Alright, a bit of back story. I knew it was recommended by the CDC for gay men to get the following vaccinations: Hepatitis A Hepatitis B HPV And the seasonal Flu Shot I've never requested the first three before, because I always knew it'd involve me coming out to my general practice doctor. But last week, I decided to do what I knew I should have done a long time ago. I decided to get the vaccinations. Fast forward to today. I go to my doctor, and I inform him that I'm interested in getting Hep A, Hep B, and HPV vaccinations. He obviously wants to know why, and this means I have to come out to him. Everything goes cool, and no issues there. However, he is obviously ignorant of the fact that men who have sex with men should be getting Hep A and B vaccinations. He actually didn't believe me! So, he had to check the CDC website to verify what I'm telling him. Obviously, it confirms what I told him. So he consents to the Hep A & B. Now, that's a small issue. I mean, sure the paper he gave me regarding Hep A & B vaccinations clearly states that men who have sex with men should be vaccinated... My frustration here is only that he obviously hasn't been recommending it to other patients he might have who have sex with men. I'm on top of my own stuff, and don't need a doctor to inform me of these things - but a lot of people are probably ignorant that they should get these vaccinations if they don't have them already. No, what really frustrated me was that he wouldn't give me the HPV vaccination. I was borderline about to become argumentative with him. Basically, I'm 31 years old, and the recommended ages to get the vaccine are between 9 and 26 - I'm obviously a few years older than 26, and so giving me the vaccine would require him to go off label. What frustrates me here is that the likelihood of the vaccine not being safe for people over 26 is infinitesimally small. He even admitted that. What frustrates me the most is that I'm an ideal candidate for it and I'm in a high risk category. I've only had one sexual partner, was with him for a long time, we were monogamous, and we both hadn't had sex previously. The likelihood of me having HPV is extremely low. Obviously, in the future, I intend to become more sexually active with more men. HPV is insanely common, and it's estimated by the CDC that 80% of the people who are sexually active have one of the many strains of HPV. This is why younger folks are targeted for the vaccination rather than older folks, because they are less likely to have sexual contact. HPV has been linked to anal cancer in men who have sex with men, and this is why it is becoming highly recommended for gay men to get vaccinated. There is evidence that it may also be linked to throat cancer as well, though this hasn't been conclusively proven. You can still get HPV even if you use a condom, though it does lower the risk. Hence the reason the vaccination is important. I've heard of numerous people - both men and women - being given HPV vaccinations even after 26 years of age. So some doctors feel comfortable going off label, and giving it to those who are older - because like my doctor said - there is no reason to expect it shouldn't be safe. So now I find myself in a difficult position. I still want the vaccination, I just need to find a way to get it. I'm thinking about shopping around to other doctors, and attempting to see if they'll hook me up. I have a feeling that if I found a LGBT friendly doctor, who actually knew something about the health of gay men (unlike my current GP), I'd probably be given the vaccination. Has anyone else had similar experiences? Were you vaccinated against HPV after 26 years of age? Did you have to shop around to get it? Have you ever come out to a doctor about LGBT health-related issues, and had that doctor show complete ignorance on the matter? Sorry, this is mostly a frustrated rant.
If the HPV vaccine is only approved or recommended for under 26 years old, he won't give it to you. Could you IMAGINE the fallout if something bad DID happen? "So doc, this guy strolls into your office and says he wants all these vaccines. You tell him he can't get the HPV shot because he's too old, but he says that he is high risk and wants it anyway. You give him the shot and he goes off and dies (whatever it may be) and now his family says you should have never trusted him when all he is is the patient coming to the doctor for treatment." He'd lose his license, his malpractice insurance would be exhausted by the lawsuit, and he'd never work as a doctor again. All because of the HPV vaccine.
Doctors have the right to look at the evidence and make their own decisions based on the science, to go off-label. The only thing that is illegal is for the drug companies to promote off-label use, which is entirely appropriate. If the evidence is overwhelmingly in favor of safety, and I do believe it is for this vaccine, the OP's doctor should have considered using it. Sounds like a lot of ass-coverage going on.
Like Greatwhale said it's entirely up to the doctor's discretion whether or not to go off label. It isn't illegal or prohibited, and in fact a lot of doctors do choose to go off label for the HPV vaccine. Doctors will usually look at things on a case-by-case basis and evaluate the benefits. In my case, due to limited sexual history, CDC recommendations, being in a higher risk category, and the safety of the vaccine there was a clear and good reason to go off label. Like Greatwhale said, it's basically ass coverage going on here, and that ass coverage is coming at the expense of my health. Based on my situation and circumstances it's clearly in my best interest to get the HPV vaccine. This is especially true because I intend to engage in a great deal more sexual contact in the future, which is going to put me at a high risk of contracting one of the strains covered. This is why it's important to get it now, before that happens.
I'm pretty sure that the HPV vaccine is significantly less effective in people who are already sexually active, which could possibly explain part of your doctor's reticence towards giving it to you.
