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fearing loss of control and putting myself at risk
Jul 8, 2007

I'm a 45 year old gay male and last tested negative in Nov. 06. I've had low self-esteem all my life, and chronic depression since I was about 12. I've always been overweight, and never felt particularly attractive--certainly not to the kind of men whom I find attractive. In fact, I've spent much of my life feeling invisible and unmemorable to other men, despite being bright, funny, kind, and generally a good guy.

In my 30s, I discovered the bear community, and felt desirable for the first time, although I wasn't necessarily interested in many of the men who were attracted to me. My sex life became more active, and opportunities for recreational sex really increased with online contacts. I played around some, went to a few sex parties, but always played fairly safely. (Virtually no unprotected anal--maybe 2-3 occasions over a number of years.) In recent years, I started enjoying pot more, too--found that it made me feel more sexual and less shy in sexual situations. Poppers, too, became a more regular thing. At the same time, I've been medicated for depression (zoloft, effexor) and low testosterone.

Trips away from home have always been opportunities for sexual adventure. On a recent combined business/pleasure trip, I hooked up a number of times. The first occasion that made me anxious was an online connection that led to my having fairly rough receptive oral sex--rough enough that I noticed my tooth had cut into my lip after it was over. There was no cum in my mouth, though. A few days later, I had unprotected anal sex (me on top) with a guy whom I later learned has been poz for 14 years. I called my doctor, and he gave me the option of a 30-day prophylaxis of Atripla, although he felt my risk was still quite low.

I've been on the Atripla for about 9 days. My appetite is weak--not a bad thing, given my chronic obsession with weight loss--and I've had some mild diarrhea as well as some general stomach discomfort. And fatigue and sleepiness, of course. And I made the mistake of not taking the meds on an empty stomach a couple of times, which led to more stomach misery. The other night, I smoked some pot to relax; it was fine for a while, but eventually made me depressed. And I assume I have to face the fact that poppers aren't really healthy either.

So, now, I feel a bit like I don't have any of the things that gave me some sexual pleasure before. I was never a pothead--just an occasional user--but now it seems I shouldn't use it at all. Poppers are probably bad, too. Sex parties are bad. Hookups are bad. Men whom I think are attractive aren't attracted to me, and, while I've been dating someone for almost 2 years, it's never been a passionate relationship, and I've been planning a breakup with him. I feel lost and tired and sad. It's possible that my health is fine--I'm getting tested again next week--but my mental state is miserable. I feel like nothing makes me happy, and I can't have the things that would. I could keep getting higher doses of antidepressants, but it seems like a losing battle.

Perhaps worst of all, I'm a highly functional person. I'm more than competent at my job, and I hide my inner sadness pretty well. I sometimes wish I was someone who'd "fall apart" more readily, but I'm not--I just keep moving. I go to therapy weekly, and it seems to just be rehash of the same issues all the time. I don't want to be the man I am. I don't like myself, because I'm not physically beautiful and desirable, and I feel like I'll never get beyond that. When a hot guy wants to have sex with me, I don't want to put any restrictions on it, because I feel like I'm lucky just to have his attention and any questions I ask might result in him just walking away. So I'm finding myself doing things that I know I shouldn't do, just because the guy's hot and I don't want to risk rejection.

I'm 45. I'm really feeling like it's too late for me, like I'll never get this stuff worked out, because my life's half over already. I feel like I've missed my chances already anyway, and the rest of my life will just be regrets and self-loathing. Do you think it's possible that I'll ever feel better? That I'll ever really be happy in my own skin?

Response from Dr. Frascino

Hello,

You report low self esteem and chronic depression since childhood. As an adult, you feel sexually invisible and unmemorable. You state you feel lost and tired and sad . . . "nothing makes me happy." You "don't like (yourself) because (you're) not physically beautiful and desirable . . . ." You feel "(you've) missed (your) chances already and the rest of (your) life will be regrets and self-loathing". And now you find yourself participating in risky sexual behaviors because you don't want to risk rejection from a hot guy.

So your question is: will you ever be happy in your own skin? I do not know. However, I can certainly say you're not happy in your own skin now. You report your weekly therapy sessions are just a rehash of the same issues and not very helpful. I would suggest you have a reevaluation by a different psychiatrist. Bring a copy of this post and my response with you to your first visit and show it to your psychiatrist. It will help focus your therapy. I would also suggest you be followed by an HIV specialist while on PEP. He will help with any PEP-related side effects and toxicities as well as arrange for and interpret your post-PEP follow-up HIV tests. He may also be a good resource for support groups in your area to help you stay safe when having sex. Finally, if you have questions about poppers and marijuana, check the archives. I've discussed these topics multiple times in the past.

Can you eventually feel better, be content in your own skin and find your "happily ever after?" Yes, you can. However, will you? That part's up to you.

Good luck.

Dr. Bob



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