<p>Sexual activity among older gay men is an underexplored topic and an essential piece to overall sexual wellbeing. Substance use and body image are two factors that may influence the sexual activity of aging gay men. A cross-sectional survey examined older gay men who lived in the Midwest region of the United States and the relationship between alcohol or drug use immediately before or during sex, body image and sexual activity. Older gay men who were 50 or older were able to participate in the survey between December 2021 through May 2022. Findings from a negative binomial regression revealed that alcohol or drug use (AOD) immediately before or during sex moderated the relationship between body image and number of sexual activities among older gay men. An association was found between body image and sexual activity for older gay men who did not engage in AOD use immediately before or during sex. Additionally, older gay men in monogamish and open relationships reported engaging in a greater number of sexual activities compared to single or widowed men. Age and overall health were negatively associated with number of sexual activities older gay men engaged in. Future research should continue to explore factors that may influence the sexual behaviors of aging gay men.</p>