Older Gay Men and the Risk of Suicide

Suicide rates in the United States have surged in recent years,¹ while in other countries the rates have fallen. Although this rise was particularly steep for women, it increased substantially for all middle-aged Americans, a group whose suicide rate had been stable or falling since the 1950s. This article will focus in particular on suicide in older gay men.

New Dr. Salber‘s Review Notes appear at the end of the story.

Risk factors for suicide

Suicide in gay and bisexual men

One common theme that underlies most successful suicides is a sense of hopelessness.

Predicament suicide

Some psychiatrists have described predicament suicide.⁵ In the absence of a diagnosable mental health condition but faced by circumstances from which individuals cannot find an acceptable escape, suicide begins to appear as the least bad option.

A decision to come out in midlife might represent such a predicament. Older men may feel that they are sacrificing everything they once valued and that there is no one with whom they can speak about it.

“Some individuals decide this is as far as they want the road to take them. Many of them are completely rational and accurate in their assessment of their situations. If they are lucky, they will cross paths with someone who can offer hope. For some, this does not represent depression but perhaps, rational choice.”

Some might consider suicide a logical choice for someone who has a painful, chronic, and terminal condition when all hope for recovery has disappeared. Depression can be chronic and is extraordinarily painful. While it may seem hopeless, it is not because it is treatable.

Related content: Is Suicide Ever a Rational Choice?

Suicide in older gay men

Most research on suicide has been done on youth with an increasing emphasis in recent years on bullying, but very little research has explored gay, middle-aged men and suicide.

The impact of loneliness

We have never been so connected with others through social media while at the same time remaining so isolated from face-to-face contact with others. But loneliness and depression, while related, are not the same thing.

The keys to fighting loneliness are identifying with a larger social group, having frequent and unplanned interactions with others, and having a chum with whom one can share the most painful of our conflicts.

Conformity to masculine norms

Boys are taught to be self-reliant by gender police who continuously remind them to take it like a man when they transgress from this norm. For gay men, this is often accompanied by a sense of shame: I am bad, therefore, I don’t deserve help.

On the other hand, according to a recent study¹⁰, highly traditional, masculine men (not admitting vulnerability, fighting, and not crying) were more likely to die by suicide than men who did not identify as strongly with such stereotypes.

The researcher stated, “High-traditional masculinity makes people’s coping strategies rigid, so when they’re under stress, they may not show that flexibility and adaptability of things like losing a job or a relationship.”

Other risk factors

A consistent correlation exists between suicide and race¹¹ and socioeconomic factors. Those from a racial minority or living in poverty have poorer outcomes and higher risks of successful suicide.

Many of the challenges that lead gay/bi/questioning men to consider suicide are not immutable. As more and more people have come out in recent years, social attitudes toward homosexuality have changed albeit with significant backlash.

Getting help

Most gay and bi men can cope successfully if they have access to the right resources. Medications may be indicated particularly if there is significant insomnia or a failure to function in most areas of one’s life.

Care-seekers are often intimidated by their perception of an imbalance of power in the counseling relationship. But, remember, you have a right to interview the therapist about their attitudes and training before making a commitment to therapy.

Coming out is a process

As I describe in my book Finally Out: Letting Go of Living Straight, coming out is not an event but a process. Not everyone has to come out to every person in every circumstance.

Having a supportive group of family and friends is very important. For those struggling with conflicts about sexual orientation, it is important to reach out to someone you trust who can offer hope.

When families are not accepting, developing a “family of choice” may be essential. The Internet has helped men isolated in rural areas or cultures with strong prohibitions against homosexuality, and it allows for an anonymous discussion of questions concerning sexuality.

Medications may be indicated particularly if there is significant insomnia or a failure to function in most areas of one’s life. Counseling may be helpful but choose carefully. A good therapist will not impose their values on their counselees.

The bottom line

Suicidal thinking is a common but treatable problem in gay and bisexual men and boys. Choosing the right therapist is critical.

References

Medical Reviewer Notes by Dr. Salber

Dr. Olson’s discussion of suicide in older gay men has provided valuable insights to many of our readers since it was first published in 2017 (and updated in 2020). Many readers, primarily gay men, have left comments about their own views of suicide – some being quite dark as may be expected when someone is living in the depth of despair.

Dr. Olson has responded to many of these comments. His replies add to our understanding of this important issue. I encourage you to continue on and read the comments as they provide additional insight into the issue of suicide in older gay men.

This post was first published on June 3, 2017. The author reviewed and updated the post for republication on February 14, 2020.

