Objective: The prevalence of mental and sexual health problems is high among gay men. They often co exist and do so amongst a certain subgroup of gay men. What kind of mental and sexual health problems are so prevalent? Do mental and sexual health issues interrelate and if so, in what way? Can we define gay men ‘at risk’ for developing sexual and mental problems? How to address the specific health care needs of gay men in psychotherapy? What are the specific characteristics of psychotherapy for gay men? The aim is to learn about and understand these issues. Design and Method: An oral presentation will be given, based on the outcome of international research, literature and clinical practice. Psychiatric interviewing, assessment of sexual functioning, gay specific history taking and aspects of gay specific development are discussed. Interactive discussion with the audience sharing knowledge and clinical experience will deepen our understanding. Results: Mental and sexual health among gay men remains surprisingly poor. Anxiety, depression, mood disorders, suicidality are more common than among heterosexual men. 4/5 of gay men suffer from at least one sexual dysfunction. Treatment focusses on symptom relief and supports gay development. Conclusions: Gay men development is characterized by developmental tasks, challenges and risks. Some gay men get clinical problems: mental, sexual or both for which appropriate treatment is needed. Contemporary issues in psychotherapy with gay men are best addressed by a developmental approach.