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Two Bottoms, Two Tops:  A Gay Men’s Relationship Dilemma – Now What?

In my private practice specializing in gay men’s therapy and coaching (for over 28 years), and more recently specializing more in sex therapy issues, one of the challenges that guys bring to me fairly frequently in asking for help is the dilemma of being in a very good relationship that neither partner wants to leave, but they face a dilemma in that they realize they are either both tops or both bottoms, and they feel the panic of a perceived sexual stalemate.  (This goes beyond just a “fear of topping” or a “fear of bottoming“; click on those terms for blog articles on each of those topics.)

It’s a dilemma when so many variables in the relationship work, like compatible interests, values, cultural frame, emotions, social factors, class issues, etc,, but when it comes down to what they really like in terms of sexual play, needs, and satisfaction, they both either like penile or anal stimulation more.  While there are many variations, such as “vers”, part of the “second half” of the coming out period for gay men often involves exploring whether they primarily identify as a top (orally or anally) or a bottom, and how they like to experience sexual stimulation that is a part of enjoying your body, and enjoying your life.  How this develops is kind of a mystery, kind of like sexual orientation itself; nonetheless, in our heart-of-hearts (among other organs), gay men know what turns them on and how they like to play with a partner(s).

Often, the couple will just kind of lay this dilemma down at my feet and say, “So – you’re the expert – what do we do?”  And while it’s fair to ask, and maybe even expect, that a long-time gay men’s specialist psychotherapist and sex therapist would have “the” answer right at the ready, it doesn’t really work that way.  The answer to “what do we do” has as many answers as there are gay male couples who face the question.  The good news is, I’ve seen many successful couples navigate this.  Here are some examples, taken from actual clinical cases (but altered some, to protect their confidentiality):

Jim and John – Jim and John met in law school and have very busy careers as corporate attorneys, working enough hours in a week for at least two jobs.  They are the envy of friends because they are both handsome, but in different ways, and emanate a sweet romanticism that others either admire or are jealous of.  There is no question for each of them that they want to share they lives together in a strong sense of commitment that they watched each of their parents and grandparents do growing up.  But, their challenge is that they came to realize they are both gay tops.  And since PrEP came along, they “live for” condomless sex in which they “breed” a gay bottom with abandon.  However, neither one of them likes to bottom.  At all.  They don’t have much interest in it, have tried it, and they end up feeling about bottoming about as much interest as they have in having sex with a woman.

So, what do Jim and John do?  Since they are both “traditionally” handsome and somewhat privileged in terms of a high income, they are social often, both locally and also attending international gay events at Pride celebrations and other annual gatherings worldwide.  And when they do, they are not shy about approaching, and “landing”, insatiable bottom guys that are very happy to take on the both of them.  However, with the COVID-19 pandemic in 2020, they weren’t socializing or traveling as much, and they were frustrated by pent-up sexual feelings.  They worked on this by brainstorming ways to have sexual contact in ways that employ Harm Reduction that allows them to take on some risk, but also reasonable precautions to avoid being exposed.  While they report to me that they can be somewhat disappointed that they don’t want more sex with each other, they honestly and frankly report that their “perfecting the art of the threesome” has been a fun experience they have cultivated over time, that has given them one more fun thing to share their lives about, among so many things.


Carlos & Fernando – Carlos and Fernando are primarily bottoms, but they are not comfortable yet having threesomes or any form on Consensual Non-Monogamy, as they were raised in traditional Mexican, Catholic families and they see any sex outside their relationship as threatening and unwelcome.  However, they each are open to exploring the idea of topping more.  They came to me asking for help on how they can experiment with that, especially when Fernando is the older of the two, at 48, and has reported some erectile dysfunction issues that might be related also to some depression.   In their case, I was working as both couples therapist and sex therapist, which have many areas of overlap, and that might also involve a medical component, as Fernando might need a consultation from an endocrinologist or urologist who is savvy at treating gay men, or at least ED issues in middle-aged men.

Sometimes “seeing how the other half lives” in terms of top/bottom sexual roles is an “acquired taste” and needs a relaxed atmosphere of expectation-free experimentation between the partners to see what might be possible in expanding their sexual repertoire.  Even the idea of challenging the notion that “only anal sex is the only legitimate form of gay sex” needs discussion.  I recently worked with a widower who was with a partner for over 30 years and they relied heavily on oral sex and cuddling, and neither one was all that invested in either top or bottom roles in anal sex.  In fact, some of the work of my colleague near Detroit, Joe Kort, PhD, has shown that a good percentage of gay male couples don’t necessarily have anal sex, and this is something that deserves more validation as an option for the gay male couples who feel this way.

It’s part of an important existential “radical acceptance” in life that not all variables will be perfect.  We might not like a certain part of ourselves, or our partners.  We might value our relationships very much, certainly enough to stay in them, but they might not always be perfect sexually, and if they are at first, they might not be sustained this way.  It’s important in relationships to be prepared that change and compromise over the many years that a relationship can unfold is a constant, and there is no “set it and forget it” when it comes to two (or even more) people who engage in emotional, sexual, social, and domestic relationships.

Staying open to expressing your feelings, identifying and evaluating practical options, and getting the help you need from the right professionals are all parts of making your relationship last theoretically a lifetime.  It’s important not to let temporary setbacks, questions, or dilemmas make you feel hopeless about having a future with a partner you love.  In most cases, it’s compassionately exploring together what feels right for you, even if your “solution” wouldn’t work for any other gay male couple but yourselves.

If you would like customized help for your situation from an experienced couples therapist and sex therapist who isn’t afraid to say they work with gay men almost exclusively, I would be honored to help you.  Email me at, or call/text 310-339-5778, for more information, or to book your consultation.

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