It's not less effective. The reason your sexual activity factors into things, and in particular how many sexual partners / encounters you had - is because of the insane prevalence of HPV. The lowest estimate's I've seen have 50% of the sexually active population infected with HPV, whereas the most realistic estimates have around 80% of the sexually active population infected with one of the strains. As I've only had one sexual partner, neither of us had prior sexual contact, and we were both monogamous the likelihood that I'm infected with any of the strains is low. This is why it's important for me to get the vaccine now, before I become more sexually active in the near future. This is the reason the vaccine is given to such young children starting at around age nine. That's because the vast majority of them are unlikely to have had any sexual contact at that time. It's the reason that people over the age of 26 aren't usually getting the vaccine, because in most cases they've likely to have had multiple sexual partners by that point in their lives. I obviously do not fall into that category, and as a result would be a good candidate to get the vaccine.
I don't think he's so much old-school as ignorant of LGBT health issues. Just like he didn't realize that the CDC recommended all men who have sex with men get the Hepatitis A and Hepatitis B vaccinations. Keep in mind, when I got the vaccination the paper the nurse gave me with it clearly states that men who have sex with men should receive the vaccinations. This is generally the source of my frustration. Yes, it was annoying that I didn't get it, but I can shop around until I find someone who is willing to give it to me. In fact, I'm thinking about making an appointment with Planned Parenthood, as I think they might be my best shot to get it. What really has me frustrated and angry, now that I've had more time to reflect, is the fact that I simply don't think my doctor understands the unique health challenges gay men face. I also don't feel that he was willing to listen or trust me on it. I feel like if I met with a doctor who understood the unique health challenges of gay men, given the information that I've given here about my background, I would have gotten the vaccine without a second thought. I would have likely gotten it because I'm a higher risk category, and someone who understood the unique health challenges of gay men would have known that. Useful Links: Cancer Network, HPV in the LGBT Community What Men Who Have Sex with Men Need to Know About Sexually Transmitted Diseases - CDC Fact Sheet HPV and Men - CDC Fact Sheet Reuters - HPV Common Among Sexually Active Young Gay Men There are some useful resources and information for anyone interested. Part of the reason I posted here wasn't just to vent, but hopefully also to raise awareness since I'm certain my doctor isn't the only one who is ignorant of the unique health issues LGBT people face. It's therefore important for each of us to take a more active role in our own health care, and arm ourselves with knowledge we can discuss with our doctors. Then, if you discover you have a doctor like mine who is fairly ignorant, you can seek out a new doctor. Which is what I plan to do.
Question, my wife and i have the same doctor. She knows i am gay and we will be divorcing at some point. Though i am not looking for a partner right now, eventually i will be and will be getting the vaccines. The question is should i stick with my current doctor or switch. I know that confidentiality laws would prohibit him froom telling her anything, but i think it would be weird any thoughts?
Like you said, he can't really discuss anything about you with her. So, if you like your doctor, and are already open with your doctor you should keep him. On the other hand, feeling comfortable and having the ability to be open with your doctor is very important. So, if you don't think you can do that with your current doctor - then yeah, you should find a new one. In looking for a new one, though, it's important to try and locate one who at least has some degree of knowledge of the unique health issues facing gay men. As I begin looking for a new primary care doctor, that's what I'm trying to focus on. Coming out to my doctor was incredibly easy. There were no issues there - I don't want to paint the picture that I had some bad experience in coming out to him. That's not true at all. The conversation literally went something like this: Me: "...I also wanted to talk to you about getting the Hepatitis A and Hepatitis B vaccinations." Doctor: "Why those? Are you starting a new job or something that requires them?" Me: "Um, no. I'm gay, and the CDC has been recommending that all gay men be vaccinated." Doctor: "Oh? Really? I didn't know that. Are you sure it's being recommended?" Me: "Yes, I'm sure. Other significant institutions recommend it as well. It's on their website, and -" Doctor: "Hm. I don't know anything about that. It's on their website? Hold on, I want to check." ...and that's where things went off the rails for me. As you can see, coming out was completely a non-issue. His ignorance over the unique health issues facing gay men was the issue.
When I was younger, the Gardisil shot came out for girls and was pushed onto every parent who had a teenage daughter. My sister got the series. My mom asked the doctor if I should get vaccinated as well. He told her that it wasn't approved for boys and that he wouldn't give me the vaccine because of that. He said that he thought they'd approve it soon, and to come back later on. It did become approved for boys, and when I went back for a physical the next year he tried to sell it to us again. I refused, because I had done some research on negative side effects and chose not to get the Gardisil series. He was upset, but I told my mom to respect my decision about what kind of non-mandatory vaccine I wanted to receive. She did. Maybe my doctor and your doctor share the same ideology. They want to be as strict as possible and not go off label. You can't change his mind, but you can change doctors. I'd be careful going looking for a yes man though. Look where that got Adolf Hitler. If the doctor doesn't want to do it, I'd second guess my enthusiasm a lot. Ultimately, it's up to you. Just don't be upset with the doctor because he doesn't want to go off label. He IS covering his ass. Nothing wrong with it.
