Heat a large nonstick or cast-iron skillet over medium-high heat. Once heated, add the sausage, onion powder, and garlic powder to the skillet. Cook the sausage, breaking it into small pieces as it browns, until it is browned and no longer pink.
Once the sausage has cooked fully and the fat has rendered, add in the butter and let melt. Once the butter has melted, sprinkle flour evenly over sausage and stir to evenly distribute flour throughout the rendered fat. Cook for 1-2 minutes to remove the raw taste of flour.
Slowly whisk in 2 cups of milk, ¼ cup at a time, whisking or stirring constantly. Once gentle bubbles begin to form along the edges of the pan, reduce the heat to medium-low. Add in nutmeg and pepper, and simmer until thickened, about 5-10 minutes. Continue to add in milk if needed to thin as desired. NOTE: Simmer longer for thicker sausage gravy, simmer for less time for thinner sausage gravy.
Once sausage gravy is thickened, turn off the heat and stir in the Worcestershire Sauce and pepper. Taste and add salt if needed.
Serve the sausage gravy over warm biscuits, grits, or oatmeal.
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Notes
Milk: Whole milk is recommended for the richest results. However, any fat percentage will work. Sausage: Use mild or hot ground breakfast sausage, not maple breakfast sausage. Keep in mind you may need to add in up to 1 additional tablespoon of butter if you use lean chicken or turkey sausage. The fat is needed to thicken to form the roux and thicken the gravy. Leftover Sausage Gravy: Store cooled, leftover sausage gravy in an airtight container for 3-4 days. To reheat, place in a dry skillet over low heat, adding milk to thin if needed. Taste and adjust seasonings before serving.