Comments:

Loren A Olson says:

10/16/2020 at 11:46 am

JT

I have read through your comment and I plan to respond. You brought up a lot of different things I’d like to address. First, I want to give it some careful thought. Loren Olson

Reply
- Loren A Olson says:
  
  10/23/2020 at 4:50 pm
  
  JT
  Let’s take a look at some of the things you wrote:
  
  • If you are not A-list beautiful, gay life is incredibly difficult unless you are super good looking with lots of money. If that guy who has been blessed with such physical beauty cannot be happy, how can I ever be? Gay life is exceedingly difficult.
  
  LAO: I have known a few A-listers, and most of them didn’t seem a bit happier than those of us who didn’t make the list. For most of us, the three ingredients that contribute to aging successfully are: good health, just enough income, and satisfying relationships with others.
  
  I do not know of any evidence to support the idea that more money makes people happier.
  
  If your standard for beauty is a porn star, you will be disappointed. Those men auditioned for their roles. They were selected for physical attributes. Many spend several hours a day in the gym. Photos are photoshopped. When you compare yourself to that magical ideal, you will feel like a failure.
  
  You are far better off if you decide what would make you healthy and set your goals for “physical beauty” accordingly.
  
  • He had an affair with a “hotter guy” and then left me, broke and almost homeless.
  
  LAO: Have you forgiven this jerk? The anger is still eating you up. Forgiveness is a gift you give someone who does not deserve it. To forgive him would not change his life but it would change yours.
  
  • I am happier being by myself, hanging with friends.
  
  LAO: As we get older, a good supportive group of friends is essential.
  
  • I would never support some twink.
  
  LAO: I have written a great deal about intergenerational or age-discrepant gay couples. Some older gay men believe that younger men who show interest in them are looking for a sugar daddy. Again, true for some, but not true for all. Many of these younger men are quite financially secure, and often have more income than the older man. These relationships can be very stable.
  
  • At 55, you are invisible, unless you are rich.
  
  LAO: This is the world that is often referred to as “the scene.” It exists. But I disagree that this defines all of us in the LGBTQ+ community. I think the eight old men that I get together with once a month (pre-pandemic) to play dominoes are just as much a part of the gay community as those who go to circuit parties. But no one is ever going to writes stories or make movies about us.
  
  LAO: It is true that older gay men become somewhat invisible. During the 1950s and 1960s (when I was a boy), a national hysteria about gay men as pathologic deviants who preyed on young boys covered the country. Seventy-five percent of the country believed gay men were more dangerous than communists. And gay men, out of fear, remained silent.
  
  During the HIV epidemic, ACT UP promoted the motto, Silence = Death. The same is true now. Older gay men need to raise their voices and be heard if they are not being seen. We need to join together to advocate for ourselves. Otherwise, we will remain invisible.
  
  • We have created a gay society completely based on sex, porn, money, and self-indulgence.
  
  • It only “gets better” for a select few.
  
  LAO: I would counter your comment with this: It only stays bad for a few.
  
  From a recent study:
  
  i. 90% of the responding singles stated they were seeking monogamous relationships
  ii. 92% percent of them expect to marry
  iii. Half of the men identified as being in long-term monogamous relationships
  
  As mature men, we can examine the values that society hands us. We can deconstruct those values and choose ones of our own making. I hope you will begin to take a look at them.
  You can read more of my writing at medium dot com/@LorenAOlsonMD
JT says:

10/16/2020 at 9:35 am

I have to agree with Max Talent (above)

I came out when I was a 17 as well, in 1983. Although it was tough to do, it was not the dark ages and I had no problem finding a gay scene in Denver Colorado. This was before AIDS swept through that part of country so the last days of the late 70’s sexual freedoms were still going strong, at least in Denver. Anyway, I learned very quickly that if you are not A list beautiful, gay life is incredibly difficult and lonely. I never felt lonely before I came out. I was very outgoing, had lots of friends, I considered myself to be above average in looks and I was masculine. But other than bathhouse sex, I rarely had a real date. I was single from the age of 17 to 21 before I met my first partner. We lasted 3 years, he had an affair with a “hotter guy” and then left me, broke and almost homeless.

I never really recovered from that, I was single again for 7 more years. Second relationship lasted for 7 until I left because of his increasing emotional abuse, he was a very damaged person. I’ve been single now since 2004, I stopped dating in 2014. I have not had sex since 2014.

