josh282282

Hi all. I recently flew to LA for a work conference and met up with Stephan one evening. He's hot AF. He did everything I asked without hesitation & is fantastic at what he does. He's genuine and kind, professional, masculine, and a lot of fun. I do not know his sexual orientation (I didn't ask), we did not do muscle worship (I'm not into that), and he is not a flight attendant (I asked). If I ever fly back to LA or if he comes to my town on the east coast, I will repeat. I absolutely recommend him. Love & hugs to all Josh PS I have been a contributing member on this forum for many years now, so I hope that lends some credibility to my recommendation...

Hi I'm a provider too, albeit slightly different. I'm a board certified physician practicing medicine here in the US. Yes, I get those, too. Even from established patients of mine. I discharge any patients who do this repetitively. I do not demand deposits to make an appointment. FYI: ALL professionals get no-shows. It's perplexing why you think your profession should be somehow exempt from this. All good business men (including physicians) must come up with strategies to manage business scheduling losses. FULL DISCLOSURE: I will never give a deposit. I've been hiring for awhile & I consider myself quite experienced now, and I have never been asked for a deposit & never will provide one. TO ALL MY GAY BROTHERS OUT THERE WHO HIRE: Do not listen to the above escort. Do not EVER pay a deposit. You WILL very possibly regret it. You will help other Gay men regret it. And if you DO pay a deposit: You will encourage MORE SCAMMERS to infiltrate the gay-escort business who will RIP us OFF! But by keeping a No-Deposit-Culture we minimize this cancer. If you DO pay a deposit: You will encourage more psychopaths to infiltrate the gay-escort business who will then PREY ON US (cuz they have YOUR personal info) BY extorting those who provide this info. To My Gay Brothers Who Cancel Last Minute or No-Show: What the fuck is wrong with you?!? Escorts are beautiful, wonderful, fun and VERY worthy of all the respect & love we can GIVE THEM. No-showing harms EVERYONE. MY SUGGESTION: If we hear of any gay poster to these boards we absolutely should BAN HIM as he helps to create the very toxicity that drives the above mentioned escort to his inappropriate deposit-demanding behavior. Love & hugs to all, Josh

Primary care physician here. I practice Medicine in a primary care clinic on the east coast & see these issues daily. Some comments. First, my love & support to all who struggle with obesity. It's a terrible disease with significant & harmful consequences. And losing weight is challenging. And as we age, it only gets more challenging. I am, of course, getting oh-so-many-requests for Ozempic from non-diabetic patients who desire it for weight loss. Daily requests. On Ozempic I've had a handful of patients really drop the weight, like 20-30 lbs. Its impressive. And I've also had some not lose weight on Ozempic. And I'm also very much aware of my diabetic patients who have been prescribed Ozempic for diabetes. This medication has really helped improve their glycemic control & reduced their risk of serious complications of uncontrolled diabetes. Its awesome. Unfortunately, since the Ozempic for weight loss craze started, some of my diabetics struggle to get a prescription filled because the pharmacy is out, all the Ozempic went to weight loss. And their health suffers. It's very disappointing. There are pros & cons to using these Ozempic products for weight loss, as outlined by several posters here which I wont repeat. But I highlighted Benjamin's note for the strength of its insight. Weight loss drugs are doomed to fail if the patient does not change their lifestyle. And to be honest, many (not all) of the patients requesting an Ozempic prescription from me have no cogent plan or strategy in specifically HOW they will change their diet & behavior. They just demand their Ozempic NOW. I ask about their plans. I listen & wait, but the answers typically are somewhat weak & poorly formed, tbh. I am fearful some, not all, on this website who want their own prescription of Ozempic may fall in the same category. The fear is many who lose weight on Ozempic will only regain it back unless they really change their behavior. History will repeat itself. With this in mind, some of my physician colleagues, including myself, have followed bariatric surgeons path. Bariatric surgeons demand prior to surgery that the patient lose a bit of weight and THEN they are offered bariatric surgery. My colleagues and I are doing similar: we inform potential Ozempic patients they must lose 5-10% of their weight THEN we will prescribe Ozempic. Simply put: whether I like it or not, I'm a gatekeeper of this "magical" drug. Therefore, I must keep many factors in the forefront of my mind: will this prescription take away an imperative drug from a patient who needs it for diabetes? What is the risk the patient will eventually regain the weight? Is this patient demonstrating clear evidence that changed behavior is present now, and likely will continue once the Ozempic course has ended? This weight loss drug will cost thousands of dollars for several months for a course and prudence & honesty demand of me that my professional prescribing behavior be judicious and fair. It's a work in progress. Ozempic is a complicated drug, isnt it? Obesity is a touchy & for some, a painful topic, especially in the judgemental Gay community where the Body-Beautiful pressure is ever-present. So to those who struggle, fight on. My love & support goes out to you. Hugs & kisses, Josh

