Although gay men represent a high-risk group for psychiatric illness and impairment, they are largely an understudied population. The purpose of the present study was to examine the sexual orientation and clinical correlates of men with pathological gambling (PG). Sexual orientation was assessed in 105 men presenting with PG. Gay and bisexual men with PG were compared with heterosexual men in terms of gambling symptoms, impairment, and co-occurring psychiatric disorders. Of 22 men (21.0%) with PG, 15 were gay (14.3%) and 7 were bisexual (6.7%). Gay and bisexual men vs heterosexual men were more likely to be single (81.8% vs 21.7%; v2 2 = 28.2; P b .001), have a lifetime (81.8% vs 44.6%; v2 1 = 9.7; P = .002) or current (68.2% vs 34.9%; v2 1 = 7.9; P = .005) impulse control disorder, and have a lifetime substance use disorder (59.1% vs 31.3%; v2 1 = 5.7; P b .05). Gay and bisexual men with PG also showed a trend toward greater impairment ( P = .04). Psychiatric comorbidity and impairment are high in gay and bisexual men with PG. Research is needed to optimize patient care for gay and bisexual men with PG.