I’m happy that younger guys have an easier time now in coming out, but I’m glad its not me, I would never want to go through it again. When you see these perfect, muscular, handsome gay porn stars blowing their brains out, you start to think “Wow if that guy, who has been blessed with such physical beauty can’t be happy, how can I ever be”. I found that I’m happier being by myself, hanging with friends and just not being part of the whole scene, but of course at 55 you are invisible (unless your rich) but I’m not, and even if I was I would never “support” some twink, at least I have that much self respect.

Gay men kill themselves because of the gay society WE have created, completely based on sex, porn, money and self indulgence. Now that gay marriage and having kids is the new gay status symbol, its even worse. I’ve never questioned my sexuality, nor do I “hate myself” for being gay, but if reincarnation exists, and I have any say in it, I will ask to be a handsome, smart, straight guy. Perhaps it’s worse, I don’t know, but unless you are super good looking with lots of money, gay life is very difficult. It only “gets better” for a select few.

Reply
Michael says:

7/11/2020 at 4:23 pm

I am 58. I have always been honest and attempt to see the world as it is. In order to spare myself and those around me any confusion or deception, in 1979 I came out at age 17 when I was still in high school. I have lived true to myself and have never had any illusions.

At the same time, I have been depressed much of my life. There were times when I was able to cope better than I do now, and periods when it lifted. I do not drink, nor do I smoke or use recreational drugs. Prescription anti-depressants have never helped me.

Five years ago, the organization I worked for closed after unjust government action. I have been unemployed since, despite many hundreds of job applications. Nobody is hiring men in their 50s. I had no choice but to sell my home and to move in with my very elderly parents.

Frequently, I would like to speak with a psychotherapist, and have done so in the distant past, but as a conservative person, I discovered early on that most therapists are leftward leaning politically. Frankly, they do a very poor job of masking their contempt, listening selectively as they wait for an opportunity to pounce politically. Even though I am an atheist, our worldviews just don’t mix.

I never married (male or female); I had a long-term relationship that ended in 2003. At my age, I am no longer interested in romance, sex or a relationship. I sleep or stay in bed 20 hours a day. My financial future will at some point require living in a car; yes, I had saved and prepared but have had to use that money to survive the joblessness.

I think of suicide non-stop. When my parents have gone, I will act upon it. I see no reason not to act anymore. I have “re-invented” my career too many times; I have education and certifications, but they are never enough; yet another student loan at my age is foolish, as is more “follow your bliss” advice. Sometimes life just doesn’t work out and there can be no fixing things. I’d like to feel I beat the clock, just for once.

Reply
- Patricia Salber MD, MBA (@docweighsin) says:
  
  7/12/2020 at 1:45 pm
  
  Please reach out to talk to a professional or the suicide hot line.
- Loren A Olson MD says:
  
  7/13/2020 at 6:02 am
  
  Michael,
  
  Dr. Salber has asked that I respond to your post. She and I are concerned about you. Your depression symptoms show clearly throughout your post, the most obvious one is a sense of hopelessness. Hopelessness then clouds your thinking about the possibility of recovery.
  
  Obviously, you have experienced a lot of losses and disappointments in your life. Those are facts. Feelings are important sources of information, but they are not factual and they skew toward negative assumptions when you are depressed.
  
  You mentioned you “attempt to see the world as it is,” but I see the world differently. You gave us an important clue when you wrote that although you’ve struggled for much of your life, “There were times when I was able to cope better than I do now, and periods when it lifted.” That tells me that you can again feel better than you do now. When a person is as depressed as you are, they often feel that the way they feel is permanent, but your own life history tells us that isn’t true.
  
  Depression is cyclical. Even if you do nothing, the depression will lift. Although suicide appears rational to you, you do not need to feel the way you do. Depression is treatable.
  
  Anti-depressant medications have varying degrees of success. I often hear from patients, “Nothing works for me.” And yet, we usually can find something that helps. Often they haven’t worked because they weren’t taken long enough or the dosages were inadequate. At times, it means finding a “cocktail” of medications or using some of the older, less frequently used medications.
  
  Sleeping 20 hours per day is destructive. After 8-9 hours of sleep, additional sleep has a negative effect and actually leads to greater fatigue. Physical activity, on the other hand, doesn’t remove energy, it creates energy. It is important to set very limited goals to begin; perhaps walking a block three times a week would be a good place to start.
  
  In addition, isolating tends to leave time to “awfulize” your thinking. One negative thought leads to another. Then another. Even minimal interaction with others helps distract from that sense of hopelessness.
  