(Primary Care Physician here) Yes, all around me I am seeing more mid-level providers, too, (known as PA's, physician assistants & NP's, nurse practitioner). They absolutely can be a welcome addition to the medical team. I support their inclusion to Medicine. But not to EVERYWHERE in Medicine. They have their serious limitations. I am adamantly opposed to mid-levels working as THE PCP. As an American trained (I'm American) board certified physician who then did a fellowship in HIV Medicine, that's 8 years. Let's count all my training years because its informative: 4 years of medical school 3 years of a primary care residency 1 year of an HIV fellowship = 8 yrs. ( I'm intentionally ignoring my undergrad degree as it is not relevant. I also am ignoring any Registered Nurse who becomes a Nurse Practitioner who is adding his/her undergrad nursing school of 4 years to their tally of 2 years of training- simply not relevant because nursing is not being a doctor). Let's add up the years of training a NP or PA gets: 2 years + ...zero = 2 years. Yes, the mid-level have 1/4 of my training. Yes, I know, I have an extra year compared to my other physician colleagues who are only boarded in one specialty. Ok, for boarded physicians without a fellowship, NPs/PA's have 2/7 of their training. Still a huge difference. YET, a NP or PA all over are becoming, no, they ARE THE PCP, primary care physician for many. I reject such lunacy. Keep reading to understand my point. Ok, let's use the 2/7 ratio and apply it to getting your commercial pilot license & make a hypothetical game for all of us to play: It takes 1500 hours of flight training to get your commercial pilots license. But let's say we start a new commercial pilots license called the Pilot Assistant (PA) License. They can get their license with only 2/7 the training of a Commercial Pilot, 428 hours (1500 hrs x 2/7). You are buying a plane ticket to fly from NYC to Los Angeles. It's a CHEAP fare. Would you buy this ticket? No, there is only another PA in the cockpit, Pilot Assistant as second in command. So there are no commercial pilots in the plane, just 2 PA's. If you are like me, I'd say forget that! It took 7 (8 for me) long, arduous years of training to become a competent Primary Care Physician. We PCPs know a lot ( but not everything). There are just oh-so-many diagnoses that I can manage myself, no Specialist needed. 7 years (8 for me) provided the PCP with freaking tons of practice traing supervised by faculty physicians to learn the craft. Do I refer a patient to a specialist when it's out of my scope & training? Of course! But that was part of my training- knowing what I should keep & knowing when to refer. NPs & PAs have only 2/7 that type of training. Guys, the difference in skill & fund of knowledge is VAST. 2/7 does not equal 7. I know that there are some on this website who may disagree with me. Possibly Unicorn disagrees. And make no mistake, I really, really like Unicorn. Hes another physician like me but he puts in his time here. He is always trying to educate the guys on this website, never gives up, and typically is spot-on! Love him. But, no. Just like I want a fully trained pilot with the FULL amount of training flying my plane, I want a full-fledged MD being the PCP. WHY is this happening? Money. NPs cost HALF of an MD. Years ago, corporate clinics/organizations started hiring NPs & it just skyrocketed from there. Yes, I strongly believe mid-levels belong in healthcare & have a real contribution to make, but they are dangerous as the PCP. They dont know what they dont know. Would they pass the boards I'm required to pass? Nope. They take a much-watered down boards. 2/7 is HUGE. But they save money! Till they run into something they haven't ever seen. And dont have the training to figure out what to do. Kinda like our hypothetical Pilot Assistant. He does ok till he runs into a situation outside of his limited training. And the hypothetical plane crashes & burns. Fly safe, boys.

Hi Benjamin I quoted my self first in this response for reference. It's the closing sentence in my above response to Gabriel/Tom. It's a rather conclusive sentence which neither asks a question nor invites further discussion. From my perspective, the matter was closed for me. Until you commented. But maybe you missed that? Possibly you are trying to help, but your tone/message, I fear, missed that goal. Or maybe I struck a nerve? My apologies if I did. You often provide genuinely insightful comments on this board and I dont want to frustrate you. Nevertheless, I still wish you well. I wish everyone well on this board. Rates negotiated between providers & clients are a frequent topic on this board. It's not a private topic, nor a proprietary subject, nor intimate details often shared between client & escort revealed during a session. I would never share such confidential subjects. What I discussed was rates. By all means, disagree with me on my take on Gabriel, but its certainly within my privilege to discuss rate negotiations here. I wont stop discussing rates (when the spirit moves),. and I strongly suspect neither will (the many) other clients on this board. How would escorts know how to deal with me from anything I write on this board? Its...um.. anonymous. When I contact an escort, none know if I am Josh from companyofmen, someone famous, or a chinese woman in Beijing (Dont tell anyone, 'kay, but I'm actually Tom Cruise)

TomLA 5 Started conversation: Thursday at 09:18 PM You should remove that comment about gabriel's rate. I don't think it's appropriate Hi Gabriel/Tom. The above is a cut/paste of the note you privately sent me on Thursday here on this site. On this particular subject, I think a public discussion between us is better than a private one. I do not take private messages sent to me to public view, but this is clearly a public discussion. In sum, I respectfully disagree with you that my comment in 2021 on your rate was inappropriate. In my comment from 2021, I discussed your rate, not your body size, skills, or personality. This is capitalism and I have every right to decide what rate I feel is too high. And this is a forum where clients talk about their experiences with escorts. To be sure, you have every right to price your services at any rate you want. Its a two-way street this capitalism. I'm just at a loss to understand your argument that I should remove a comment I made about your rate from 2021. At this time, I will not be taking my comment down. But I genuinely wish you the very best in your endeavors, both escorting and personal. Josh

HI Unicorn! I just want to thank you for all your contributions to the Mens Health forum where you have contributed such excellent medical advice that is supported by good scientific evidenced medicine. I have come to look forward to your medical posts where you really explain in an articulate fashion the medical views of our esteemed medical community. I agree that you present recommendations with a lot of data to support it and its a treat for me as a physician to read them. You consistently contribute in the forum and thats awesome. A lot of gay/bi guys are benefiting from your input. They may not post a response or a thank you to you, but I'm sure they are here! Please continue. I HAVE MADE A MISTAKE I originally felt that since the OP requested physicians stay out of this discussion, and as I'm physician, I should stay out of this discussion. But I have discovered, boy, was I wrong! To leave the most knowledgeable potential contributors (MDs) out of a medical question is a foolish quest and one I should not enable. AND, for every one person with a medical question that gets posted here, there are probably 10 more guys thinking the same question. And those 10 are wanting Answers. What if one of those guys want a medical opinion from a honest to goodness MD? How can one poster demand all the doctors follow such a peculiar request to Keep Out? It's to those that I will consider in the future. SO, if anyone (and I'm also looking at you, TonyDown) posts a question here on Mens Health, even if you definitively ask physicians to stay out, I will very possibly ignore the stay-out-request and put in my medical two-cents (it the spirit so moves me). Why? Cuz this is a mens health PUBLIC FORUM. If you dont want the public to respond, dont post here. Love, hugs, and good health to all, including TonyDown!!! Josh PS TO EVERYONE: TonyDown reacted to my post from 4/22/23 up above with a "party" sign. I have no idea what that means. Does anyone know?? And thank you to the others who reacted with a positive sign: luv 'ya!!

