Topics in Sex Therapy for Gay Men: Overcoming Fear of Topping
[WARNING: CONTAINS SEX THERAPY CONTENT NOT SUITABLE FOR UNDER 18]
Many gay men quietly struggle with anxiety about topping — even when they want to do it, even when they feel they “should” be able to.
If you’ve ever found yourself avoiding topping, overthinking it, or feeling pressure to perform in a way that doesn’t feel natural, you’re not alone.
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.
Many gay men experience anxiety about topping at some point in their lives, even if it’s not something they openly talk about.
For some, the fear is physical — concerns about performance, erection reliability, or stamina. For others, it’s psychological — worries about dominance, expectations, or whether they will “do it right.” And for many, it’s a mix of both, shaped by past experiences, early messaging about sex, or comparison to unrealistic standards.
What makes this particularly difficult is that topping is often culturally framed as something that should feel natural, confident, even automatic. When it doesn’t, men can feel like something is “wrong” with them — which only increases the pressure.
If this is something you’re dealing with, you’re not alone — and it’s more common than most men admit.
For over 30 years, I’ve worked with gay men navigating these exact concerns, helping them move from anxiety and self-doubt into a more confident, grounded sexual experience.
You can schedule a brief consultation with me here to talk through what’s going on and get a clearer sense of how to approach it.
Often, the fear of topping isn’t really about the physical act itself. It’s about what the role represents.
Topping can carry associations with responsibility, performance, and even identity. Some men worry about being evaluated by their partner. Others feel pressure to live up to an internalized image of what a “good top” is supposed to be. Still others may have had one or two negative experiences that created a lingering sense of hesitation or avoidance.
Over time, this can lead to a pattern where topping is postponed, avoided, or approached with increasing anxiety — which then reinforces the original fear.
Understanding where this fear comes from is important — but insight alone usually doesn’t resolve it.
What I often see is that when this pattern isn’t addressed directly, it tends not to stay static. It expands. What begins as hesitation around topping can gradually affect overall sexual confidence, relationship dynamics, and even how a man sees himself. For many men, this is the point where reading about it isn’t enough — something more active is needed to shift the pattern.
At that point, it’s no longer just about sex — it’s about avoidance, identity, and confidence.
This is where structured, ongoing work can make a meaningful difference — not just understanding the fear, but actively changing your experience of it.
There can also be a physiological component. Anxiety activates the body’s stress response, which directly interferes with arousal and erection. This creates a frustrating cycle: the more pressure someone feels to perform, the harder it becomes to do so — reinforcing the original fear.
In some cases, men may begin to identify themselves as “not a top,” when in reality, the issue is not preference but anxiety.
Addressing this requires a combination of psychological and practical approaches.
This often includes:
- Reducing performance pressure
- Reframing expectations
- Building confidence gradually through experience
- Improving communication with partners
- Understanding how arousal actually works under stress vs. relaxation
Clinical Perspective
I’ve specialized in therapy and coaching for gay men for over 30 years, working with individuals and couples across a wide range of concerns — including depression, anxiety, OCD, ADHD, substance use recovery, relationship conflict, and career development.
Over time, more gay men have sought help specifically around sexual concerns. As an AASECT Certified Sex Therapist, this has become a central part of my work.
Many clients describe a sense of relief in being able to talk openly with another gay man who understands sexual nuance and doesn’t shy away from direct, honest conversation.
Sexual concerns are never just about sex. When sex becomes anxious or avoidant, it often affects confidence, relationships, and overall quality of life.
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, respond to that feedback with communication, lubrication, pacing, and adequate preparation.
If your anatomy truly limits compatibility, seek partners who can comfortably accommodate you. They exist.
When anatomy isn’t the issue, psychology often is. Past sexual pain, trauma, or difficulty with assertiveness can drive this fear. Topping involves taking an active interpersonal role — and like any assertive skill, it can be learned.
2) Fear of Not Being “Dominant” Enough
Many gay men grow up with their masculinity questioned or undermined. That history doesn’t disappear — it often reappears in sexual situations.
Some men worry they don’t look or act “masculine” enough to top. But dominance is not a fixed personality trait — it’s a dynamic interaction between two people.
There is no universal standard. There is only what works between you and your partner.
Authenticity is far more effective than performance.
If a partner requires you to become someone else to feel acceptable, that’s not a skill deficit — it’s a compatibility issue.
If you’re recognizing yourself in this, it’s usually a sign this isn’t just theoretical — it’s something actively affecting your experience.
You don’t have to sort this out alone — this is exactly the kind of work I help men move through in a practical, structured way.
3) Fear of Erectile Dysfunction
This fear is extremely common.
Erectile dysfunction can have medical causes, psychological causes, or both. I often work on the psychological side while coordinating with medical providers when needed.
Performance anxiety is one of the most common drivers of erection difficulty.
The more sex becomes something you monitor, evaluate, or try to control, the more difficult it becomes.
Sex is not a performance. It’s a responsive, relational experience.
4) Fear of Not Satisfying Your Partner
Satisfaction is not about perfection. It’s about attunement.
Notice your partner’s responses. Stay present. Adjust.
Many men overestimate how much they need to “perform” and underestimate how much their partner is responding to connection, responsiveness, and confidence.
5) Fear of Not Knowing How to Create Variety
Sex is not a technical exam.
Porn can provide ideas, but it often creates unrealistic expectations. Most satisfying sexual experiences come from curiosity, communication, and responsiveness — not memorized technique.
Confidence develops through experience, not pressure.
Conclusion
Some men identify strongly as bottoms. Others as tops. Many as versatile.
This article is not about pushing you into a role — it’s about removing the anxiety that blocks you from experiencing your full range of desire.
Given the challenges many gay men face in the world, sex and intimacy should be sources of pleasure, confidence, and connection — not stress.
Fear doesn’t have to define your experience.
With the right kind of support, these patterns can shift — often more quickly than men expect.
If this is something you’re dealing with, it’s very workable — but it usually doesn’t resolve on its own without some intentional effort.
I work with gay men throughout California via secure telehealth, helping them build sexual confidence, reduce anxiety, and feel more at ease in their relationships and bodies.
You can schedule a consultation here: tel:13103395778 or email Ken@GayTherapyLA.com
If you’re unsure, you’re welcome to reach out briefly and get a sense of whether this would be a good fit.
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.