The most common mental health issues that bring gay men into therapy

Today I’m going to explore 8 common topics gay men can talk about in therapy to improve their lives and relationships.

This is by no means an exhaustive list. Just like our straight counterparts, we can experience grief, addiction, life transitions, anxiety, and depression. That’s not what I’m going to talk about today.

The Statistics

We’ve all read The Velvet Rage or Straight Jacket and we know how difficult it is to be raised as a queer person in a heteronormative society. So I’m not going to inundate you with those negative statistics here. Bottom line, it’s still hard to be gay. Despite all the political progress we’ve made the mental health statistics are still shockingly worse for LGBTQ+ folks when compared to our straight counterparts.

Hope

And there is hope. Like the queer theorist Jose Esteban Munoz has written in his inspiring seminal text Cruising Utopia “Queerness is not yet here…we must dream and enact new and better pleasures, other ways of being in the world and ultimately new worlds.” And I think that is true for us as queer men. We must have hope in a new and different future.

Just a reminder, this resource is not meant to take the place of therapy or counseling.  If you need support, please find it for yourself.  You’re worth it! 

What are the 8 main things that gay men can explore in therapy to improve their lives?

1. Coming out

At a certain point most LGBTQ+ people come out of the closet. Meaning, we tell the rest of the world that we identify as something other than straight. This is a huge rite of passage and is different for everyone. Some people have very supportive families and come out in middle school. Others can live most of their lives as heterosexual and come out later in life.

While coming out is a big step, it’s typically just the beginning. 

Our sexual identity is a big part of who we are as people, but it’s usually just one layer of the onion. Once we peel that back, we can begin nurturing self-love and compassion for all of who we are.

Assumed straight

Currently, most folks are considered straight unless they say otherwise.  Keeping secrets because of fear of rejection can take a toll on our mental health.  It also teaches us at a young age that it’s not ok to be ourselves. Hopefully there will come a time when it is not assumed that everyone is straight, but we’re not there yet.  

Everyone has a unique coming out story.  For most of us, before we start on that journey we learn how to hide parts of ourselves from the world.  This can have a lasting impact. 

An easy coming out story

Here’s an example of an easier coming out story.  Let’s say you didn’t have to come out.  Your family and community didn’t assume that you were straight.  You’re allowed to explore your identity at your own pace without any pressure to present in a certain way.  There is no shame about the gender of the person you love and your family provides resources for you to learn about safe same-sex sex and sexuality.  You have queer role models and you feel supported and empowered.

Not so easy coming out story

Now here’s an example of a not so ideal coming out story.  Imagine you grow up in a conservative and religious family.  Your parents make negative comments about gay people your whole life.  There are no “out” and respected members of your community. In fact, you’re told that gay people go to hell and sexuality is a choice.  As you’re developing your sexuality, you feel shame and disgust about the person you are. Over time you internalize that homophobia and it makes it difficult to love and accept yourself exactly as you are.  

Your coming out story

If we think about the examples above as two poles on a spectrum, chances are your own story falls somewhere in the middle.  What was it like to come out? Did you have any feelings about the examples listed above? It can be important to understand your own coming out story to assess if you’re carrying some internalized homophobia.  Spoiler alert, you probably are.    

Life after coming out

Even with the best family and friend circle in the world, we’re all fed heteronormative messages through movies, books and other media outlets. I’ve yet to see an LGBTQ+ hero or heroine in a Disney movie, but maybe someday.  These subliminal messages tell us from an early age that we’re different, other and “not normal.” Taking in messages like that can have all sorts of consequences on self-esteem, self-worth and confidence.

2. Learning to share all of ourselves with the world

After we come out, there is a deeper process that can happen when we learn how to stop hiding different parts of ourselves. 

Think about it, if you become good at hiding your sexuality, what prevents you from hiding other parts of yourself. Maybe you really like playing the ukulele, but you worry others will judge you on some level so you conceal that part of yourself.   And it can go on from there.

If some of these concepts ring true for you, you may be wondering what to do about changing these patterns.

Let ourselves be seen

As Brené Brown points out, vulnerability is not a weakness. In fact, as gay men if we’re able to let ourselves be seen by one another fully, we can shed the blanket of shame that has been holding us back.

How to be seen?

You can start small. Have coffee with a friend and tell them something that you’re struggling with. Be honest about something that you may not be proud of. If they’re a good friend, they will see your struggle, empathize with your experience and you’ll leave feeling lighter and more connected.  Therapy can be an excellent place to start the process of shedding your skin. 

3. I’m overusing drugs or alcohol. 

This is such a common coping skill for those of us who’ve lived through some form of trauma. 

