josh282282

Yet another example of why I have a strict policy: No Ubers. No deposits. No exceptions. I've been hiring for years and I have never paid either a deposit nor an Uber & have had some very hot experiences. When the very few instances I've been asked for a deposit or an Uber I immediately decline. The escort has always backed down.

A NOT BEFORE DISCUSSED REASON TO SAY NO TO DEPOSITS: Hi all again. Many men on this thread on the debate of deposit/no deposit have read the unfortunate tales of victimization that some of our community members have described when they provided a deposit in the past- the escort took their deposit money and ran. Its a horrible experience to be a victim. Consider this: There ARE criminals out there. And they seek out vulnerable and seemingly weak victims. And many people in society think gay/bi men are weak. Even if you disagree we are a weak people, many others will disagree with you. Many of us were victimized in our youth by a society that despised gay men or any boy with seemingly weaker attributes. Tragically, being bullied and harmed is not a rare event for many gay men in their past history. Yet, when you provide a deposit, this actually creates more gay/bi victims. And these victims are your brothers. Why? You know when you travel out of the country and go to that wonderful "tourist" spot? The part of the city where its charming & quaint, full of history and beauty? Sad to say, but they often are full of pick-pockets and criminals. Why? Because tourists are easy prey. They come in "vacation" mode: not paying attention, drinking too much, ignoring clues around them, looking very "touristy". If Americans only worked on not acting so, well, touristy in these areas, the crime might go down! When criminals think of gay and bi men, they may think we are weak and easy prey. Then they hear from here and there how easy it is to put up a Rentmen profile & advertise escort services. Then when approached online by one of us, they demand a deposit. We give in because their effort seems well meaning, they seem well spoken, and promises you he just needs "reassurance" with a deposit. You send the deposit but he runs. Another victim. And that criminal is bragging and laughing about his exploits to his shady friends. ("OMG, that stupid idiot actually sent me $100 online....!!!!"). Birds of feather flock together- these are crooks. And the more the escorting community for gay men is full of guys who WILL pay a deposit, the escorting pool attracts more and more shady criminals who want to steal from and victimize us. Sure, there are escorts who are genuine and provide their services with a deposit with no problem! But word of mouth/advertising of deposits make our hiring community like a tourist hot spot in a beautiful country: a place for criminals to go to target easy prey. Ruins everything. So don't think just because you paid a deposit and your particular escort is honest that that choice alone does not add to the problem. It does. It makes all of us who hire more at risk for others to victimize and harm us, just like acting like a tourist in touristy areas makes those areas less safe. Escorts who take deposits and run inevitably provide (if they show up) bad service to us. They are not going to do all the things you want them to do. They will be horrible providers. They only want our cash. We dont want to encourage them to advertise escort services. Protect not only yourself (NO DEPOSITS!) but protect your brothers and this wonderful hiring community- no deposits!! You want a safer place for gay/bi men? Help create a community that is not making itself a target. "Be the change you wish to see in the world" Mahatma Gandhi Love to all Josh PS: to all escorts- many of you are genuine, good at what you do, and oh-so-much-fun. You would never harm any one of us. And you dont demand deposits! Dont ever change. You are beautiful.

