Topics in Sex Therapy for Gay Men: Overcoming Fear of Topping
[WARNING: CONTAINS SEX THERAPY CONTENT NOT SUITABLE FOR UNDER 18]
This article comes from my work with gay men around confidence, relationships, and sexual self-understanding.
If you want to see what working with me looks like:
Individual Therapy (CA) | Coaching (Worldwide)
The eggplant emoticon is often used online, such as in Instagram or gay apps like Grindr and Scruff, to connote a penis.
In part one of this two-part article, I explored the fear of bottoming. Here, we turn to a different but equally common concern: the fear of topping.
Clinical Perspective
I’ve specialized in therapy and coaching for gay men for over 27 years, working with individuals and couples. My practice includes depression, bipolar disorder, OCD, ADD, substance abuse recovery, dating skills, career development, and couples in conflict.
Over time, more gay men have sought help specifically around sexual concerns. As of June 2019, I was completing the education and supervision process to become a Certified Sex Therapist. Even before that, sexual issues formed a large part of my work. Many clients feel relief talking with another gay man who understands sexual nuance and doesn’t shy away from frank conversation.
Sexual fears directly affect quality of life. When sex becomes anxious or avoidant, emotional well-being often follows. While therapists write extensively for straight men, licensed clinicians rarely address gay male sexual concerns with this level of specificity.
What Fear of Topping Looks Like
Fear of topping usually isn’t about disinterest. Many men want to be the penetrating partner and even crave it. Anxiety blocks access to that desire.
In my clinical experience, these fears tend to cluster around five themes:
- Fear of hurting a partner
- Fear of not being “dominant” enough
- Fear of erectile dysfunction
- Fear of not satisfying a partner
- Fear of not knowing how to create variety or control
Let’s look at each.
1) Fear of Hurting a Partner
Younger or less sexually experienced men often worry they might physically hurt a partner, especially if they are well-endowed. That concern makes sense.
First, separate realistic concerns from anxious projections. If your anatomy has caused discomfort in the past, you need to respond to that feedback. That means communication, adequate lubrication, pacing, and foreplay that allows the sphincter to relax.
Some men explore poppers. If you do, educate yourself carefully. Never combine them with erectile dysfunction medications such as Viagra or Cialis, as that can cause dangerous drops in blood pressure. Learn the risks first.
If your anatomy truly limits partner compatibility, seek partners who enjoy or can comfortably accommodate you. They exist.
When anatomy isn’t the issue, psychology often is. Past sexual pain, trauma history, or difficulty with assertiveness can drive this fear. Topping involves taking an active interpersonal role. Like any assertive skill, it can be learned.
In CBT-oriented work, we often treat topping as a form of embodied communication. Confidence grows with practice, not perfection.
2) Fear of Not Being “Dominant” Enough
Many gay men grow up with their masculinity questioned or undermined. That history can surface during sex.
Some men fear they don’t look or act “masc” enough to top, especially if they present as more femme. There is no universal standard for dominance. Every partner defines it differently.
Sex doesn’t involve judges or supervisors. It involves two people. Ask your partner what he likes. Borrow inspiration from porn if helpful, but build your own style. Authenticity usually works better than imitation.
If a partner requires you to change who you are to feel acceptable, that’s a compatibility issue—not a failure.
Confidence begins with self-validation.
If this feels like more than just interesting reading, you don’t need to sort it out alone. You’re welcome to email me at Ken@GayTherapyLA.com, and we can explore whether working together makes sense.
In another article, I discuss gay men and erectile dysfunction.
3) Fear of Erectile Dysfunction
This fear is extremely common. Erectile dysfunction can have medical causes, psychological causes, or both.
I often treat the psychological side of ED while coordinating care with physicians. Anxiety about “performing” fuels many topping fears.
No one is watching you. Sex is not an evaluation. Confidence helps erections far more than monitoring does.
Trust yourself. Relaxation supports arousal. When you trust your body, your partner relaxes too.
Feedback can help, but don’t seek constant reassurance. Asking afterward what your partner enjoyed can offer useful patterns without turning sex into a performance review.
Not every bottom orgasms from penetration alone. Anatomy varies. Simultaneous orgasm is fun when it happens, not a requirement.
As the song from La Cage Aux Folles reminds us: “I am what I am.”
4) Fear of Not Satisfying Your Partner
Satisfaction depends on attunement, not perfection.
Notice your partner’s breathing, sounds, and body language. Check in verbally when needed. Care and attention coexist with dominance.
Be cautious with breath play or choking. True restriction carries medical risk. Many forms of dominance don’t require danger.
Sex improves when partners feel safe, seen, and responsive to each other.
5) Fear of Not Knowing How to Create Variety
Some tops worry they lack technical skill or creativity.
Sex doesn’t require acrobatics. Porn and books like The Gay Kama Sutra can offer ideas, but instinct matters more.
Try different positions, pacing, depth, or sensations. Ask. Suggest. Guide. Many bottoms enjoy a top who takes initiative.
This isn’t a contest. There are no scores or penalties. Skill grows through curiosity and confidence, not pressure.
Conclusion
Some gay men strongly identify as bottoms. Others prefer topping. Many identify as versatile.
This two-part series aims to support whichever part of you feels blocked by fear.
Given the discrimination gay men face, intimacy and sex should feel like sources of pleasure and empowerment. Fear doesn’t have to define your experience.
With support—especially CBT-based work—these anxieties can soften or disappear.
The opposite of fear is ease, confidence, and enjoyment. That shift is possible.
If you’d like support, call or text 310-339-5778, or explore telehealth coaching worldwide.
Ken Howard, LCSW, CST
GayTherapyLA©
Therapy for gay men who want more than symptom relief — they want understanding, integration, and direction.
If this topic resonates, you’re not alone — and this is exactly the kind of work I do with men who want real, practical change, not just insight. I help clients turn understanding into action — improving confidence, relationships, and quality of life in a thoughtful, sex-positive, and affirming therapy space.
About the author
Ken Howard, LCSW, CST is a psychotherapist and AASECT-Certified Sex Therapist with over 30 years of experience working almost exclusively with gay men. A former USC faculty member, he is also the host of The Gay Therapy LA Podcast, where he explores the psychology, relationships, and inner lives of gay men — and he brings that same depth and practicality into his work with clients through therapy (CA) and coaching (worldwide) via telehealth.