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Men who have sex with men

Intermittent or Event-Driven Truvada for HIV Prevention

Hi Dr. Olson,

I’ve been on Truvada for about three years. Occasionally, I stop taking it when I’m not sexually active. I’ve stopped for as long as three months and then started back up again. My doctor says this is fine but I’ve heard from sex partners this approach lowers the efficacy. Your thoughts?

First, I must tell you I am not an expert in the prescribing of Truvada, so I consulted with some doctors who are.

Intermittent use of Truvada is called event-driven pre-exposure prophylaxis (ED-PrEP), and it has proven highly effective in reducing HIV men who have sex with men (MSM) who engage in anal intercourse (receptive or insertive sex). It is an alternative to daily PrEP dosing for some men. At this time, the data are only available for Truvada; data are not yet in for Descovy. But you need to know more.

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“Is My Husband Gay?”

Dear Dr. Olson,

Several months ago I met my boyfriend at a party and we really clicked. He asked me out and we’ve dated since then. He treats me very well. A few months after we started dating, he told me he thought he might be bisexual. He said he’s never been in a sexual relationship with a man, but he admits to having erotic fantasies when in the presence of attractive men our age. He admits those attractions are growing stronger. He vacillates between wanting a relationship with me and exploring his same-sex attractions. He doesn’t want to commit to me “until I understand my sexuality better.” Should I try to encourage him to stay with me or set him free to explore his sexuality? Am I being too old fashioned?

First let me say that most people who are bisexual will tell you that just because they’re bisexual doesn’t mean they cannot be monogamous. If you read through the comments on my essay “The Messy Realities of Bisexuality,” you will find many who say that whether you are bisexual or heterosexual, everyone experiences attractions to people outside their primary relationship. But we also have a choice: to control those desires or act on them. Bisexual people are no more promiscuous in their sexual behavior than heterosexuals. But heterosexuals aren’t all that good at monogamy either. Continue reading

I Think My Husband Might Be Gay

Dr. Olson:

My best friend recently told me that she thinks my husband might be gay. My initial reaction was to tell her she’s crazy and to mind her own business. But now that I’ve had some time to think about it, I wonder if she could be right. I’ve seen the signs for some time but always made excuses for Daniel since he’s a good husband and great father to our kids. What’s the best way to bring up the subject with him? Should I be blunt and just ask him if he’s gay?

If you ask your husband directly if he’s gay, he might automatically deny it, just as you initially denied the possibility when your friend suggested it. Then you’d be left wondering if he’s being truthful—either with you or with himself. 

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Children of Gay and Bi Fathers

Dear Dr. Olson,
I was married to a “bi” man for over twenty years. We never told our son until we separated and were divorcing. He wanted to know why we were divorcing, so his dad told him. Our son was a teenager when my ex-husband disclosed this. How does keeping the sexual orientation of a parent secret from a child affect a child/teen/man psychologically? My ex had sex with only men besides me before and during our marriage and identified as openly gay after our divorce. 

You have asked a good question that does not have an easy answer. First of all, it depends upon the child’s level of maturity and experience in the world.  Continue reading

I Love my Wife but I Think I’m Gay

I frequently hear from gay men, “I love my wife but I just can’t shut off the attraction I have for men. What should I do?” As I was working on an essay for Psychology Today, I got an email from my ex-wife, whom I divorced 32 years ago, asking me to have lunch.  “Nothing serious.  Just haven’t caught up in a while.” I quickly accepted the invitation. My experience is unimaginable to some straight spouses, and for us, it didn’t come easily or quickly.
Sometimes we’re left with the choice between a bad decision and a worse decision, but things may not be as bad as they seem.  Click here to read

The Shame and Guilt of Same-Sex Attraction

Hi, Dr. Olson,

I am a middle-aged divorced man, and since my divorce I have been struggling with my sexual identity. Perhaps I have always been in denial or confusion with my sexuality. Growing up I had female friends but felt intimidated by them sexually. My first sexual experience was with a childhood friend, but I felt sick, ashamed, and guilty. This increased my need to always have a girlfriend to suppress this shame. Following my divorce, I felt incredibly lonely and started flirting with guys online. For the first time, I felt attractive. Who am I?

Your story is very familiar to me and not much different from my own. Some find it hard to believe that a man could reach middle age before questioning his sexual identity, but in my research, I have even interviewed a man in his nineties who, having lost his wife of over fifty years, began to explore his same-sex attractions. Seeking an answer to the question of who I am led me to write Finally Out: Letting Go of Living Straight.  Continue reading

Alcoholics Anonymous and Honesty about Same-Sex Desires

I’m very conflicted now. I am in my midsixties and have been married since I was in my early twenties. I’ve struggled with depression, alcoholism, and drugs most of my life. The first twenty-five years of my marriage were a complete nightmare for my wife—infidelity, alcohol and drugs, and all the lies and false promises I made. For several years, I have been clean and sober with the help of AA.

My wife and I haven’t had a sexual relationship in several years. I have always had a high sex drive, and one day while surfing Craigslist I decided to try having sex with a man. I did, and I liked it. Honesty is a big part of AA and for staying sober. I am hiding this, and now all I feel is shame and guilt and it has ruined my sex life. Any advice?

Thanks for contacting me. First, congratulations on your sobriety. I know how difficult that struggle is. Substance use disorders are chronic conditions, much like diabetes, that can never be cured but must be managed on a day-to-day basis. Continue reading

Making the Decision to Come Out

I’m a fifty-year-old man with two sons, ages 23 and 25.  I have struggled with my sexual desires for men for as long as I can remember, and as I get older, it seems harder and harder to resist this, but I have had only very limited experience with men.  How did you decide you are gay and what made you decide to leave your family and come out?

Leaving my wife and two young daughters was one of the most difficult things I have ever done.  I struggled with the decision for many years.  The question of leaving my family and coming out or staying married and trying to repress my desires seemed to have no good answer. Continue reading

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