Hi JB_Studio38/ Mocha/Jarrod_uncut (and all the other names you have had on this platform in the past- there have been many) No. I, and my fellow client colleagues, are not willing to be "on call" with money for you when escorting is not working out financially for you. Although I do NOT wish you or any other escort financial harm, we are not responsible for your solvency. But to you and all escorts in the world: I'm hopeful you prosper. You provide a wonderful service to the community. Ah, you are not satisfied with my advice? Allow me to elaborate. You and I are both business men. Similar fields, albeit with a few differences. I'm a physician. You are an escort. We are both seek to ...heal our clients (or patients). As a physician I have high overhead costs in maintaining my office: support staff salaries, my office rent, my exorbitant malpractice premiums, to name a few, costs which rise yearly which is alarming & frustrating. And just like you, before I take home one dollar, ALL my overhead MUST be paid first. Heck, I was hundreds of thousands of dollars in medical school debt before I even got paid to see my first patient! Yes, I genuinely understand your predicament. I live it daily. But when a business informs the client this is my fee, BUT then says, "oh, I also need a deposit", um, yah, no. Or the escort says, "Oh, I need you to pay my Uber". Also a big Nope. See, all of my overhead AND my own salary AND (this is the critical point I fear you dont understand) the cost of the lost revenue is wrapped up in the fee I charge for that office visit. You think patients call, make an appointment to see me and don't show up? It happens DAILY. Every physician has no-shows. You think patients get a bill (after I provide them medical services) from me and always send a payment? Nope. I get patients who stiff me ALL.THE.TIME. But that loss is factored IN to my fees. That's Business. I don't charge multiple fees. I have protocols that attempt to minimize loss. For example: two no-shows and my staff informs the patient they are discharged from the practice. You think you are the only businessman who takes risks and experiences financial loss? Think again. I don't come to this platform and bitch & whine & come across as a lunatic because my patients stiff me. Rather, I focus on my wonderful patients who stay, pay, and make it all worth while. To all escorts: keep providing your excellent services. Stay professional. Continue to hone your craft. Keep detailed reports of what's not working. For what's not working focus on strategies to minimize loss and maximize profit. You are an escort to make MONEY - there is nothing wrong with that! So am I. But demanding fees (deposits or Ubers) will ultimately turn away good clients & make you seem unprofessional. Good clients (like me) stay away from escorts like that. Including staying away from JB_Studio38/ Mocha/Jarrod_uncut. Asking for a fee makes you look sketchy. Its a bad look. Love to all, Josh

I've been hiring for years. I have met some wonderful, and hot, escorts. I've never paid for a deposit nor paid for an Uber. On rare occasion I've been asked to, I politely but vehemently decline. The escort has always backed down. My friends: no deposits, no Ubers. Hugs to all Josh

Salutations all I'm planning a repeat trip to Rio and considering booking a hotel I haven't used before: the JW Marriott Hotel Rio de Janeiro in Cococabana. I once stayed at a different hotel in Rio that refused me to bring up a garoto to my room and I'm looking to see if anyone has roomed at the JW Marriott and had similar problems. Any and all reports or concerns regarding this hotel welcomed. Josh

Good morning Primary care physician here. I work in a mid-size physician group on the east coast (not NYC) & do this (treating patients high pressure) for work all day long, so I'm familiar with your issue & I'm rooting for you to conquer it! You do not have a "minor" problem. You have hypertension, also known as high blood pressure. Its in the family of cardiovascular disease. Its dangerous & potentially lethal. Its the number 1 killer of Americans (I am aware you live in the UK but I did not investigate UK health statistics), which means more deaths than cancer. Are you aware of that? If your doctor told you that you had cancer, would consider it to be a "minor" issue? I'm not trying to be indelicate or confrontational but (hopefully) educational. Your health future depends on you fully understanding & controlling your blood pressure. Gay folk are wonderful & beautiful and we can't afford to lose one of us prematurely. Strong work on the exercise! It may help. Keep it up. A) Other interventions to consider: 1) lose 15 lbs (if that applies to you) 2) significantly reduce (best is stop) your alcohol intake. Maximum is 2 drinks per week (on 2 different days, not 2 drinks on 1 day). 3) reduce your salt intake. (For example- canned soup has crazy high amounts of sodium) 4) stop all nicotine products (yes, even vaping is smoking). B) Is your blood pressure controlled? If not, are you on max dose ramipril 20 mg a day? If so, are you only on ramipril? Most people with high blood pressure need 2 (or more!) medications to adequately control their blood pressure. When is your next appointment with your primary care physician? I wish you all the best in your journey in getting healthier! Josh

Hey there. Could you explain a bit further? What specifically you mean by "LGBT characters"? Also, specifically what "themes" do you not support? It such a broad topic that it's almost impossible for the reader to understand what you meant. Could you supply some examples? I'm just confused and would enjoy exploring your views more. Josh

Hi I wonder if you could elaborate? I'm interested in understanding your opinion better. What do you mean regarding age-appropriateness in tv, cartoons, chidrens movies etc with opposite sex couples? I distinctly recall seeing as a very small child (before even 5 yrs old) on children's cartoons, movies, tv etc opposite sex married couples being portrayed. I don't mean seeing couples actually having sex, kissing, or anything like that. I just recall seeing opposite sex couples in media, the school reading books, media etc doing basic things family activities. For example, Sesame Street had multiple opposite couples: Gordan & Susan Robinson & Luis & Maria for starters. Was that age-appropriate or inappropriate display of human sexuality in your opinion? Thank you in advance for your thoughtful reply. Josh

