As a result of societal expectations and to avoid societal homophobia, many lesbians and gay men in China marry heterosexual partners and do not disclose their own sexual orientation. This study used qualitative methods to explore why gay men enter into such marriages of convenience. A total of 17 in-depth interviews were conducted with lesbians and gay men who had entered “formality marriages.” All interviews were digitally recorded for transcription; transcripts were analyzed using grounded theory to determine themes. The reasons for engaging in formality marriage can be grouped into broad categories, including: maintaining mianzi (reputation) and lizi (inner reality), avoiding moral distress, social discrimination, working in tizhi (social systems), accounting for their social relationships, and fulfilling filial piety. From our model we can see growing up as a member of a minority sexual orientation group means being discriminated against and marginalized in the family, work place, community, and society at large. Formality marriages not only offer a way to maintain one’s personal and family reputation ( mianzi) in different contexts, but also avoid moral distress and maintain a personal private sexual orientation ( lizi) with their own homosexual partner. Formality marriage serves as a compromise to ensure cultural continuity, and it harmonizes individuals’ interpersonal relationships and traditional Chinese family values. Understanding the reasons for formality marriage practices can help health professionals to create public health campaigns to dispel stereotypes and stigma about homosexuality, and to develop culturally sensitive services for homosexual populations.