Ten Things Gay Men Wish They Could Share in Therapy
Therapy promises openness, yet many gay men still hold back parts of their truth. Silence often grows in the spaces where shame, fear, and old wounds live. For some, it is the weight of words they have never dared to say. For others, it is the fear of being judged for the very parts of themselves that need the most acceptance.
Imagine a man walking into his first counselling session. He sits down, knowing he wants to talk about the loneliness that grips him every night when the house is quiet. Instead, he speaks about work stress and surface-level problems because that feels safer. Deep down, he wonders whether his therapist could ever understand the complexity of his world, the struggles with body image, the sting of family rejection, or the weight of feeling not gay enough or too gay. He leaves the session relieved but still carrying the silence he had hoped to release.
This is not unusual. Many gay men bring only part of themselves into therapy, leaving the most tender truths unspoken. Yet those unspoken truths are often the very ones that hold the key to healing.
Naming what is hidden creates space for connection, courage, and change. Therapy becomes most powerful when the silence is broken and when the fullness of our stories can be explored without fear.
Here are ten things gay men often wish they could bring into therapy but sometimes feel they cannot.
1. Sexual Fantasies, Desire, and Fetishes
Fantasies can be playful, creative, or deeply personal. They may involve role play, power dynamics, or scenarios that feel far removed from everyday life. Some men also have fetishes, which are specific interests or turn-ons that can be an important part of their sexual expression. These might include clothing, objects, sensations, or particular situations that hold erotic meaning.
Yet many gay men keep fantasies and fetishes hidden in therapy. There is often worry that a therapist might misunderstand, judge, or assume these desires are unhealthy. This fear of judgement leads many men to stay silent, even when these aspects of their sexuality are a natural and important part of who they are.
Fantasies and fetishes are rarely just about the literal act. They often reflect deeper needs, such as the desire to feel free, to explore intimacy, or to experiment with vulnerability and control in safe ways. When men suppress them, shame and secrecy grow. When they are spoken about openly, therapy becomes a safe and non-judgemental space to explore sexuality without fear.
Why it matters: Unspoken fantasies and fetishes can create unnecessary guilt or secrecy. Sharing them in therapy helps men accept their sexuality, understand their deeper emotional needs, and experience intimacy without shame.
2. Internalised Homophobia
Internalised homophobia is the lingering echo of prejudice absorbed from society. Even openly gay men can carry feelings of self-doubt or shame, shaped by years of negative messages. It may appear as self-criticism, reluctance to show affection in public, or an inner voice saying, “I would be happier if I was not gay.”
These thoughts can feel too shameful to admit, even in therapy. Yet acknowledging them is a step towards undoing their grip. Therapy can provide tools to challenge internalised beliefs and rebuild confidence.
Why it matters: Without addressing internalised homophobia, self-esteem and relationships may suffer. Speaking openly about it creates pathways to healing.
3. Body Image Pressures
In many gay spaces, appearance can feel like currency. Muscularity, youth, and slimness are often idealised, leaving men who do not fit these ideals feeling invisible. Some men spend hours at the gym or restrict food intake, while others withdraw socially to avoid comparison.
Admitting body image struggles in therapy can feel shallow compared to “serious” issues. But body dissatisfaction affects mental health profoundly. It influences confidence, relationships, and self-worth. Therapy can help men examine the roots of body image pressure, reduce comparison, and develop healthier self-talk.
Why it matters: Poor body image can increase anxiety, depression, and loneliness. Therapy helps men find value beyond appearance.
4. Relationship Dynamics and Open Agreements
Relationships among gay men are diverse. Some are monogamous, while others are open or non-monogamous. These choices can bring joy but also raise challenges around jealousy, boundaries, or honesty.
Men often hesitate to discuss these dynamics in therapy, fearing judgement from therapists who assume monogamy is the only healthy option. Even men in monogamous partnerships may hide moments of temptation or attraction, worried that this will be seen as betrayal.