Hi there Mr TonyDown, I hope you are well. And before I ask my question, be sure to know I am in no way telling you how to find answers, look for help at all, or live your best life. I didn't fully understand the above part of your request for how you did not want medical advice. But since I am I physician, I stayed out per your request cuz you were clear on not wanting medical advice. Heck, I give (medical) advice all day long (and get paid for it). I'm very much ok not giving out when not asked. And, no I am not offended in not being asked for medical advice. Not at all. So... you actually... were looking for medical advice.... Why so adamant in refusing actual comments from the actual physicians who attend this site, but rather only from non-physician anonymous strangers? Just curious. Hope you are well. Josh

No, no, no. The transgender community is NOT to blame for the reversing of gay acceptance of the Gay community. Not in in long shot. If there is one to blame for any reversing of Gay acceptance is its the hate-mongering that has come from religious extremists and right-wing politicians who hate anything that's different. Right-wing politicians curry favor from their right-wing base by fostering hate-mongering. This only augments more hate in society, which spills over to other communities. To blame the transgender community is very misplaced and deeply disappointing. And to insinuate any reversing of gay acceptance of the Gay community is due to the Poly(amorous) community is also misplaced and inaccurate. The Poly community is about Love and increasing the ability to Love. There is nothing about hate. How does anyone come across Love and turn it to hate? Anyone interfacing with the Poly community & then diminishing their acceptance of different community (the Gay community) only reveals that persons own inability to love, and rather, to hate. The Poly community are not to blame. I inadvertently became friends with some people in the Poly community roughly 10 yrs ago. I found them to so loving and kind, not only to one another, but to me. I saw no arrogance of superiority-like stance in them to me or others. They totally knew I was Gay and they knew I was not equipped/capable of having a poly relationship. Nevertheless, they treated me wonderfully. Tragically, the transgender community is such a misunderstood & maligned group by society. But we are an amazing group of Gay/Bi men on this board. We must not buy, misdirect, or buy into hate. This board is full of (mostly) intelligent, kind and generous men who I hope agree with me. much love to all, Josh

Clinician FAQs Updated October 31, 2022 Print This page provides answers to frequently asked clinical questions about monkeypox. Vaccination Schedule and Use Who should receive a vaccine to prevent monkeypox? Monkeypox pre-exposure prophylaxis (PrEP) should be offered to people with the highest risk for being exposed to monkeypox such as: Gay, bisexual, and other men who have sex with men or with transgender or nonbinary people, who in the past 6 months have had A new diagnosis of one or more nationally reportable sexually transmitted diseases (i.e., acute HIV, chancroid, chlamydia, gonorrhea, or syphilis) More than one sex partner People who have had any of the following in the past 6 months: Sex at a commercial sex venue Sex in association with a large public event in a geographic area where monkeypox transmission is occurring Sexual partners of people with the above risks People who anticipate experiencing the above risks The above was DIRECTLY copied from the CDC website from MPX. Unicorn: the above puts most of us on this site at risk for MPX with recommendations to vaccinate. There is NO discussion that recent reductions in incidence translates to no need to vaccinate. I respectfully, but strongly, disagree with your opinion on this vaccination matter. Do you think we have reached herd immunity (95% of sexually active gay men in the US have antibodies from natural infection or from vaccination)? I dont think we have. We stopped polio in the US YEARS ago, but we STILL vaccinate children, right? So do you advocate stopping polio vaccination in the US? You might argue MPX is less dangerous and a self-limited disease compared to polio, therefore there is less urgency to needing MPX vaccination. But tell that to immunosuppressed men with AIDS who could die from MPX (and there are a few who already have). Tell that to my patient with rectal MPX who experienced epic suffering (and was diagnosed 2-3 wks ago). Shingles is a self-limited disease but the CDC still recommends shingles vaccination for everyone 50 yrs & older, right? I deeply respect your strong medical acumen & your critical contribution to this website but I think you are wrong on this. EVERYONE: We are Gay men who are on a website for gay men who hire escorts, or are escorts whose clients are gay men, or are gay men who have multiple gay male sexual partners, or are planning in the near future to do some/all the above. For men who fit in this category (um, that's most of us here on this website, right?), the CDC is clearly recommending vaccination. At this time Unicorns interpretation of the CDCs data that MPX vaccination is no longer necessary is counter to the medical communities recommendations & a misinterpretation of the CDC data. Yes, incidence of new MPX is down, but we haven't finished the race. KEEP RUNNING (AND FUCKING) STRONG. COMPLETE YOUR 2 DOSE MPX SERIES OR START YOUR MPX VACCINATION SERIES TODAY. Love & hugs to Unicorn & everyone else, Josh

