Chemsex and Its Impact on Gay Men's Health
- Chris Tompkins
- Sep 10
- 4 min read
Examining the intersection of substance use and sexual behavior among gay men.
KEY POINTS
Chemsex is increasingly common among gay men, with one in five participating worldwide.
Substance use during sex often reflects coping with long-standing shame, not just pleasure.
Untangling desire from shame can guide gay men toward connection, intimacy, and self-understanding.
When we talk about chemsex—the use of substances like meth, GHB, or other drugs during sex—it’s important to recognize how common it has become in the gay community.
A recent meta-analysis found that about one in five men who have sex with men worldwide have engaged in chemsex, and nearly a quarter have practiced sexualized drug use more broadly (Georgiadis, 2025).
This isn’t fringe behavior—it’s something many gay men have either experienced themselves or witnessed in our circles. And while conversations often focus on the risks—addiction, unsafe sex, health consequences—what strikes me most is what lies beneath.
Desire, Shame, and Belonging
Chemsex isn’t only about sex or substances. It’s about our relationship with desire, with shame, and a search for belonging.
For many gay men, desire is one of the first parts of ourselves we’re taught to fear. Early messages tell us that wanting intimacy, connection, or pleasure is wrong. That our bodies are somehow dangerous. That our attraction is a “sin,” a pathology, or something to keep hidden. Over time, these messages teach us to turn away from our desire, to avoid it, or to try to manage it instead of letting it guide us.
Desire isn’t dangerous—it’s sacred, and our bodies are meant to experience pleasure. It’s not just physical, but emotional, mental, and spiritual, guiding us toward connection, intimacy, and the people and experiences that make life feel meaningful.
Turning to Coping Mechanisms
But when desire is wrapped in shame, it makes sense that we turn to coping mechanisms. Substances can dull the fear of rejection or lower our inhibitions. They can quiet the voice of shame long enough for us to take risks we’ve been told we shouldn’t. Being sex-positive and non-shaming is one thing; needing substances just to have sex points to a deeper wound, an emptiness that nothing outside ourselves can truly fill.
Layered on top of this, one of the deepest wounds comes from being taught from a very early age that a higher power is against us. The message doesn’t disappear when we leave religious spaces. It remains with us in our collective psyche, shaping how we perceive ourselves and how we interact with one another.
In a recent article in The Cut, called "We’ve Reached Peak Gay Sluttiness," the author explores rising drug use among gay men and the culture of sex with substances. It’s something I see over and over in my work: Chemsex isn’t just about pleasure. Often, it’s a way to anesthetize the shame we’ve carried for decades.
When we’ve learned, from a young age, that our bodies or desires are wrong, substances can feel like a way to quiet the shame we’ve learned to carry in our bodies. But it’s a false freedom. The shame hasn’t suddenly disappeared—it’s like holding a beach ball underwater, resting just beneath the surface, waiting to pop back up.
A client of mine recently shared that he had lost his libido. For more than a year, he hadn’t ejaculated, and the silence around it has been a burden he’s carried alone. At first, he avoided bringing it up with his husband, holding the shame inside. When he finally spoke about it, he admitted he no longer felt like “part of the club.” For him, being gay had always been tied to having sex. Without it, he wasn’t sure who he was anymore.
Reconnecting With and Honoring Desire
Through our work together, he began to see that gay identity isn’t contingent on sexual activity. And more importantly, his desire isn’t limited to sex. Desire is about wanting to feel alive, to be close, to move toward what we love. As he learned to reconnect with desire emotionally, relationally, and spiritually, he began to reclaim his sense of self.
The legacy of AIDS still casts a shadow over these conversations. One reader of the article in The Cut, a lesbian woman, reflected on watching “a phalanx of male friends die of AIDS in the 80s and 90s,” and added, “I sometimes feel that a strong strain of suicidality courses through the gay community.” It’s no surprise, then, that many gay men carry guilt or shame in ways that manifest as self-punishment—through substance use, self-sabotage, unhealthy relationships, or ongoing struggles with mental health.
Chemsex isn’t only about seeking pleasure. For many, it’s a way to ease the pain of shame—shame that tells us our desires are too much or not allowed. Substances can take the edge off that weight, but they also keep us at a distance from true intimacy.
Desire itself is not the problem. Shame is. When we begin to untangle the two, desire can shift from a source of fear to a guide, helping us move toward connection, intimacy, and the life we want to live.
Honoring desire, rather than numbing it, is where the work—and the healing—begins.
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Chris Tompkins is a gay male therapist in West Hollywood (Los Angeles) who specializes in working with adult gay men, individuals and couples. He supports clients navigating identity, relationships, religious trauma, addiction, and self-esteem. To learn more, explore therapeutic services or schedule a free consultation.