CASE STUDY: My obese gay patient just told me he is a Bear.

Jun 11, 2021 | Barriers to Health Care, Blog, Communication Skills for Doctors, Equity Work, Health of Bears, Medical Education, Uncategorized

Talking with gay male patients about cardiovascular health

What is a Bear?

Bears are a sub-group of gay men generally identified by their larger body size, and facial and body hair which connects them to community and with sexual partners. In the medical clinic, they are frequently seen as obese men at increased risk for cardiovascular disease and diabetes.

These men have likely heard plenty of societal messages and health providers saying they are fat. While weight loss may be a goal for some patients, consider instead addressing the sequelae of large body habitus as a strategy to build trust as a non-judgemental provider.

Medical education about gay men is commonly limited to risk of HIV, STIs and substance use. These men need all the same age-related screening as non-queer patients.

Case Study: Mac goes to the doctor

Together with artist & designer Horacio Abdala, we created this case study in the forms of a graphic dialogue between a Bear named Mac and his family doctor.

Mac shares with Dr. Chan his concerns about knee and back pain, and issues with erections. Joint pain impacts his daily life in general, and often interferes with mobility in the bedroom. He understands that his body size puts extra stress on his body.

Regarding his erectile dysfunction, Dr. Chan explains there are a number of potential causes including diabetes and heart disease, and psychological issues like performance anxiety and depression. In some men, the excess abdominal fat may produce estrogen and affect testosterone levels.

Dr. Chan commonly screens gay and bisexual men in her clinic for sexually transmitted infections, depression and anxiety, substance use disorders and tobacco use. In recent years she is managing HIV among positive guys, and prescribing PrEP for HIV negative people.

Just like all men over 40, Mac also needs screening for diabetes, high blood pressure and cholesterol. When he turns 50, he’ll be screened for colon cancer, in addition to an anal Pap test for HPV.

As Dr. Chan says, he doesn’t need to lose weight in order to be healthy. In fact, she learns that Mac has tried many times and struggled, and thinks a focus on getting healthier is better in the long run.

By managing his blood pressure and blood sugar, eating nutritious food, and getting some exercise he will likely see improvement in his everyday activities as well as his nighttime endeavours.

Recommended health screening for Bears

Unique screening for Bears*

Joint and back pain
Hernia
Hypogonadism
Erectile dysfunction
Obstructive sleep apnea
Gout
GERD
Kidney stones
Skin and soft tissue infections

Screening for gay & bisexual men

Sexually transmitted infections
- HIV & Syphilis
- Gonorrhea & Chlamydia urine/swabs
- Hepatitis A/B immunity
- Hepatitis C infection
Depression & anxiety
Substance use
- Tobacco + Cannabis
- Alcohol
- Crystal meth/GHB/other substance
Anal pap for HIV+ (evolving evidence for HIV-)

Screening by age and risk factor

Cholesterol/Diabetes/Hypertension
Colorectal & Lung cancers
Pap of cervix and ultrasound chest for trans men

*These recommendations are based on current evidence and clinical experience. Providers should use their own clinical judgement in collaboration with your patient to develop an individualized screening plan.

Resources

Download the poster by Horacio Adala

Read blog posts related to Health of Bears