I agree with you: facts are facts. And I need to go with national data, not just what I see cuz you and I know what I see may be skewed in a misleading direction. But I think MPX is being under-reported some. Not all the cases I am seeing are being reported. Its still hard to always get a swab for MPX to confirm a diagnosis. So, its a clinical diagnosis with confirmation (at least for me) when I follow the patient for several weeks and the lesions take weeks to heal (with the concurrent history of sexually active gay man, all other causes of lesions are ruled out etc, sxs consistent with MPX etc etc). So some patients are just diagnosed and stay home. No reporting to the public health departments. Some (I wonder outloud) are just self diagnosing and wont come in contact with the medical community due to shame and embarrassment. They just suffer at home and wait it out. I have NO data on this, but for minor infections (a couple of lesions on the trunk for example) I can totally see some guys doing this, especially the uninsured. If I can get a swab, great. But the false neg rate is higher than I would like. In June and July MPX was this crazy, new infection that neither physician nor patient knew much about. We were all scared, calling around, making headlines etc. A MPX infection, even if it was just SUSPECTED was reported. Now we know its a self-limited (for most) disease that is more of a pain in the ass (literally) than life-threatening. So some are just calling their doctors and sending pictures of there lesions, they wont even come IN to the office. So yah, I still think MPX is being underreported. How much? Who knows. And THAT IS WHY I urge all gay men reading this post from me who are sexually active or plan to be in the future: GET MPX VACCINATED TODAY. Dont get caught with your pants down, ok? FYI: I see the same with Covid infections. I'm still seeing covid, more than I would like. But they are HOME tested and return poz, no PCR testing (meaning no reporting to public health departments). So yes, I definitely am seeing LESS covid in Nov '22 then I did in June/July '22 (it was crazy high then) but I wonder if the current incidence of covid is higher than what the reported public health numbers are. Obviously, I dont know for sure. But thats why I urge all readers to get their UPDATED Covid bivalent vaccine which came out in September. If you haven't been vaccinated in the past 70 days, then you are NOT up to date. Are my observations linked to a peer-reviewed scientific study? NO! And I fully concede to you that I could be wrong in my medical recommendations to gay men that they should be vaccinated. I just don't think I am wrong. But ask my current patient with rectal MPX where every bowel movement causes such excruciating pain he feels he is going to pass out and he will say, "Oh, no honey, MPX is so very real. I wish I wudda got vaccinated and prevented all this suffering...". So, yah, I'm urging all my sexually active gay male patients to get vaccinated. warmest regards Unicorn, Josh

Although I technically agree with most of what you said, it was a bit harsh, Unicorn. I have frequently (and privately) lamented Billybob's choice of words. He uses words that scientists & physicians use. So, sure, I understand them, as do you, but we were trained to do so. I fear non-scientists/physicians may not understand him at times. Medical school was like a 4 year degree in a Foreign Language. Nevertheless, I rarely disagree with the ideas/content behind the words he chooses. He's quite bright & knows his shit (good on you, Billybob!). BILLYBOB: might I make a suggestion(s)? 1) PLEASE dont leave till March. Stay! We NEED you on the Mens Health Forum. You know Science & how to read & interpret good research. If all the smart kids leave the room, this forum risks becoming an echo chamber of misinformation, medical distortions, and unrestrained craziness. 2) When you write a post, BEFORE, you hit "Submit Reply" go back & read what you wrote. Remove all scientific words/phrases & replace it with a word or phrase a 12 yr old would understand. THEN, you have increased the knowledge of your audience 5 fold, cuz I fear you lose some of the participants on this forum as they cant understand your well-thought-out responses. Even I have to sometimes re-read again (and again) your posts to make sure I'm getting you right. But, you are NEEDED, ok. We love you & hate to see you go. UNICORN- I strongly disagree with you in your advice that gay men on this forum no longer need MPX vaccination due to the significantly reduced incidence of new infections in November '22 vs July '22. The men on this forum either HIRE HOOKERS (like me! ) or ARE HOOKERS! Um, could there be a higher at risk group for MPX? FYI: I am still seeing MPX infections in my clinic (large East coast city with a sizable gay community), albeit much less compared to July. Just as we finish the race is NOT the time to stop running. These MPX infections HALT men in their tracts. No more going work, going out with friends, heck, no more going out period. And it lasts several weeks. Gay men (especially those who hire & their escort compatriots) are (VERY) sexually active (I'm not judging cuz I luv sex & hiring!!) and there is still enough MPX infections going around that if we dont continue & complete the MPX drive, the new infections will start going back UP. TO MY BELOVED FORUM MEMBERS, clients & escorts alike: MPX isnt fun & it's no joke. I just saw (another) case of rectal MPX & sure, the patient is not gonna die, but he is having epic suffering. Dont switch places with him. Please get MPX vaccinated ASAP. Love & hugs to all Josh

PUBLIC SERVICE ANOUNCEMENT To all my esteemed friends on this board: be very aware and leery of all the NON-PHYSICIAN members who are urgently giving you medical advice here on this board. Conversely, time and time again, physicians (like Unicorn and there are others but I forget their screen names) are here giving sound, cogent responses and advice. I, as a board certified family physician do so, too: PLEASE GET COVID VACCINATED. IT SAVES LIVES. Ignore these lunatics here on this board who are NOT physicians giving anti-covid vaccine rhetoric. Do you get legal advice from a friend? NO, you go to a LAWYER. Do you get accounting advice from anonymous accountant sources? NO, you go to an ACCOUNTANT. Do you call your mom to fix your plumbing problems? NO, you call a PLUMBER. Listen to the doctors! So DO NOT LISTEN to these non-physicians (like pubic-assistance, for example) about medical care and especially vaccines. They seem to know oh-so-much (and are ever so abrasive) that the whole medical community seems to NOT know and disagrees with. Pubic-assistance and his lot never went to medical school They operate OUT of their depth. Don't let them hurt you by listening to their unproven and unsupported (and peculiar) medical advice. They have political agendas where physicians only agenda is life saving. Every one wants to be a doctor. No one wants to go to medical school. IN SUM: PLEASE GET COVID VACCINATED. IT SAVES LIVES. warmest regards and much love to all, Josh PS You got the new covid vaccine with the bivalent dose of covid, the one with the Omicron variant in it, yah? PPS You got your flu vaccine, too, right? PPS And of course you are getting as soon as you can your Monkey pox vaccine? I mean we are all a bit slutty on this board.....

