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Purpose: Adolescent sexual minority men (ASMM) are affected disproportionately by HIV, and little is known about their utilization of sexual health care services. We aimed to examine demographic, regional, and political influences on the sexual health care experiences of a unique sample of racially diverse ASMM from across the United States. Methods: Data were collected between April 2018 and February 2019 as part of the baseline survey of an ongoing pragmatic trial of a suite of HIV prevention interventions for ASMM. At the time of analysis, 699 participants had completed baseline and were included in multivariable analyses examining demographic, regional, and political differences in perceived access to and experiences of sexual health care. Results: The majority of ASMM reported not having had various sexual health care experiences in the past 12 months (70.8%–85.7%, respectively), and a large proportion reported low-to-moderate perceived access to such services where they live (37.8%–64.1%, respectively). Some groups were significantly less likely to report perceived access to, or having had, certain sexual health care experiences, including ASMM in their early- to mid-teens and those who lived in rural areas, the South, and Republican state-level political climates. Conclusion: These analyses indicate that ASMM underutilize sexual health care and point to specific groups with the lowest rates of engagement. To address the sexual health needs of ASMM, structural changes need to be made in the sociopolitical arena (e.g., federal nondiscrimination legislation) and medical system (e.g., mandated training in LGBTQ care) that will reduce LGBTQ-related stigma and increase access to needed care.