Early-life traumas contribute to lasting health effects, including greater vulnerability to mental health issues, substance use, sexual risk behaviors, and cardiovascular disease. Among Black sexual minority men (SMM), childhood sexual abuse (CSA) is a prevalent yet underacknowledged public health crisis that is part of a broader web of social and psychological adversities, including resource instability, homophobia, and stigma. This chapter uses a Life Course perspective to examine the neurological, cognitive, and behavioral effects of CSA and how it affects long-term health and quality of life (QoL) trajectories for Black SMM. The chapter provides an in-depth examination of CSA in light of several key Life Course principles including timing, transitions, and agency. The chapter identifies promising intervention approaches that can address the harmful pathways of CSA and promote QoL across the life span. Key points for future research and policy prescriptions are also discussed.