Hi all (Primary care physician here) Plz dont let the article mislead you. Mycoplasma is most certainly not a new STI (its Sexually Transmitted Infections now, not STDs). I've know about mycoplasma for many years. Unfortunately, and till more recently, testing for mycoplasma was harder. But I've been using a urine test for my patients for mycoplasma for a handful of years now, so testing has definitely been available for some time. It's just some doctors dont keep up with the medical literature. (Unicorn: I most certainly dont mean you as I respect you & your fund of knowledge greatly. If I recall correctly, you did hospital medicine before you retired so this is not your field so I would not expect you to know these details. It's out patient primary care doctors who serve gay men who most certainly should know). But let's be more thorough. Many sexually active gay men SAY they get tested regularly for STIs but in my professional opinion, they are sadly mistaken. A FULL battery of STIs has ALL of the below tests. And yes these tests are commercially available. 1) urine testing for gonorrhea, chlamydia, trichomoniasis (are you aware of this fun STI & getting tested for it, right?), ureaplasma (another lesser known STI but still plenty common), and todays topic, Mycoplasma. 2) blood work to test for syphilis (an RPR) and HIV. 3) A swab of your throat and anus for gonorrhea & chlamydia. So, YES, if you have not had your throat/anus swabbed then NO, you are NOT STI tested. Wait, you say your doctor/clinic doesn't do swabs? Get a new doctor because a full battery of STI tests includes swabs of your anus & throat. And testing includes mycoplasma & ureaplasma testing, too. Unfortunately there are too many doctors who say they serve the Gay community but arent up to date. Please request good care. Many of us on this forum are quite sexually active (good for us!!!) & getting a full battery of STI testing every 3 months, yes, every 3 months is important for good genital health. As a physician who treats many gay men in a large city on the east Coast, I test my gay patients oh-so-frequently and treat STIs all week long. Treatment per the CDC which I use for mycoplasma is: If M. genitalium is detected by an FDA-cleared NAAT: Doxycycline 100 mg orally 2 times/day for 7 days, followed by moxifloxacin 400 mg orally once daily for 7 days Much love to all, Josh PS. I use Labcorp, not Quest so I'm unsure what Quest offers. I think if I recall correctly I first heard of the mycoplasma/ureaplasma tests in 2018, but I could be off by a year.

I went to the West Coast for a business meeting & some R&R once. In advance, I communicated & booked a session with Beefmuscle. It was all set to go: time, place, his rates. No red flags in our communication. I'm not new to hiring so I did no faux pas of over-texting him, was not disrespectful online with him, nor attempted to haggle his rate down. He no-showed. Fuck this loser. Dont hire him.

Wait, this is a website where gay men not only promote the hiring of prostitutes, we CELEBRATE the hiring. Yet, we are coming up with the above judgmental and cruel comments towards our gay brothers not on this board as IF we are on some Higher Holy Ground than they? Um, wat? Are we really that juvenile & petty (and off base)? Surely we can do better... Although I wouldnt set foot on a cruise right now due to Covid, I have done several gay cruises in the past & found them fun & exciting. And no, I didnt do any drugs, get drunk, nor have wild sex. Most dont on gay cruises, contrary to what you might think. It's mostly normal every day gay guys just wanting a vacation. But I find it amazing that often the loudest detractors of gay cruises are gays that have never been on one. Why is that? There are no more queens on a gay cruise than on this board. And tbh, I respect the queens. It was the queens at the Stonewall Inn in NYC in 1969 who first fought back against the police tyranny, not the respectable gays in the closet. The queens initiated the Stonewall Riots & ushered in the modern gay civil rights movement. I am no queen myself, but I am fully aware I owe a lot to that group. Unfortunate they dont get the respect they deserve, especially from this board. Love to all Josh