I’m using drugs and alcohol to self-medicate

Drugs and alcohol are readily available and often socially acceptable forms of self-medication.  Whether you’re feeling anxious, depressed or just plain down on yourself, overconsumption is a common way to turn off the brain.   

Turning off the brain

There are drawbacks to using drugs and alcohol to cover up feelings of anxiety, or any feelings for that matter.  By numbing out, you’re also depriving yourself of the opportunity to develop better coping skills. And there’s the risk of substance misuse or dependence.  You don’t want to replace one problem with another.

The statistics

For a statistical point of reference, the Center for American Progress has compared LGBTQ and heterosexual drug and alcohol use. It is estimated that between 20-30% of LGBTQ people over use drugs and alcohol. The general population is closer to 9%.

I’m thinking about changing the way I use drugs or alcohol

Maybe you’re drinking more than you’d like or you’re concerned about the way you use drugs in social situations. Chances are you’re using for a reason and by coming to know more about why you’re overusing you can make the changes that are best for you.

4. I have body image issues as a gay man

If you’re a gay man with body image issues, you are not alone.  Do an image search for the term “gay men” and you will find mostly naked, muscular and white men.  That is what society and the advertising world is telling us we need look like in order to be happy.  What happens when you don’t have an eight pack and huge pecs? 

A negative perception of your body can lead to all sorts of problems including eating disorders, depression, sexual acting out to name a few.

The research

According to research done by Feldman in 2007, 15% of self-identified gay men have an eating disorder.  While 5% of heterosexual men report the same concern.  (By eating disorder, the study was referring to anorexia, bulimia and binge eating disorder.)  

In addition to eating disorders, which can be life-threatening, a number of gay and straight men deal with body dysmorphia.  Body dysmorphia is a general intense dissatisfaction with one’s body that can lead to depression and other mental health conditions.

Why is it so hard for gay men to love their bodies?

There’s intense pressure for most of us to try and conform and fit into societies view of masculinity.  While this is hopefully continuing to evolve, it’s still very present in our culture today. 

Do you struggle with your body?

There are a number of questions you can ask yourself to determine what your relationship is like with your body.

• Are you uncomfortable with your relationship to food? Do you overeat and feel guilty about it? Do you under-eat and feel irritable or fatigued? Food is meant to provide energy and life. If you’re feeling guilt, shame or embarrassment about your eating habits, seek support.
• Do you feel uncomfortable naked? If you find yourself hiding parts of your body when you’re having sex or ashamed to put on a bathing suit, seek support.
• Does the way you feel about your body prevent you from having an intimate relationship with someone? Are you ashamed of the way you look? Are you scared of how others will see you? If so, seek support.

Other signs you may struggle with your body

• Binge/purge eating patterns
• Over exercising
• Drugs
• Depression
• Self-hatred
• Low self-esteem
• Self-harm
• Self-medication through drugs or alcohol

What can you do if you’re a gay man with body image issues?

One of the best things you can do is work on loving your body, exactly as it is today.  Period.  However, I know that’s easier said than done. 

Here is a list of ways to begin accepting your body as it is today.  This list was inspired by a resource on The National Eating Disorders Association website. I have taken inspiration from their list of 10 Steps to a Positive Body Image to create the list below.  While this list may be helpful, it is not meant as a substitute for counseling or professional support.  If you or someone you love is struggling from an eating disorder, please call the hotline at the National Eating Disorders Association for support and guidance. 1-800-931-2237

New way of thinking

What would it be like to love your body exactly as it is today? No matter how unhappy you are with the way you look.  No matter how many goals you have yet to reach with diet or exercise.  What would it be like to accept yourself exactly as you are today?

But I’m goal oriented

Great! There are areas in your life where it’s important to set goals and work toward them.   The way you feel about your body is not one of those areas. Strive to make the love for your body unconditional. We’re going to change, grow and age throughout our lifetimes. As corny as it sounds, the relationship that we have with ourselves is lasting and permanent. We need to nurture it.

Gay men can love their bodies

As a community, let’s start the process of loving our bodies, exactly as they are today.  Think about how you treat other gay men and yourself.  Can you be kinder?  Are there ways to be more supportive?  We face enough adversity out in the world at large, let’s nurture kindness and compassion, at least with ourselves.  One Grindr conversation at a time.

5. I have trouble being vulnerable, making connections or building community.

Being vulnerable is hard. Think about it, to be vulnerable you have to put your authentic self out there. As discussed above, that can be a huge challenge for many of us in the LGBTQ+ community. 

