Top 10 Things Gay Men Should Discuss with their Healthcare Provider
Following are the health issues GLMA’s healthcare providers have identified as most commonly of concern for gay men. While not all of these items apply to everyone, it’s wise to be aware of these issues.
1. Come out to your primary healthcare provider
In order to provide you with the best care possible, your primary care provider should know you are gay. Knowing your sexual orientation and sexual behaviors will help your healthcare provider offer the correct preventative screenings, and order the appropriate tests. If your provider does not seem comfortable with you as a gay man, find another provider. You can consult the LGBTQ+ Healthcare Directory for help finding a provider.
2. Reducing risk of getting or transmitting HIV
Many men who have sex with men are at an increased risk of getting HIV, but the ability to prevent aquisition and transmission of HIV has improved drastically in recent years. If you are living with HIV, anti-HIV medications can help you live a normal lifespan and prevent you from transmitting HIV to your sex partners (Treatment as Prevention), taking this worry out of sex. Studies show that if you take anti-HIV medications and have an undetectable viral load, HIV cannot be transmitted through sex (Undectable = Untransmitable).
If you don’t currently have HIV, taking pre-exposure prophylaxis (PrEP) is an effective way to nearly eliminate the chance of you getting HIV. It is important to remember that PrEP does not protect against other sexually transmitted infections (STIs) like gonorrhea and chlamydia. If you aren’t taking PrEP and you have an unexpected exposure to HIV, taking post-exposure prophylaxis (PEP) within 72 hours can drastically reduce the chance of you getting HIV from that exposure. PEP can be prescribed by emergency rooms, by your primary healthcare provider, or by some sexual health clinics. Know where you can get PEP ahead of time. If you are HIV negative and are in a relationship with someone who is living with HIV, you can talk with your primary healthcare provider about options for prevention.
3. Hepatitis immunization and screening
Men who have sex with men can get Hepatitis A, Hepatitis B, or Hepatitis C through sexual activity. These infections can be potentially fatal, or can lead to very serious long-term issues such as liver failure and liver cancer. Immunizations are available for Hepatitis A and B, and are recommended for all men who have sex with men. Condoms can reduce the transmission of viral hepatitis, and are currently the only means of prevention for the very serious Hepatitis C Virus. Hepatitis C can also be transmitted through exposure to the blood of another person, such as by sharing needles. If you have Hepatitis C there are newer, highly effective treatments that can cure it.
4. Fitness (diet and exercise)
Problems with body image are more common among gay men, and gay men are more likely to experience an eating disorder such as bulimia or anorexia. While regular exercise is very good for your health, too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can be dangerous. Obesity also affects many gay men and can lead to a number of health problems, including diabetes, high blood pressure, and heart disease.
5. Substance use/alcohol
Gay men use substances more commonly than the general population, and not just in larger cities. These include a number of substances ranging from amyl nitrate (“poppers”), to cannabis, ecstasy, and amphetamines. Some of these substances have significant health risks. If your drug use is interfering with work, school or relationships, your healthcare provider can connect you to help. You can also talk to your healthcare provider about strategies and local resources to help optimize your safety when using substances.
Depression and anxiety appear to affect gay men at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe, for those men who remain “in the closet” or who do not have adequate social support. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive primary care providers and mental health services may be more effective in the prevention, early detection, and treatment of these conditions. A good way to begin to address depression/anxiety is to tell your healthcare provider you would like to discuss your emotional health at your next visit.
7. Sexually-transmitted infections (STIs)
Sexually-transmitted infections (STIs) occur commonly in sexually active gay men. These include infections for which effective treatment is available (e.g. syphilis, gonorrhea, chlamydia), and for which no cure is available (e.g. Human Papillomavirus, herpes). Condoms can reduce the risk of many sexually transmitted infections when used properly. You can have an STI without having any symptoms, and still pass it to your sex partners. Getting screened for STIs regularly is important for your health and the health of your sex partners. Most sexually active men should get tested at least every 6 months, but every 3 months may be more appropriate if you have a higher number of sex partners.
8. Prostate, testicular, and colon cancer
Gay men may be at risk for prostate, testicular, or colon cancer. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be harder for gay men due to barriers to accessing culturally sensitive care. All gay men should undergo these screenings routinely as recommended for the general population.
Gay men use tobacco at much higher rates than heterosexual men. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and a whole host of other serious problems. All gay men should be screened for and offered culturally sensitive prevention and cessation programs for tobacco use. Additionally, gay men over the age of 55 who have smoked for many years should ask their healthcare provider if yearly lung cancer screening is right for them.
10. HPV (virus that causes warts and can lead to anal and other cancers)
Human papillomavirus (HPV) — which causes anal and genital warts — is often thought to be little more than an unsightly inconvenience. However, besides causing warts, HPV also causes anal cancer and cancer of the throat. A vaccine to prevent HPV infection is recommended for all men and women age 9-26 years and also for gay men age 27-45 who are not planning to remain monogamous. It is estimated that 90% of HPV associated cancers can be prevented if you get the vaccine. The HPV vaccine does not cure, nor protect against strains of HPV you have already been exposed to. Several treatments are available for HPV-associated pre-cancerous lesions. Screening for anal cancer is sometimes recommended for gay men living with HIV, in whom the risk of anal cancer is higher. Discuss with your provider if screening for anal cancer is appropriate for you.
Revised 2021. (2012 Author: Robert J Winn, MD AAHIVMS)