Happy New Year my brothers. I'm not gonna address gkim1986 directly but take this to everyone on the forum cuz I strongly suspect he isn't the only one making this horrible and potentially dangerous error. It is NOT "best" to get a prostate "biospsy" done to "avoid any wrong diagnosis". No way is it time to make this medical recommendation. WAY too soon. And its the wrong person giving the medical recommendation. gkim1986 is NOT a urologist. The OP needs to see a urologist before any recommendations are made. gkim1986 is practicing Medicine without a license and doing it very poorly and dangerously. As Unicorn well said in his post, a prostate biopsy is typically NOT the standard of care for hematospermia (blood in your cum) except in uncommon situations. Why is this important? Because prostate biopsies are NOT easy, benign procedures. There are significant risks associated with this procedure, so they shouldn't be taken lightly. Because of this, prostate biopsies should not be recommended by a non-urologist. Oh, wait, you dont know the risks of prostate biopsies? Of course not. Why would you. You are not a physician. Prostate biopsies can cause (there is more to the list but this is a start): 1) Rectal bleeding. How does blood seeping out of your underware and soiling your bed sound to you? 2) Blood in the urine. Pretty. 3) Urinary tract infections (UTIs). Painful & dangerous. 4) The above UTIs can spread to the bloodstream and the guy can go into sepsis. Fuck. 5) Difficulty urinating, meaning the guy has to push and push as he stands there to get his urinary stream going. Or he now gets up many times all night long to urinate. Sounds like a party. Yah, lots of fun. Yeah, its NOT a benign procedure. It has its risk. It has its benefits. Am I saying the OP should NOT get the procedure? NO! I am NOT! Am I saying the OP SHOULD get the prostate biopsy? NO, I AM NOT! I am not his urologist and that should be discussed between the OP and his urologist, not by gkim1986! Yet, prostate biopsies are an important and integral procedure in proper urologic care. Notice the word "proper". Please note: gkim1986 is not trained to give proper medical advice. Folks, giving medical advice is dangerous stuff, even from those who are trained to do so. Advice can go amiss (oh, what I have seen in my professional career...). Just talk to my patients who had prostate biopsies and have had the difficulties listed above (which I have seen). It isn't pretty. I'm not saying prostate biopsies are bad and should not be done. I'm just saying only urologists should be making recommendations. A urologist goes through 4 years of medical school and roughly 5 more years of surgical training in residency (thats 9 years if you are counting) to be able to decide who should and who should not get a prostate biopsy. Yet, sometimes prostate biopsies are not only important but critical. Do I think that gkim1986 is trying to HARM the OP? Nope. I just suspect he doesn't realize that what he is doing is dangerous. How many times do patients go to their doctor (like a Urologist in this situation) and DEMAND a certain procedure because he read it online that its "best to get your biopsy done to avoid any wrong diagnosis" (quote from gkim1986). Yet, that procedure is NOT indicated. Not only that, but its a potentially dangerous procedure?? You think this doesn't happen frequently? It does. All the time. And bad things happen. And sometimes its cause a patient heard something from a "friend" who gave him advice and now the patient is in the physicians exam room with bizarre, inaccurate and potentially harmful information. YOU KNOW WHAT? I think a lot of people reading my post do the same exact thing as gkim1986 does inadvertently: give medical advice when the person (you) has NO training or medical experience to give such medical advice. Yes, I genuinely think this because every day I hear from my patients "I heard from my friend...." and 80% of the time is wrong, weird advice and I gotta fix the inaccurate and harmful ideas my patient has. WHAT YOU SHOULD BE DOING? PLEASE READ THIS. Ok, I know you care about your family, friends, loved ones, co-workers etc. They start talking to you about a medical problem they have. And you care about them. You may even love them. You want to help them. Of course you do. INSTEAD of giving medical advice AND POTENTIALLY HARMING YOUR LOVED ONE consider the below suggestions: Your loved one: "Oh, my god. I'm having blood in my cum. WTF?" You: "That sounds awfully scary. Have you discussed this with your PCP?" OR Your loved one: "Oh, my god. I'm having blood in my cum. WTF?" You: "That sounds awfully scary. Have you discussed this with your PCP?" Your loved one: "...um... no, I dont have a PCP." You: "You know, I have a PCP who I really like and trust. Why dont I give you his/her number and you can call him/her to make an appt to discuss this?" OR Your loved one: "Oh, my god. I'm having blood in my cum. WTF?" You: "That sounds awfully scary. Have you discussed this with your PCP?" Your loved one: "No, but I'm so scared. My uncle died of cancer a couple of years ago and it was horrible. I'm just so scared to even make the call." You: "Yes, I understand. I'm sorry you lost your uncle from cancer. This has gotta be so unnerving to you bringing back terrible memories. Why don't you and I make the call to your doctor together, and I will even go with you to your doctors appointment for moral support? You got this, man. I'm right here with you." The above scenarios, and variations of the theme, are the ONLY things you should be recommending to your loved ones. Really, you can KILL someone with the wrong medical advice. But these are your loved ones. They deserve the BEST from you. And the best means NOT giving medical advice. STOP giving medical advice. Instead, give love and encouragement. Give blow jobs, too if its consensual. Cuz BJs are awesome. Warmest regards to everyone on this board. May 2022 be a prosperous, safe and healthy year Josh

Suggestion: all NON-PHYSICIANS on this website stop giving their medical opinions/experience here. Your information can be misleading & unhelpful. And typically wrong. Do we go to our plumbers for accounting advice? Do we go to our barber for legal advice? It took my 8 (yes, eight) long, arduous years for me to to learn my craft (I'm a physician) from medical school to residency. Unless you have gone thru such a journey your (inaccurate) advice is potentially very DANGEROUS. Yes, for real. Bad advice can lead someone astray, to their peril. One of the first things one learns in medical school is "First, do no harm". Possibly one of the most challenging issues I must navigate as a physician is trying to fix the erroneous, distracting, & sometimes bizarre ideas my patients have heard "from a friend" or "read online". When I fail to help my patient successfully navigate this problem, they get hurt. I know you mean well. But it's not helpful. Thank you Unicorn for answering the questions/comments above. Your medical opinions were spot on. I have given thumbs-up on his answers so you can see his & my (two physicians) concordance. Much love to all, Josh

THINKING ABOUT IT?!? Just DO it! (In your eyes) you are one hot tamale. You're so hot you can even filter out good paying customers by asking for a selfie. That's some pretty amazing hotness you say you are. Run with it! So heck, I'll go one step further cuz You THE MAN: you gotta, GOTTA, quit your day job RIGHT NOW. Dont think bout it one moment more. Dump that low-paying loser job & run to the very easy, low-risk job of Escorting. Just ask the other (very wonderful) escorts on this website. They constantly are saying how EASY & DRAMA-FREE escorting is. Why can't that be you, too? And escorting will be fun. You will never have ugly clients (cuz they sent you a real & truthful selfie, right?). You will never fear for an STI (its amazing how protective selfies are). You will never be stood-up by a client. And your hotness will repel all the Crazies, so it's one win after another for you!! I bet you are thinking 'why didnt you think of this before'? Well, you can make it up by charging yet NOT kissing, rimming, or blowing your clients. But what escort needs to provide those activities. I mean, clients rarely ask for them anyway, right? Once again, its Smooth Sailing to the Easy Money Ocean for you. Jump on that ship A.S.A.P. And it looks like your personality is PERFECT for escorting. Clients REALLY love a good narcissistic provider. We eat them up! Dont change a thing. You do you! So STOP, STOP, STOP asking for advice cuz you come up with INCREDIBLY SMART IDEAS ALL THE TIME! Run, dont walk, to the phone, QUIT your day job now- NO 30 DAY NOTICES REQUIRED- and set up your RM ad today!!! Your BIGGEST fan, Josh