Vulnerability

Webster’s online dictionary states that when you’re vulnerable, you’re “capable of being physically or emotionally wounded.” When you put yourself out there, there is the risk that you could be hurt.  If you spend most of your time in self-protection mode, it’s hard to make connections. It’s hard to be vulnerable.

Brené Brown on vulnerability

In one of her TedTalks, Brené Brown speaks about how vulnerability shows up differently in men and women. If we go a step further, we can only imagine the effects of shame on gay men.

Brown shared a story about how she was challenged by a man at a book signing. The man said that his wife and daughter would rather see him die on his white horse than fall down in shame. He felt there was no room for him to be vulnerable. He had to be strong and stoic.

What keeps shame alive?

According to Brown and her research, silence, judgment and secrecy keep shame alive. As gay men, we’re all too familiar with silence, judgment and secrecy. For those of us that spent any time hiding in the closet, we know how soul crushing it can be to live in hiding.

Gay men and vulnerability

As a therapist, I see how much we struggle as a community to connect and be vulnerable. Here are a few examples of some of the problems I see. Picture a type-A, high-achiever who must find success before he can connect more openly with another guy. Or the 20-something gay guy who had no trouble coming out to his family, but has challenges really expressing his emotions to the men he dates. Or the guy who spends lots of time on apps to find sex, but wants and struggles to find a deeper relationship.

6. I’m a gay man with social anxiety

Social anxiety is a common condition that many people struggle with.  The symptoms can be alarming because they often are felt in your body as well as your mind.  The rapid heartbeat, sweating and dizziness can resemble other more dangerous medical conditions.

While there are some gay spaces that are safe and welcoming, there are many that are not. Most gay men can recount stories of feeling judged upon entering a gay bar.

Why is it important to treat social anxiety?  

Social anxiety can get in the way of dating, making friends, networking, moving ahead in your career and finding connections with other people.  If you don’t treat social anxiety, you’ll be at higher risk for other mental health conditions.

Is social anxiety treatable?  

Yes!  There are many treatments options for social anxiety.  As with any mental health concern, there is no one size fits all approach and it may take some work to find the right treatment for you.  But don’t give up.

7. I’m struggling with internalized homophobia. 

Internalized homophobia is something that can show up in surprising ways. 

What is internalized homophobia?

Internalized homophobia is the act of turning the hatred, stigma and fear of a homophobic society back in on ourselves. I did just use both of the words I’m trying to define in the definition, which would make my third grade vocabulary teacher very angry. So let me elaborate.

Trying to fit in as a gay person in a straight world requires some internal gymnastics. We learn to hide ourselves expertly, as we explored above. This is often on a very deep and unconscious level. For example, as a gay man you may learn to throw your voice to sound more masculine or dress differently so as not to stand out. Just because we haven’t personally been the victim of a hate crime doesn’t mean that we aren’t affected by being born gay.

Lasting consequences

All this hiding can have lasting consequences. It can manifest into self-hatred and loathing on such an unconscious level that it’s hard to notice at times. As sexual minorities we have to notice the effects of the societal pressures and be aware of the pitfalls along the way.

Could you be self-sabotaging because of unconscious internalized homophobia?  Maybe.  By slowing things down and exploring why you do the things you do, you can hopefully find a way out of the maze. 

8. I have low self-esteem

Another common issue that brings gay men into counseling is low self-esteem. 

Gay men with low self-esteem

Low self-esteem can lead to higher rates of depression, suicidal thoughts, risky behavior and problematic substance use.  This is not something that should be taken lightly. And it’s not something you have to just grin and bear.

There is no quick fix to improve your self-esteem.  Many have tried with drugs, alcohol, sex or working out.  When you think poorly of yourself on a deep level, external changes rarely help.  Working on your self-esteem is an inside job.

Looking at your negative thought patterns is a good place to begin the internal work needed to improve self-esteem.

Negative thoughts

What are negative thoughts?  They are the work of a tough inner critic.  They say things like:

You’ll never be good enough.  

No one thinks you’re hot.  

Why are you such a loser?  

Negative thoughts usually come from a place of feeling inadequate or unworthy.  When you grow up gay in a straight world, even with the help of a supportive community, you have to grapple with being different.  That can show up in a number of ways.

The Trance of Unworthiness

The author and psychotherapist Tara Brach has addressed the “trance of unworthiness” in her book Radical Acceptance, Embracing Your Life with the Heart of Buddha. She states that “feeling unworthy goes hand in hand with feeling separate from others, separate from life.”

When you don’t feel worthy, there can be a strong tendency to want to mask those tough feelings with drugs, alcohol, work or general busyness. Masking the problem only provides temporary relief. It doesn’t address the problem at the core.

