The presentation highlights the importance of homosexuality in understanding depression and suicidality among men. This issue is not sufficiently acknowledged in research and practice even though international studies report homosexual and bisexual men to be at high risk for depression and suicidality. Results from a meta-analysis of international studies will be presented and they are consonant with the few study results from German speaking countries. In the scientific literature, the increased risk is mostly explained through the harmful effects of “minority stress”, i.e., expected or actual violence and discrimination resulting from being homosexual or bisexual. In addition to minority stress, many homosexual and bisexual men are also confronted with negative social reactions long before coming out because of gender role nonconformity, and that increases the risk for later psychological distress. These findings highlight the need to consider sexual orientation issues in the prevention and treatment of depression and suicidality. There has been some progress in this respect but examples of related ignorance are encountered in the current mental health literature and in suicide prevention programs.