate to gay causes and still feel somehow superior to "those" gay men who are more obvious about it.

I had a client who was incredibly involved in LGBTQ+ advocacy work but couldn't bring himself to hold his boyfriend's hand in public. His internalized homophobia wasn't about hating gay people - it was about feeling like he needed to be "respectable" to earn acceptance.

Dating and Relationships (Or: Why Is This So Hard?)

Why is gay dating so much harder?

Because it is harder. Not impossible, but genuinely more complicated than straight dating.

First, the pool is smaller. In straight dating, you can reasonably assume most people you meet are potential partners. Gay men are working with maybe 5-10% of the population, and that's in major cities.

Second, most gay men missed out on normal teenage dating experiences. While straight kids were learning relationship skills through awkward middle school crushes and high school relationships, we were figuring out how to survive being different. So we enter adult dating without some basic relationship development.

Third, dating apps have made gay dating feel like shopping for hookups, even when that's not what you want. The emphasis on immediate physical attraction and quick decisions doesn't leave much room for the slower burn of actually getting to know someone.

And honestly? A lot of gay men are carrying unresolved trauma and haven't learned how to be vulnerable with other men. Intimacy can feel threatening when you've spent years protecting yourself from rejection.

What makes gay relationships different from straight relationships?

There's no instruction manual for gay relationships. Straight couples inherit generations of social scripts - who proposes, how to handle finances, what holidays look like with families, how to divide household responsibilities. Gay couples have to figure all of that out from scratch.

That can be liberating - you get to create a relationship that actually fits you both instead of following predetermined roles. But it also requires way more communication and negotiation.

Then there are the external pressures straight couples don't face. Different levels of outness, family acceptance issues, workplace dynamics. One partner might be completely out while the other is still navigating family relationships. One might be comfortable with PDA while the other isn't ready.

Gay couples also deal with community pressures that are unique. The gay community can be small and gossipy. Everyone knows everyone's business. There are unspoken rules about dating within friend groups, ex-partners who stay in social circles, and social hierarchies based on looks, income, or status.

Family Stuff (The Complicated Reality)

My family says they accept me, so why do things still feel off?

Because acceptance often comes with conditions that nobody talks about openly.

Your parents might genuinely love you and want you to be happy, but still carry their own internalized homophobia. They accept you, but they're not comfortable with your boyfriend at family gatherings. They're supportive, but they don't ask about your dating life the way they do with your straight siblings.

There's also something I see constantly - families who "accept" your sexuality but treat your relationships as less serious or permanent than straight relationships. They don't expect your partner at family events. They don't include him in family photos. They refer to him as your "friend" to extended family.

And then there's the grief piece that nobody prepares you for. Even with accepting families, you're often mourning the relationship you wish you could have. The conversations about crushes you never had as a teenager. The prom photos where you couldn't bring who you really wanted to bring.

Many gay men feel guilty about being sad about family relationships that look "good enough" from the outside. But grieving what you didn't get to have is normal, even when your family is trying their best.

When do I need to talk to someone professionally about this stuff?

Here's what I tell guys: if you're asking the question, you probably already know the answer.

Gay men are conditioned to be "resilient" and to minimize our struggles. We're told we should be grateful for acceptance and that mental health challenges are just "part of being gay." That's garbage.

You don't need to be in crisis to benefit from therapy. If you're feeling lonely despite having friends, if dating feels hopeless, if you're successful on paper but feel empty inside - those are all valid reasons to seek support.

Same goes for substance use to feel comfortable in social situations, perfectionism that's making you miserable, or family relationships that leave you feeling drained and frustrated.

The biggest indicator? If you find yourself thinking "I should be over this by now" about anything related to your sexuality, family relationships, or dating life. That's usually a sign you're minimizing legitimate struggles that could improve with the right support.

Finding a Therapist (What Actually Matters)

Should I see a gay therapist or LGBTQ-friendly therapist?

It depends on what you need, but there's something to be said for not having to explain the basics of gay male experience.

A good LGBTQ-affirming straight therapist can absolutely help you. But with a gay therapist, you don't have to explain what code-switching is. You don't have to describe the unique pressures of gay social spaces. You don't have to justify why family acceptance still feels complicated.

More importantly, you want someone who understands that being gay isn't the problem that needs fixing. The problem is living authentically in a world that wasn't designed to support you.

I've had guys come to me after working with well-meaning therapists who kept trying to help them "accept" their sexuality, when the real issue was learning to navigate minority stress or address perfectionism that stemmed from growing up different.

What should I actually expect if I start therapy?

Good therapy for gay men doesn't feel like conversion in reverse - nobody's trying to make you "more gay" or fix your "internalized homophobia" with rainbow flags and affirmations.

It's more about untangling what's personal versus what's cultural. Learning to recognize when your anxiety is about a specific situation versus when it's your nervous system responding to minority stress. Understanding which relationship patterns are about personal preferences versus trauma responses.

You should feel understood without having to over-explain your experiences. Your therapist should get why coming out didn't solve everything, why family relationships remain complicated even with acceptance, and why dating feels more complex than it does for your straight friends.

The goal isn't to make you "normal" by straight standards. It's to help you live as authentically and confidently as possible as a gay man in a world that's still figuring out how to support people like us.

These are the real questions I hear in my practice working with gay men across Europe and the UK. If you're ready to explore these topics without having to explain the basics of gay male experience, let's talk.