I respectfully disagree with you. Completely. You are running a business, and it should be run with the standard business model western society is familiar with. Or get questions/concerns/issues/pushback. Or people who refuse to use your services. FYI: I practice what I preach. I'm a physician in private practice & run my business (clinic) all by myself. I see patients in my clinic and I love what I do. But whether I'm running a primary care clinic or an accounting firm or law firm or whatever, the same business principles apply to me. To you too, as well. It's not uncommon for me to see patients on a Saturday. I hate putting patient requests for appointments too many weeks in advance. Patients want (need) to be seen sooner, not later. It's their health. So I offer on occasion a Saturday here & there to keep appointments a reasonable amount of time from when they request it. Which means I gotta ask my staff to come in on their weekend and work. And PAY THEM OVERTIME. It's quite costly & frankly, a negotiation with my staff & a logistical complexity. My patients know nothing about that. Nor should they, they just seek care. But my fees for being their physician needs to cover everything that entails the cost of providing the patients medical services: its gotta cover my staff salaries, overtime, rent, utilities, malpractice etc & ultimately my paycheck. So escorts asking clients to pay for an Uber just looks bad. And guess what? Sometimes I have no-shows just like escorts. Escorts seem to think they are the only ones who experience no-shows. But I get them & it frustrates me a lot. Sometimes its even on a Saturday, dang it! And sometimes it's a patient I've never seen before who no-shows ON A SATURDAY. But no-shows are part of the reality of being in business. And my fees need to take that into account, meaning I expect a certain (small) percentage of my appointments to end as no-shows (therefore no money for me). Therefore, an escort asking clients to pay his rate PLUS an Uber is ridiculous. An escorts hourly fee should encompass ALL of the expenses (including transportation costs), which should include allowing a percentage of no-shows. Demanding me to pay for an Uber makes the escort seem unprofessional. When I start sniffing "unprofessional" I refuse to book. Unprofessional is also this maybe-I'll-offer-a-better-time-if-they-take-care-of-me mentality. No matter how much my patient pays me, whether I like the patient or not, whether I'm tired, bored, busy, sick whatever, the ultimate in Professionalism is ALWAYS giving my 100%. Did you know that physicians by law are NOT allowed to accept "gifts"? Sure, we can (gladly!) accept a (small) plate of cookies or something of very marginal value, but anything of value is a HUGE no-no in the medical profession. The agreed upon fees that are paid to me are the complete reimbursement for my services. I cant give one patient one standard of care, and another one a different (higher) standard (cuz he bought me opera tickets). The reason why gifts are forbidden in my profession is if allowed, patients might think, "oh, he wont take good care of me today cuz I didnt bring him a nice gift". A patient gets my 100% cuz he's my patient, not cuz of a gift. My fee, which incorporates the cost of my overhead & my salary, is the complete reimbursement for all my services. It's called Professionalism. So yah, no Ubers for me. Sure, I've been asked a few times. And always declined. And ALWAYS found a guy who doesn't ask for an Uber.

Board certified primary care physician here. I treat sciatica all the time. Back pain is a (very) common complaint in primary care. But, NO, syncs comment above is inaccurate. Opiates, such as Vicodin, are NOT indicated for long term LBP chronic pain. It has nothing to do with fear of lawsuits or legal restrictions (btw, what legal restrictions were being referred to? As a licensed physician with a DEA license its perfectly legal for me to prescribe opiates, although I very rarely do). Opiates rarely improve functioning and create a host of other issues that can be quite detrimental to the patient. First do no harm, after all. So any Pain Treatment plan typically declines opiates as an option. My deep empathy to you, Axiom. Sciatica is horrible. LBP SUGGESTIONS FOR ALL (not in any particular order of importance, and each patient needs a tailored treatment plan- please see your primary care physician) 1) Weight loss 2l Physical therapy 3) Epidurals 4) a TENS unit 5) ibuprofen 6) lidocaine patches 7) yoga 8 neurosurgery 9) gabapentin/lyrica 10) Cymbalta 11) exercise 12) probably more but I'm too tired to think any further, it's been a long day, and I'm exhausted but riddled with insomnia Warmest regards to all Josh

Wishing for no drama, & with respect to your contribution to our wonderful boards, and I'm sure it was just an oversight, but some people from the transgender community might be offended by use of the term, "Shemales". Perhaps "transman" might be better? This is a welcoming community, after all. Might I respectfully suggest an edit on your part? Hope you are well, Josh