  Depression takes away one’s ability to experience pleasure, but also one’s ability to anticipate pleasure. Depression leads to magnifying the negatives (It’s too much work. I don’t have the right clothes. Nothing will work anyway so why bother?) and it minimizes the potential benefits. You need to approach these things like work, not pleasure.
  
  Plenty of research tells us that money doesn’t make us happy. After our basic needs are met, more money doesn’t lead to more happiness. Although your life isn’t want you thought it would be, isn’t what you sacrificed for, it can be more than it is now.
  
  But I also detect in your note a sense of hope. If you had no hope, you wouldn’t be reading articles like this. It is clear that you are searching for some answers, some way out of your despair. If you have no hope, borrow some from me. In fifty years of treating depression, and struggling with my own experiences, I KNOW that you don’t have to feel the way you do.
- Michael says:
  
  10/23/2020 at 7:25 pm
  
  I’m sorry, but respectfully doctor, you are wrong. Having “hope” now makes me feel foolish, the way one does after buying a lotto ticket. Everything is so much worse. Despite submitting hundreds of resumes, and being “pro-active” (cliche alert), employers still reject a person older than 50, and certainly one who has been out of work four-plus years. Employers are more cruel about age than are snotty gay men on the prowl. When I was young, I suffered a serious back surgery which forced me to always find work that allowed me to sit-stand to avoid pain. Thus, I worked in private education. Over the years, however, wear, tear, age, arthritis, and stenosis, make even that sit-stand-lay solution impossible. I apply for on-line work, but five hundred unanswered resumes remind me that reality exists. On your advice, I went to a psychologist for the depression, and then a neurologist for the back, and applied for disability afterward but was turned down. After four years, I have no money coming in (less in savings after the doctor’s visits) no possibility for a job, and please, not yet another student loan when the old ones remain unpaid… All the years of resiliency, retraining, re-educating, and re-inventing (yet another What Color Is Your Parachute cliche) myself are backfiring in my face. Because I coped with depression and back pain so wisely and quietly for so long, ie., avoiding doctors and painkillers and doing the adult and responsible thing by not complaining, and by finding work that accommodated the problem; the result is nobody believes I have pain or depression because I went so long without care! So much for being a responsible adult, eh? How I came this far without becoming an addict or alcoholic, I have no idea, but each night I fall asleep actively imagining a heart attack and stroke to take me out. I flushed my blood pressure pills down the toilet. I informed my elderly parents that they might find me like this, but it upset them, so I pretend I am better and smile to spare them. And I don’t want money to buy happiness; I want a job. I’ve gone the volunteering route, retraining is financially and physically ridiculous, disability rejects me, employers reject me, I can no longer wait until I am 70 for Social Security. What am I supposed to do for the next twelve years? Instead of talking about “hope,” with all respect, perhaps you should take a bright page from cancer doctors and learn to tell people that a problem can’t be fixed, you face an un-ending humiliating dilemma that will cause you to suffer greatly, and that you may not make it. Frankly, we need euthanasia clinics; they speak the truth that cleanses.
- Loren A Olson says:
  
  10/24/2020 at 3:20 am
  
  I’ve been wrong before, and I’m not afraid to admit it. But I don’t believe I wrong in what I previously posted. I stand by it.
  
  You say “nobody believes” you have pain and depression. But that is not true. I believe you. But I also believe that you have not received adequate treatment for them. Depression feeds on physical pain, and depression makes the pain worse.
  
  Being turned down for disability doesn’t mean that they don’t believe you. I do any number of exams for disability and in the process review treatment records. If there are no treatment records, the examiner is apt to conclude, as I have, that treatment has been insufficient to make a determination.
  
  I cases where the facts are confusing, it is often necessary to be represented by an attorney. Some lawyers specialize in this area and will offer an initial free appointment for the first visit. They will know if your case has weaknesses and can make recommendations. If they feel you case merits, they will represent you with a contingency fee, i.e. a portion of any award you receive.
  
  I will never stop talking about hope. While some depressions are much more refractory to treatment than others, you need to be receiving regular treatment before you can say that yours is untreatable.
  
  Cancer doctors also speak of hope. Sometimes the disease is terminal, but the oncologists will still work to improve the quality of life.
  
  Even if we had euthanasia clinics, you would not qualify because your depression has not received adequate treatment. That is the truth they would speak.
  
  Depression distorts peoples’ thinking so that they see only the negative. They dismiss anything that attempts to contradict the symptomatic sense of hopelessness and despair.
  
