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Ask the Experts About LGBT Health

Q: Coming Out

Dear Dr. Makadon,

I'm a 26 year old guy. At first I thought I might be bisexual, but the more I try to figure it out, the more I think I might just like guys. I've never done anything with a guy except online chat. When I'm with a girl I feel awkward and I feel like I can't totally engage with her sexually or even in terms of feeling connected. I think about coming out, but I'm scared because once I tell people, I can't really take it back. My friends are all straight. I don't know anyone I can talk to who wouldn't go blabbing to the whole town. Do you have any advice? I'm pretty sure I'm going to come out. I just don't want to mess it up. Thanks.

-Not That Confused Anymore


A: Response from Dr. Makadon

Dear Not That Confused Anymore,

I am glad you wrote about your concerns about "coming out," as often people feel have a hard time asking about this. It can be a difficult issue to talk about and one where there are a number of issues to consider.

As you have experienced, coming out is not always an all or none event. At one point you described yourself as bisexual, and now you feel as if you are ready to "come out" as gay. Some people choose not to identify as either gay or straight and may consider themselves bisexual even though they may prefer to have sex with men or women. Some choose to describe themselves as "queer" to try and avoid usual choices open to identifying your sexual orientation. This issue can also relate as much to how you identify yourself (gay, bisexual, straight, or queer) as to who you want to have sex with (men and/or women). Some may feel that they are gay, but not feel they are ready for a sexual relationship or even ready to talk about sexual orientation. Sexual orientation may be an unstated or unacted upon desire. People can be desirous of being with men or women and not be prepared to talk about this or act on this desire. Also, many people do in fact find that their sexuality is fluid and may change with time. Coming out as gay doesn't mean you can't take it back.

You have expressed a desire to talk about being gay and what that will mean for you. If I were seeing you as a patient I would want to talk with you about what being gay means for you. Are there things about feeling that you are gay that you are nervous or anxious about? What are your desires and what does it mean to you to be gay and out in the world?

I ask first about how you feel because while there are many gay people who are out and very comfortable with who they are, the process of getting there for many can be difficult. Despite gay characters on TV, gay people in sports and government, and many local and national gay organizations, there is still stigma about being gay. I would want to find out if you have ever felt depressed or isolated. It is also important to find out how you feel with respect to being gay in your family, in your school, among your friends. Do you feel you have gotten to know people who you feel are good friends, or do you feel lonely or isolated, a common feeling for many? Do you have people you can talk with? If you want to talk about your sexual identity, but are having a hard time, there are resources in many communities that are available to help you.

I would also want to talk with you about whether you have been sexually active or what your desires are about becoming sexually active. Sexual intimacy should be enjoyable. At the same time, it is important to know what you want and feel comfortable with now, and also that you learn about how to enjoy sex and stay healthy without contracting HIV or other sexual transmitted infections. Everyone who is an adult can make their own decisions about what they want to do, but I feel it is my job to make sure that you know what it takes to stay healthy. For safer sex guidelines check out www.fenwayhealth.org/safersex.

In addition to being safe about sex, it is important to think about not letting drugs or alcohol affect your judgment and lead you do things that could compromised your health.

Despite the questions and concerns I have raised, coming out and feeling good about being gay can make a big difference in how you feel about yourself. I don't know what your life has been like. Many live somewhat isolated lives before coming out and feel they are different from their friends without always knowing why. Coming out healthfully can help you live up to your maximum potential with no limitation to how much you can and should enjoy your life. It may take some thought and some work along the way, but I know you will find it well worth the effort.

If you want to speak with someone about this, you can call Fenway's Help Line (see information at the bottom of this response) where they are glad to lend an ear about coming out. They can also provide you with other resources. Lots of communities also offer groups and individual sessions on coming out. The folks at the Help Line can help you with that.

Good Luck, and write again if you have more questions along your journey.

-Harvey

Toll-Free Listening Lines

Fenway Health's Gay, Lesbian, Bisexual and Transgender Helpline and The Peer Listening Line are anonymous and confidential phone lines that offer gay, lesbian, bisexual and transgender adults and youths a "safe place" to call for information, referrals, and support. In addition to issues like coming out, HIV/AIDS, safer sex and relationships, our trained volunteers also address topics such as locating GLBT groups and services in their local area.

Gay, Lesbian, Bisexual and Transgender Helpline (617) 267-9001 Toll-free: (888) 340-4528

Peer Listening Line (617) 267-2535 Toll-free: (800) 399-PEER

You can receive help, information, referrals, and support for a range of issues without being judged or rushed into any decision you are not prepared to make. Across the country, Fenway's HelpLines are a source of support. Talk to our trained volunteers about safer sex, coming out, where to find gay-friendly establishments, HIV and AIDS, depression, suicide, and anti-gay/lesbian harassment and violence. No matter what is on your mind, we are here to encourage and ensure you that you are not alone.

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Forum Experts

Dr. Makadon

Harvey J. Makadon, MD is Clinical Professor of Medicine at Harvard Medical School and Director of Education and Training at The Fenway Institute at Fenway Health in Boston.  He is a member of the Division of General Medicine at Beth Israel Deaconess Medical Center and is the lead editor of The Fenway Guide to LGBT Health, published by the American College of Physicians in 2007.  He has long been involved in developing both educational and clinical programs to serve gay, lesbian, bisexual and transgender populations.

Dr. Raney

Patricia Raney, MD, is a staff physician at Fenway Health in Boston, Massachusetts. She is a graduate of the University of Massachusetts Medical School and is Board Certified in Family Medicine. Her clinical interests include women's health and wellness, primary care, preventive care and the health concerns of lesbians, bisexual women and transgender people. On a more personal note, she is an avid stone carver.