Dear Daniel, I'm SO sorry you had to experience this. You deserve better. Escorts provide a beautiful service. They bring excitement, intimacy & healing to a broken world. I mean that. FWIW, I'm a physician & now concentrate solely on outpatient care. And on my schedule I have no-shows all the time. Its frustrating. And it harms my other patients who we declined offering an appointment to cuz we were full but we could have helped in the end. This happens to every outpatient physician. Any doctor who says differently is being dishonest. Ok, my 2 cents worth given I'm a "provider", too (of different sorts): 1) Focus on those you did serve, especially those you really served well. You cant always hit it out of the ballpark with everyone, so when you know you did well, congratulate yourself & be happy. And you seem to already be doing this as evidenced by your statement: Keep remembering those clients. They will keep you sane. Ok, specific suggestions: 1) My staff do NOT give an appointment to patients less than an hour away (but doc, I'm only 5 min away from your office!) from the scheduling appt time. If they are 5 min away they will invariably do some errand like stop at Starbucks and THEN be late. Nope. Maybe dont do the "now" appointments? 2) Keep a log of encounter inquires that result in a booked appointment. Briefly log how they found you (which means you gotta ask them), their tone (they were lewd & sexual from the get go or... seemingly professional... or shy ...or...). Log a "gut reaction" you get from these inquiries (I think this is gonna go well to hhhmm, I think he sounded sketchy....). Note times/dates of inquiries. Note how many bank & forth volleys of texts/phone calls till the booking was made. Add more criteria as you seem appropriate. THEN start looking for a trend. For example, 80% of inquires with a booking between 1000 pm & 500 am (the scheduling process time, not the actual meet up time) lead to no-shows but only 20% for other times. With that data, you can start implementing interventions to manage/diminish these time-wasters. For ex: if the above example is true, turn OFF your phone during those times & have an auto text-message go out saying something like you are "out" till the am but you are "VERY interested" in their "inquiry" but this "text will not go thru" so "please repeat your inquiry again tomorrow". Time-wasters may lose interest & walk away. 3. For bookings made in advance, try confirming the day before. For example, if they make a booking 5 days in advance, inform them during the initial booking process that the day before the appointment you will need a definite confirmation text (email or phone call or whatever you choose) to guarantee the next day appointment. No communication= cancelled appt. Many doctors offices do something similar. Might work for you? 4. My office has a 3 strike rule: 3 no-shows & the patient is discharged from my practice. No exceptions. And patients are informed of this. For you: one no-show & never book again. Block their number, too. 5 While booking, ask their specific goals of the session. Make them articulate their needs. You might be able to see patterns of time-wasters & then decline to book. Maybe time-wasters arent as articulate & you can sense it? Dont book those. 6 If you arent already, consider all confirmed bookings to require a 2-3 min phone conversation to confirm everyone's intentions. Maybe people are less likely to flake out if they spoke with you in a real, live human being voice versus 100% of the booking process done via text? 7. If talking with a prospective client you sense hesitation/potential flakiness, dont hesitate to speak to your concern. "I sense you are a bit unsure of your goals. Let's put off scheduling a definite appointment till we are both on the same page & I know I can give you a rocking-awesome time". 8. Like attracts like. You should strive to be the consummate professional. Never flake on a client. Its bad charmma & you risk getting a reputation for flakiness & geting like-minded clients. Physicians have been honing strategies to decrease no-shows for years, and we are still fine-tuning the strategies, cuz we arent as successful as a group as we want. Dont get discouraged & keep at it. I'm rooting for you. And come back & let us know how its going! Hugs. Josh

Hi LookingAround Hi LookingAround I must state, and I write this to you out of respect, that you seem rather self-assured in a field where you are not an expert. If that comes off as disrespectful, my apologies. Tone can be challenging to convey online & I mean you no disrespect. You stated the existence of a "national database" that I, as a physician (and all other US physicians & NPs), can access and see what meds my patients are taking. You come up with nothing but heresay nor proof of said existence. By all means, prove me wrong. Could you link me to the login to this website? I'll register & start using it. For real. It would help my patients receive better care. I then bring up the possibility that the database you reference is the scheduled drug database that each physician can get access to, meaning this is what you mistakenly refer to. But these databases only contain scheduled drugs, not PrEP drugs. You are strangely silent on this. You then bring up that surely most physicians are linked up via our EMRs. You even bring up Epic, showing that a third of hospitals use it to support how linked up we physicians are. But I then clarified for you, with a quote from the VERY article YOU linked, that it was a survey of what EMRs hospitals use, not outpatient clinics such as what the OP uses. And Nurx is not a hospital, either. Can you provide that link that shows all these amazing things you say exist? You have never been an EMR user as a physician, so I'm quite curious to see what you know, that I do not. Please educate me. But with concrete support as I have done so with you. And I hope I offer my comments respectfully as there is no reason to fight. Debate yes, fight no. My point to everyone reading this thread is there is some inaccurate idea among patients that the medical community here in the US is linked up in one way or another. I sadly report to you that, no, it doesn't exist. A huge, vast majority of the time when you see your physician, unless he/she is part of a large medical group, the EMRs from other groups do NOT auto-communicate. I wish they did!!! But I offer more evidence that this flummoxing issue is resolved in that Nurx communicated directly with the OP PCP. I think the OP just forgot that he gave Nurx his PCPs name. I'm still hopeful that the OP calls his PCP tomorrow & inquires for us. I went to Nurx website and found this in their FAQ: Does Nurx share information with my primary care physician? If you want us to, we can share your information with your primary care physician. We believe it is a good idea for your primary care physician to have a full picture of your health, and encourage you to share the health information we have about you with your primary care physician. You’re in control though, so we will not send them anything without your express permission.

Nope. That's HOSPITAL based EMRs, not outpatient clinics like the primary care clinic that the OP doctor works in (or mine). Below is from the very article you posted. But I would love to see a recent survey of the breakdown of EMR use in the outpatient primary care setting. I've seen previous year surveys but I just searched & couldnt find one, although I know surveys such as those do come out. "For its "U.S. Hospital Market Share 2021" report, KLAS examined EHR purchasing activity and contracts across the country from Jan. 1 to Dec. 31, 2020. This includes EHR market share data for acute care specialty hospitals and other specialty hospitals. "