“I’m glad it’s happening at this point in my life,” says the ‘Ferrari’ actor. “It’s nice to have the recognition, but gives me the platform to use it for something positive.”

It’s been almost two decades since Patrick Dempsey sauntered onto the small screen as neurosurgeon Derek “McDreamy” Shepherd on ABC’s Grey’s Anatomy (even longer since his breakthrough role as an endearing outcast in 1987’s Can’t Buy Me Love).

His heartthrob status created such a fan frenzy that he graced the pages of this very issue countless times over the years. Now he’s taking home the Sexiest Man Alive crown.

“I’m glad it’s happening at this point in my life,” the Maine native, 57, tells PEOPLE in this week’s cover story. “It’s nice to have the recognition, and certainly my ego takes a little bump, but it gives me the platform to use it for something positive.”

Closest to his heart is the Dempsey Center, which he founded in honor of his late mom to support cancer patients and their loved ones.

People’s Sexiest Man Alive 2023; Patrick Dempsey photographed at a private location (Dolphin House) in Malibu, CA on October 5, 2023.
Patrick Dempsey. CARTER SMITH
Other passions include being a family man to wife Jillian, 57, a makeup artist and founder of her own clean beauty line, and their kids Talula, 21, and 16-year-old twins Sullivan and Darby, as well as honing his penchant for race-car driving.

So what went through his mind when he first heard the news? “I was completely shocked, and then I started laughing, like, this is a joke, right? I’ve always been the bridesmaid!” he says, laughing.

“I’d completely forgotten about it and never even contemplated being in this position. So my ego is good.”

People’s Sexiest Man Alive 2023 cover; Patrick Dempsey

As for how his kids will respond, Dempsey insists they’re “just going to make fun of me and pick on me and figure out every reason why I shouldn’t be,” he says. “Which is good, they keep me young.”

In December he’ll show off his racing skills in the Michael Mann–directed biopic Ferrari (which received an interim agreement from SAG-AFTRA amid the actors’ strike), playing Italian driver Piero Taruffi. The film taught him a lesson in risk-taking — but off the track.

“I’d been following the movie for years, so I called Michael and said, ‘I want to discuss being a part of this,’ ” Dempsey recalls. “That taught me if you really want something, you have to do it yourself.”

For more on 2023’s Sexiest Man Alive, pick up this week’s issue of People, on newsstands Friday.

People’s Sexiest Man Alive 2023; Patrick Dempsey photographed at a private location (Dolphin House) in Malibu, CA on October 5, 2023.
Patrick Dempsey. CARTER SMITH
Now the actor is learning that good things really do come to those who wait.

“I’ve got the bumper stickers, T-shirts, posters,” he jokes of his new title. Does this mean he’s peaked? “I peaked many years ago,” he says, laughing. “But I’m still here.”

Ferrari is in theaters Christmas Day. For more information on the Dempsey Center, visit dempseycenter.org.