Therapy offers the chance to talk openly about relationship structures, desires, and challenges, supporting couples and individuals in finding what works best for them.
Why it matters: Suppressing these discussions prevents couples from building stronger trust and communication. Therapy can help normalise diverse and beautiful relationships.
5. Loneliness Hidden by Social Connection
On the surface, many gay men seem socially active. They may attend events, have friends, or appear confident online. Yet underneath, loneliness is common. It may feel easier to hide this truth than to admit, “I go home alone and feel empty.”
Therapy can uncover the gap between external connection and internal experience. Naming loneliness helps reduce its power. With guidance, men can work towards building deeper, more authentic connections and addressing patterns of isolation.
Why it matters: Loneliness is linked to depression, anxiety, and poor physical health. Acknowledging it in therapy makes it possible to seek change.
6. Fear of Ageing
In a culture that celebrates youth, many gay men fear becoming less visible or desirable as they age. This fear may be compounded by ageism within the gay community itself. Some men worry they will be overlooked socially or romantically, while others fear being left without support later in life.
Admitting these fears in therapy can feel uncomfortable, as though they confirm decline. Yet therapy can help men explore meaning, self-worth, and belonging beyond appearance. It can also validate the wisdom and resilience gained through age.
Why it matters: Fear of ageing can increase anxiety and reduce confidence. Therapy helps reframe ageing as a stage of growth and connection.
7. Family Estrangement
Rejection from family leaves wounds that can last a lifetime. For some gay men, estrangement is permanent. For others, family relationships continue but remain strained or conditional.
In therapy, talking about family rejection may feel too painful. Some men worry that their therapist will encourage reconciliation when distance may be safer. Therapy validates grief and acknowledges the importance of chosen family as a source of love and stability.
Why it matters: Family estrangement can fuel feelings of loss, shame, and loneliness. Therapy helps men grieve what has been lost while celebrating chosen family.
8. Sex and HIV Stigma
HIV stigma continues to shape the experiences of many gay men, even in the era of PrEP and effective treatment. Some men avoid discussing HIV status or safer sex practices in therapy out of fear of being judged. Others carry trauma from living through or learning about the AIDS crisis.
Silence around sexual health can create unnecessary shame. Therapy provides space to confront stigma, talk openly about health, and support men in reclaiming confidence and safety in their sexuality.
Why it matters: HIV stigma fuels isolation and anxiety. Therapy offers education, acceptance, and emotional support.
9. Masculinity, Femininity, and Shame
Masculinity and femininity are often loaded terms in the gay community. Some men feel pressure to present as more masculine to avoid judgement. Others worry they will be criticised for being too feminine. These struggles often start in childhood and may continue into adult life.
Therapy can help men explore their authentic identity, free from labels or external expectations. By examining the roots of these pressures, therapy supports men to embrace themselves without apology.
Why it matters: Suppressing self-expression leads to shame and isolation. Therapy validates diverse expressions of masculinity and femininity.
10. The Weight of Silence
What unites all these struggles is silence itself. Silence may feel protective, but it often hides the very issues that need the most care. Many gay men wait for their therapist to open the door to these topics, while therapists may assume clients will bring them up on their own.
Healing begins when silence is broken. Therapy is not about perfection, but about presence. Speaking what has been hidden can transform shame into strength.
Why it matters: Silence in therapy prevents progress. Breaking it allows for true healing and connection.
Creating a Safe Space
The role of therapy is not simply to listen but to create an environment where difficult truths feel safe to share. Safety means gentle curiosity, cultural understanding, and validation of every part of a client’s experience. At Bent Couch Counselling, nothing is too heavy, too complex, or too messy to explore.
Gay men often wish they could share much more in therapy than what is usually spoken. Sexual fantasies, internalised homophobia, body image, relationships, loneliness, ageing, family estrangement, HIV stigma, identity pressures, and the silence itself—all of these deserve a voice.
Therapy becomes transformative when silence is replaced with honesty. Every gay man deserves a space to speak freely, to be heard without judgement, and to heal without shame.
Shaun
