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The term "sex addict" is thrown around a lot these days. But what does that term actually mean? And what does it mean for gay men in particular? My first clinical job out of graduate school was at a sex addiction treatment facility. Since then, I’ve developed a practice heavily focused on the experiences of gay men. Here are my thoughts on how sex addiction overlaps with our community—and why we’re more likely to be wrongly diagnosed.
What is Sex Addiction? And Is It Real?
Sex addiction (SA) is not just code for having a lot of sex. It usually refers to extremes: masturbating to the point of physical injury, watching porn compulsively for 16 hours, having anonymous, compulsive sex with people you’re not even remotely attracted to, emptying your savings account to pay for sex workers, and so on. Technically, sex addiction is not a recognized diagnosis by the American Psychological Association. Anecdotally, however, sex addiction has become widely recognized in the mental health field. Major celebrities, such as Tiger Woods and James Franco, have publicly sought treatment for this condition. There are now dozens of sex addiction treatment centers and specialized therapists throughout the world. Typically, we qualify addictions as phenomena that can lead to dependence, overdose, and even death. These criteria are much easier to measure with a chemical addiction such as an opioid. But with a behavior, particularly one that is a natural part of human biology, it’s much more difficult to align sex with our widely recognized addiction paradigms.
Sex Addiction and Gay Men
The diagnosing gets tricker for gay men. Many common sexual behaviors in our community, such as cruising locker rooms, visiting bathhouses, and anonymous Grindr hookups, can sound quite similar to the symptoms of sex addiction. This can lead clinicians to be more easily inclined to diagnose us with sex addiction compared to straight men. Further complicating matters, the predominant sex addiction recovery mode is very heteronormative. Most sex addiction recovery work loosely promotes an “ideal” or “healthy” set of sexual behaviors. These ideals are largely consistent with a traditional monogamous long-term heterosexual relationship. While there’s nothing wrong with that frame, many gay men are not interested in that paradigm. Instead, they may want to practice non-monogamy or other sorts of nontraditional or varied sexual practices. They may want to use hookup apps, visit steam rooms, and so on. It’s fairly easy to dissuade straight men from those types of behaviors, as they are much less commonplace and acceptable in their community. But for gay men, removing these sexual practices can make someone feel disconnected from both their community and their sexuality altogether.
Internalized Homophobia & Shame
Gay sex should be celebrated—not vilified. For now, we don’t have universally recognized diagnostic criteria for sex addiction. Who’s to say what is “healthy” or “compulsive” sex? Are we going to determine a specific number of sexual partners that’s acceptable or prescribe certain time limits on porn? I would argue that healthy sex isn’t about quantity—its about quality. It’s about understanding your subjective relationship with sex. Unlike addiction to a deadly substance like cocaine, which is objectively dangerous, sex is innately healthy and normal. And even if you’re a gay man who does have an unhealthy relationship with sex, you’re not alone. These struggles don’t necessarily mean you’re an addict. Instead, I would argue that sex is complicated for all men. Unfortunately, we’re quick to judge gay sex. This only reinforces pre-existing narratives that there is something malignant about gay sexuality to begin with. If we know anything about addiction work, it’s that shame only feeds into the addiction. Shame may temporarily halt addictive behaviors, but it ultimately feeds the self-loathing that drives the need to self-medicate in the first place.
Gay Men and Meth
Another complicating factor is crystal meth. Many gay men who engage in compulsive sexual behavior are also under the influence of meth. Crystal meth dramatically increases one’s libido, often leading them to engage in hyper-sexual behaviors. A lot of gay male meth addicts will also label themselves sex addicts. Often, however, they are not. To discern if you are a sex addict, you need to assess your sexual behavior when you are sober. Substances dramatically augment our sexual behaviors. The truth is, most meth addicts are not sex addicts. But some are. You’ll need to stop using meth first and foremost before you can assess if there is a secondary sex addiction. Active substance use can make the task of diagnosing almost any co-occurring disorder next to impossible.
How to Get Help
I absolutely believe that sex addiction is real and that those struggling should seek help. Unfortunately, I believe that gay men are more likely to be labeled sex addicts. So be skeptical if you receive this diagnosis. Consider seeking a second opinion if you have any doubt at all. If you do legitimately believe you have a problem with sex addiction, there are resources at your disposal. You can check out local 12-step meetings, such as Sexual Compulsives Anonymous or Sex and Love Addicts Anonymous. You can also seek psychotherapy and look for outpatient groups at various treatment centers. What’s very important is that you find resources that cater specifically to gay men. Otherwise, you may feel misunderstood and unseen by clinicians who simply do not understand the common sexual experiences of gay men. My recommendation is to work closely with a therapist to help you define what sexual behaviors are problematic—or addictive—for you.