No, no, you did not originally write "ask". You specifically used the word "right". Any businessman, of any field, can of course ask for anything, even $10,000,000,000,000 to engage in business dealings. I'm skeptical that the logical & sane men on this board would disagree with that. Yet, few would pay that. But you are coming across as it's their right. There are no rights in this detail of minutiae of hiring regarding asking for pics prior. But it is bad business practice. You may have tweaked your sentence in follow up (thank you for responding, kind sir!) but your revealed your true thoughts on this. To All Readers: don't add toxicity to hiring. There is enough toxicity already. Campsite Rule: leave the site better than you found it. Say NO to pic requests.

Could you elaborate on how/when escorts achieved this societal "right" to get pictures of potential clients? I've never heard of this before and I'd like to learn more.

Are you SURE you are correct on that? The current standard of care is for seniors to get TWO shots, not one, of the current covid vaccine. I hypothesis that you accidentally misunderstood your doctors office. I think they probably DO recommend the 2nd vaccine as I'm sure they are interested is promoting good science, right? I recommend (primary care physician here) all seniors reading this post to get their second Covid vaccine 6 months after their first one. This is not MY opinion. Rather, it's the USA medical community's recommendation. I don't get to have an opinion but must use the scientific data which the CDC uses to generate the best medical recommendations. Don't believe me? Read on. From the CDC's website regarding covid vaccinations: Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States: Summary of recent changes (last updated October 31, 2024): People ages 65 years and older, vaccinated under the routine schedule, are recommended to receive 2 doses of any 2024–2025 COVID-19 vaccine (i.e., Moderna, Novavax, or Pfizer-BioNTech) separated by 6 months (minimum interval 2 months) regardless of vaccination history Clinical Guidance for COVID-19 Vaccination | CDC WWW.CDC.GOV View FDA-approved and FDA-authorized uses of the Covid-19 vaccines in the United States. Please pursue good health. Hugs, love, and great sex to all, Josh

DEAR MODERATORS I genuinely feel that TallMuscl37/Mocha is not contributing in a positive or helpful manner to this community. Instead, my fear is his epic rants, hostile attitude, & bizarre ideas PUSH people, both client & escort, away. This is not productive in my opinion to the overall goals of this board, nor does it further its prowess or stature in the community. Yes, people respond to his posts, and he angrily responds back, but I suspect these abrasive discussions push 10x the people away rather than increase the boards membership. Please end this person's contribution privileges. At least for a 60 day period. I thank all moderators for their tireless work. It is ever so appreciated. Josh Dear TallMuscl37, First, I wish you good health & hope for a better future. From a professional prospective (I'm a physician), I recommend: 1) Find a therapist to work thru the issues you have brought to this website. Your feelings & frustrations are absolutely valid. Therapy would be safe & therapeutic place to work on them. This website is not. 2) Talk to your doctor about a SSRI medication like celexa or venlafaxine. It will will help with mood & anger. I say NONE of this to harm or mock you, but to help you. I fully accept you may not appreciate my advice. I also apologize for anger or sadness my words bring to you. Nevertheless, I stand by them. Regards Josh

Greetings, Sync. Physician here. I'm a PCP, board certified, and still practicing Medicine. I'm dreadfully worried about you. Your PCP is relating to you completely nonscientific rubbish. There is no evidence that covid vaccines are cancer-causing to the elderly. There is no "alternative treatment" to covid except for initial treatment with Paxlovid. Your PCP appears like he is practicing outside of the Standard of Care & possibly promoting unfounded & dangerous treatment plans to his patients. Please be aware that for a physician to be accused of practicing "outside the Standard of Care" is a HUGE ACCUSATION. The entire medical community is in agreement to the benefit of covid vaccination & STRONGLY urges everyone to get vaccinated. Sure, there are a few conspiracy theorist physicians out there who are against covid vaccines, but the scientific community sees them for who they are: dangerous. While I understand you have built a 30 year trusting relationship with your PCP, it might be time to rethink that relationship. Ask him to provide you the specific medical literature that supports his anti-covid vaccine stance. He should only provide research from peer-reviewed journals with robust support from the medical community. Fringe journals don't count. Non-mainstream websites that are unknown are suspect. Medical influencers are high risk for quackery. If he does provide that type of research, my original criticism is true. Run. I get it. It will be easier to get mad at me, discount what I'm saying, maybe even attack me here on this forum. Fine. I'm strong enough to take it. Indeed, the stronger your internal emotional response you have, the more likely there is truth in my statements which is unconsciously resonating with you. But I'm hopeful that you still consider my point & take logical action to protect your health. You deserve to stay beautiful and strong. I strongly urge you, and everyone, to get covid vaccinated. I did. Declining covid vaccination is fine until you get covid and are running to the ER due to difficulties breathing, as I have seen clinically. I've seen many people like you. Your strategy is similar to the guy who refuses to wear a seat belt while driving., thinking, "I've never been in a car accident yet, so I really don't need one." Poor and uninformed strategy. Trauma surgeons OR time are filled with people with that strategy. Please get covid vaccinated. You deserve to stay healthy. Josh

