PurposeThis study aims to explore innate and sociocultural forces that lead gay men to purchase invasive and non-invasive cosmetic medical treatments.Design/methodology/approachThis work draws on a literature review and personal reflections to identify and interpret patterns and themes on drivers that encourage gay men to use cosmetic medical treatments.FindingsIn line with evolutionary theory, the authors suggest that the male proclivity to evaluate a partner’s sexual desirability on the basis of physical appearance and youth remains consistent among gay men. They also posit that sociocultural norms, such as media imagery, portray gay men as physically attractive and youthful. Among gay men, homonormative ideals that define attractiveness fall on a continuum ranging from hyper-masculinity to hypo-masculinity, with each end encouraging gay men to accept different beauty standards.Research limitations/implicationsTo date, service researchers have mostly overlooked the role of evolution in consumers’ propensity to purchase professional services. This study sets the foundation for researchers to consider both instinctual and sociocultural norms that encourage consumers to purchase not only cosmetic medical treatments but also professional services in general.Practical implicationsGay men represent a prime target market for cosmetic medical treatment providers, as their desire for physical attractiveness and youth remains constant as they age.Originality/valueThis study offers novel insights into gay male consumption of cosmetic medical treatments and services from theoretical and practical perspectives.