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Adolescent gay and bisexual men (AGBM) are at disproportionately high risk for HIV and other sexually transmitted infections, yet healthy sexuality and HIV prevention programs grounded in experiences unique to AGBM (e.g., coming out) are lacking, as is the formative work necessary to inform such programs. A richer understanding of factors informing AGBM’s decisions to have or not have sex is needed. To fill this gap in the literature, we conducted qualitative and mixed-methods analyses of data collected in online focus groups with 75 ethnically diverse 14–18-year-old AGBM across the United States. Findings suggest that many reasons why AGBM choose to have or abstain from sex mirror those noted in the previous literature as influential for heterosexual adolescents (e.g., temptation, “horniness”). AGBM conveyed additional experiences/concerns that appeared unique to their sexual identity …