No. Your understanding of the timing of the dose is incorrect. You should take DoxyPEP ASAP after sex, not wait for 24 hours. What you are describing is not consistent with the research on DoxyPEP. As time elapses away from the encounter, effectiveness decreases. Please note the "ideally" is not 24 hrs LATER, but "within". Per research that was published from the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2211934 Participants were counseled to take 200 mg of doxycycline ideally within 24 hours but no later than 72 hours after any condomless anogenital, vaginal, or oral sex and to take no more than one dose every 24 hours. No. That is also incorrect. If you have more than one sexual parner experience in a 24 hour period you should only take 1 two hundred milligram dose, as soon as possible after the first encounter in that 24 hour period. Dosing for a Saturday nite sex play should not wait till Monday. Also, no need for repeat doses within that 24 hour period. In other words, only one dose per 24 hrs. Yes, you can take daily if you are having daily sexual encounters. I wish you, and all my brothers safe sex & travels. Josh

Hi Lucky & everyone else. Physician here: I am recommending to all my patients 60 years and over to get the RSV vaccine. There are thousands of reasons to get RSV vaccinated. Dont be embarrassed. Just go get your RSV vaccine if you are 60 or over. Its easy. Just one vaccine needed in your lifetime, it's not yearly like flu vaccination. Per the CDC: While most children who contract RSV experience mild symptoms, the CDC estimates that each year, between 58,000 and 80,000 children younger than age 5 years are hospitalized due to RSV infection. The CDC estimates that RSV causes approximately 60,000-160,000 hospitalizations and 6,000-10,000 deaths among older adults every year.

Hi everyone Yes, I agree. There are some who would see catty=rude. I am in that category. There are others on this board who agree. That's not a bad idea. Thank you for the suggestion! I will try it next time. Anytime we can elevate our discussion is likely an improvement which will benefit us all! But I will report I have had many DMs from different men from this board who have I have never met, never had a DM with before, and no any contact whatsoever just come right out and ask their question in their DM, no introduction or explanation. Nevertheless, over these 9 yrs of being a member here I have answered all of them with whatever guidance, assistance, or opinion that I can provide. Offering help is easy. And if it makes another gay mans journey on this earth a bit easier, I'm all for it. I believe you! But doesn't that just make any rudeness here behind anonymity even more unnecessary? The overall issue is that when we are rude to one another on this board, other people, especially potential members, read that rudeness and this may turn them off from becoming contributing members themselves. And this board devolves into a sewer of rudeness. Who needs that? We all have .. some amount of life issues/sorrows/sadness etc. Don't we come to this board to laugh, get other peoples point of view, get some guidance etc? We don't come here to be treated rudely. If we are rude to another, this will only bring down the whole board in one way or another. I urge all of us to be respectful and helpful as much as possible. We ALL will be better for it. JOSE SOPLANUCAS: I'm not mad at you. I just know you can and actually do better (in person). You are a contributing member to this board and you can make a positive contribution to all of us. JUST to bring up a reminder of one of YOUR recent posts. There is a recent post from the Lounge where a different member asked why does this board have so much "snarkiness" as the initial post question. It was a good debate. Unfortunately I really don't know how to post and copy posts from that debate to a different debate like this one. BUT the below debate is copied FROM you, Jose. So you have thought about this topic. And I hope that debate helps inform you on this one. I genuinely wish you all the best, Jose. And love and hugs to everyone. From Jose Soplanucas: All of that, plus years of clashing and beefing between particular posters. I will try to do better. PS Edit here: Joses post is from the June 13 2024 The Lounge post of "Why is There So Much Snarkiness Here?