  My intent here is not to minimize the real problems you face. My point is to suggest that I do not believe that all possibilities for improvement have been exhausted.
- Patricia Salber MD, MBA (@docweighsin) says:
  
  10/24/2020 at 11:44 am
  
  Thank you, Dr. Olson, for your words of wisdom. Most important, this: “Depression distorts peoples’ thinking so that they see only the negative. They dismiss anything that attempts to contradict the symptomatic sense of hopelessness and despair.”
Loren A Olson says:

2/19/2020 at 6:59 pm

Dear Max,

Your self-hatred shines through clearly. You have described yourself as a gay man and then go on to state all of the things you see wrong with gay men. As one of us, you’re therefore applying all of these generalizations to yourself. And frankly, many of them are just wrong.

What you have described may be true of some but your observations are certainly not true of all. Prejudice is based upon the law of small numbers, i.e. observing characteristic of a small group, elevating that characteristic to a “master status,” and then apply it to an entire population. It is the basis of all prejudice.

You wrote, “Gay men have thousands of sex partners in their lives.” That would be a near impossibility for almost anyone. You went on to say, “Such people are not looking for love. Gay male relationships are universally non monogamous, so I don’t think gay men even know what love is.” Saying that gay male relationships are “universally non monogamous,” is absolutely an exaggeration. And I know many, many gay men who are capable of enduring, committed relationships.

You said that my comment, “in order to find love one must believe one is lovable,” is a “meaningless cliche.” But how can you possibly expect to find someone to love when you think so little of yourself and every other gay man you might meet.

I know that nothing I can say will change your mind. But your opinions are based upon life experience that is totally different from my own and most of the gay men that I know. But with your negativity and making your observations based upon observations from gay hook up sites probably means you will continue to be alone.

I wish you the best.

Loren Olsn

Reply
MaxTalent says:

2/19/2020 at 11:08 am

Meaningless cliche’s of “in order to find love one must believe one is loveable” are totally irrelevant. Gay men have thousands of sex partners in their lives.Such people are not looking for love. Gay male relationships are universally non monogamous, so I don’t think gay men even know what love is. There is a mountain of literature by gay men where they refute the very motion of monogamy and how such “straight definitions” of a “marriage” do not apply to gay men. Gay hook up sites are littered with “couples” looking for additional partners. In all my years of living as a gay man I have not once met a gay “couple” that did not break up after a year or two unless they had just settled into being room mates who had sex with others.
So, where does this leave gay men as they get older? Alone and lusting after men they have no chance of getting, and certainly not chance of having yet another “,romance,” with.
It is no accident that professions that are creative are full of gay men. Their whole lives are s fantasy. They live in their heads. They break up when their fantasy of their partner being the man they want is shattered by reality. Facing the fact that one’s whole love life has just been repeated acts of masturbation , using another man as an object of a fantasy, is rather depressing, but it is not at all the fault of “society”.

Reply
Loren A Olson says:

2/3/2020 at 3:40 pm

Dear Max,

I consider myself an honest gay man, but I disagree with a lot of what you’ve written. Some might consider suicide a logical choice for someone who have a painful, chronic and terminal condition when all hope for recovery has disappeared. Depression can be chronic and is extraordinarily painful. While it may seem hopeless, it is not because it is treatable.

Being gay is not a “lifestyle.” It is an enduring physical, romantic, and/or emotional attraction to people of the same sex. Many of the terms you used to describe gay people (fickle, cowardly, fearing intimacy, incapable of commitment, backstabbing, and obsessed with casual sex) are stereotypes. While stereotypes are always true for some, some people take these characteristics that are true for some and elevate them to master status. Then they apply them to all people in a category as if what is true for some must be true of all.

Loneliness is epidemic in much of the Western world, but not just in the LGBTQ community. We have never been so connected with others through social media while at the same time remaining so isolated from face-to-face contact with others. But loneliness and depression, while related, are not the same thing.

Your comments, Max, also reflect a number of stereotypes of aging people as being past their “best if used by date,” but aging carries with it opportunities we’ve never had before. But here is where I would agree with you: Unhappiness is our responsibility. We must come out from behind our computers to find it. Many older men have found long term relationships (LTRs) late in life, some with men much younger who appreciate their wisdom and experience.

But to find love we must first believe we are lovable.

Reply
- MaxTalent says:
  
  2/10/2020 at 5:45 am
  
  I am a gay man, I gave an accurate, honest picture of what I have experienced. I know you find it unflattering , too bad. It’s the truth.
  
  Anyone who doubts what I am saying is true can just create a profile on the many gay hook up sites and see what a total train wreck gay men are.
  
  Their unhappiness is a result of their own faults and their own choices.