Where to start?

The first step to addressing issues around self-esteem is slowing down and turning inward.  Imagine if you had a plumbing leak. You could start patching various holes and grabbing buckets to catch the water.  However, to really fix the problem you’d have to first understand the overall scope of the issue.

The same is true for human suffering. Suffering is universal, that is a main principle of Buddhist teachings. As with the plumbing leak, fear can keep us from looking at the full extent of the problem.

If we allow ourselves to zoom out and search for the root of our suffering, we can then begin to face it.

Love yourself, flaws and all

Whether you choose to explore and face the suffering through meditation, art, mindfulness or psychotherapy, the first step is coming to know more about the pain.  It can seem counterintuitive to lean into the pain, but we have to understand the problem before we can work on it effectively.

It certainly won’t be easy, but chances are when you realize the depth and extent of your suffering, you will also realize the hope, possibility and chance for growth.

Affirmations

Once you understand where your pain comes from, affirmations can provide a powerful tool to start healing your self-esteem.

What is an affirmation?  

When I say affirmations, I’m referring to short and powerful positive statements that you can repeat to yourself in order to challenge negative thought patterns.  Keep reading for some concrete examples below.

You can use affirmations in a variety of ways. I recommend brainstorming a list of 10-20 that feel meaningful to you. Think of statements that empower you and make you feel good about your strengths.  If you’re struggling, I’ve included a list below that you can use as a starting off point.

How to use affirmations

Once you have a solid list of affirmations, pick 5 that resonate the most with you.  Then repeat them to yourself or say them out loud several times throughout the day. You can add calendar reminders in your phone or post a list by your mirror. The point is to repeat the positive statements often enough that you begin to form new neural pathways and actually rewire the way your brain works.

Here are 10 examples of positive affirmations that you may find useful.

Self-acceptance

Self-acceptance is a practice of accepting and loving yourself exactly as you are today.  Whether you feel like you need to lose five pounds or be more honest with your partner, acceptance is a crucial step toward relieving your suffering.  The self blame, criticism, and judgment does little to help you achieve your goals. Often times it only makes you feel worse or seek out some substance or activity to make the bad feelings go away.

Think about how much mental space would be opened up if you stopped beating yourself up.  

Think about what it would be like to look in the mirror and actually have some compassion for the person looking back at you.  

Self-compassion

Having compassion for ourselves means that we have empathy for our own suffering.  We acknowledge that suffering is a part of the human condition and instead of trying to make it go away, we notice it.  

Think about it, if you saw a child fall down and start crying, you’d probably have compassion and empathy for the kid.  You may even give them a hug or ask them if they’re ok. However, when your inner child is in pain, how often do you try and sooth them?  

This is a great quote from Gabor Mate about self-compassion.  The sentiment he expresses can be applied to the fact that you’re reading this post right now.

The very fact that you’re here, means you love yourself…. There’s a possibility of transformation, there’s a possibility of being human and by being human I mean being comfortable in your own skin.  And I’m worth it enough to be here.

-Gabor Mate, Self-Love

Loving yourself

Loving yourself doesn’t have to mean that you buy expensive gifts or post tons of shirtless selfies.  If you’re actively trying to improve the way you treat yourself, that’s self-love. Maybe the only act of self-love that you did today was read this article.  That’s fantastic! That means somewhere inside is the capacity to care for yourself. Nurture that. Encourage that. Support that. Getting your finances in order, seeing a therapist, taking care of your health, these are all acts of self-love.

Dealing with the pain

Practicing self-compassion doesn’t mean that we ignore the pain.  In fact, being compassionate with yourself makes it easier to tolerate the suffering.  Pain and suffering are a part of the human experience. Perhaps you’ve felt a great deal of pain in your life for being gay.  Maybe you had a bad childhood or suffered a great, life-changing loss. Can you be kind and patient with yourself as you grieve and heal?

Here is a great quote about being kind and making space for your pain.

Becoming intimate with pain is the key to changing at the core of our being—staying open to everything we experience, letting the sharpness of difficult times pierce us to the heart, letting these times open us, humble us, and make us wiser and more brave. Let difficulty transform you. And it will. In my experience, we just need help in learning how not to run away.

-Pema Chödrön, Practicing Peace in Times of War

In summary

As gay men, there may be a number of different concerns that bring us into therapy.  Remember to find a therapist you feel comfortable with, be as honest as you can be, and seek the support you deserve.  You don’t have to do it alone. 

If you’re looking for a therapist and you live in the states of California or Colorado, please reach out and we can set up a free consultation to explore what it would be like to work together. 

Take good care.