Hi Dr Daddy! Thank you for asking!! But alas, I had to postpone my Summer trip as my colleagues need coverage for their vacations and I've (reluctantly, but generously) offered to cover them for their Summer vacations. But I'm definitely planning on a Fall trip to Brazil (and yes, they WILL for cover me) & really grateful to peoples help on this board. It's convenient that Jose Soplanucas admits he was the rude & inappropriate one here. Recall my Crime to send him one, ONE, DM. But since this board is full of typically really friendly & helpful guys, I'm not letting him bring me, or my travels, down. In my profession (physician here) I've come to find out people who who come across as mean, irritable and generally unpleasant to be around harbor under-the-surface issues. With love & support they can still come around! So no hard feelings toward you, Jose. May love & great sex find you. But if one looks at my history on this board (I've been a contributing member since 2015, my, how the time has flown...), one can read my contributing posts on any number of topics. I just wonder at what level of participation does Jose Soplanucas finally accept when a members contribution permits him to ask a question? Keep being awesome everyone. Love & hugs to all. Even Jose Soplanucas. Josh PS. Jose: I clarified my above post to reflect that I yes, you are correct. It was not one question but 3 questions but one DM. I apologize for the mistake. But my critique still stands: one DM enrages you. Jeeze . And looking at your below post shows your behavior grows more rude and into toxicity. I am astonished you feel it's OK. Do better.

Hello Josh here. Im a board certified physician & still practicing Medicine. This is important to keep in mind. My Medical Advice: Please stop listening to these non-physicians on this forum. They are not trained nor skilled in giving medical advice, which you ABSOLUTELY are seeking on this forum. Do you go to your accountant for plumbing advice? To your pastor in how to fix your leaky roof? (No & no, right?) Per your report you said your Ortho recommended AGAINST an MRI, although he is open to it. You are asking non-surgeons typical course progression & outcomes of your particular diagnosis, a diagnosis they have never studied nor treated. And to be sure, they are giving such medical advice (your Ortho does not seem yet very interested in the MRI, yet the Dr Googles are oh-so-strongly urging you to get one). It's impressive but unfortunate to see such Dr Googles in play. They have not taken your medical history nor examined you. They have never ordered an MRI, nor know the clinical indications of when one is needed or not. Such negligent actions are potentially dangerous. To you. It took me many, many years of arduous training, and now with decades of experience, to know when to give medical advice & when to withhold. These men on this forum way over estimate their skills. Yes, they care about you, I do not doubt that for a moment. But they lack good judgment & insight in this field. I examine shoulders all the time. I order xrays all the time. I even order MRIs of shoulders, too. But without taking a history from you, examining you, reviewing your xray, I can NOT answer your questions. Yet, given that, My Advice to You: you have questions, concerns? Write all your questions down & go BACK to your Ortho. Ask THAT doctor your questions. I'm sending hope your way, and to your shoulder, that your clinical situation improves. Josh PS. To ALL readers of this forum: I strongly suggest you reconsider using, as is very frequently done here, this forum for medical advice. Their 20 min Google search type of advice here is untrained & therefore dangerous. If only giving medical advice was that easy! Nearly a decade of medical school & residency and I am very skeptical of MY advice if it's not the proper forum for me to deliver it (like in an exam room). Yes, these men mean well, but they truly do not know how dangerous their advice is.

Hey folks! Thank you for the help & info. It's very, very appreciated that you took the time to offer me help! TBH, this is unlike the response I got from a guy on this board I DM about Rio this week. Yes, he answered my DM but not only did he outright refuse to answer my question but was quite rude & inappropriate to me. And it was just a question about saunas, nothing inappropriate at all! (Jeeze, why bother to respond at all then?). But your suggestions will be used! And off to Rio soon I will go.... Hugs to all Josh

Hi All. I'm off to Rio soon. But it's been years since I've been to the Rio saunas and hired a garato. But its been since before the covid pandemic & I fear my knowledge base is outdated. I need updated guidance on saunas. 1) What are the names of the currently open gay saunas w garatos? 2) Which nights are best for which sauna? In the past most saunas had maybe two busy nights with mostly dead nights the other night. In the distant past some wonderful man wrote out a brief week spreadsheet of the saunas and which nights they were busiest. Is there an updated one? 3) What is the current going rate for a programa? Love & hugs to all. Josh

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 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!!