There are many of us in the fields of mental health and self-help who understand that basic unhappiness is primarily related to how we think about ourselves. Self-esteem and selfworth are basically the result of two major components. First, there is a demonstrated competence and success in areas of life in the EXTERNAL WORLD that are important to us. These include intelligence, relationships—intimate, friends, family, co-workers, etc.— physical self, emotional self, and work or career. The second component consists of core feelings in the INTERNAL WORLD of self-love. This includes internal feelings of value and worth, internal feelings of love, and internal feelings of self-acceptance. Both aspects of selfesteem are internally self-directed.

Often, the reason we feel less than good about ourselves begins with futile attempts to align our feelings of self-worth with cultural standards, and the opinion of others. We look for outside validation which often is not forthcoming. As each of us is different, we cannot expect our core uniqueness to align with that of others. The moment we harshly judge ourselves based on our difference, we give into devaluing and degrading our sense of self. When we harshly judge others, we can be sure its roots are in our own selfdegradation. The external components of selfesteem relate to how we function in the outside world in areas of life that are IMPORTANT to us. If we are not functioning in a way that supports a positive sense of self, we either are not living up to our potential—often due to internal self-degradation—or we are trying to live up to the ideals of someone else. When life is not going the way we want it to, it is time to explore whether we are trying to please others (or the culture at-large) at the expense of our own desires and passions.

Following one’s own heart leads to true satisfaction and self-worth. If our lack of self-esteem is the result of internal feelings of dissatisfaction, then it is time to find ways to accept ourselves exactly as we are now.

People with high self-esteem are willing to accept, improve, or change those aspects that are perceived to be “imperfect” or different from the cultural norms. They resist the need to harshly judge themselves or others, and they shun gossip. They surround themselves with people who accept them as they are, and for who they are.

Tools for enhancing self-esteem include:

1. Monitoring your self-talk. Stop the internal bully. Put up a mental STOP sign when you find yourself inappropriately judging yourself or others. Stop all criticism. It has done nothing for you in the past, and will do nothing in the future.

2. Taking risks. Push yourself into new and uncomfortable situations, realizing that imperfect outcomes or failed plans do not mean personal failure. Each person has different risk tolerance. Reward yourself for trying, no matter the outcome.

3. Giving to others. Contributing allows us to see our value in new ways.

4. Being assertive (also known as “healthy communication”). If you’re introverted, that means making an adjustment from keeping self-expression internal. If you’re extroverted, that means modifying selfexpression, and learning to listen and process your feelings more before you speak.

5. Understanding that self-care is self-esteem. Manage your nutrition, health, diet, and exercise. Take small steps, but move forward with health empowerment.

6. Experiencing personal growth classes, spiritual retreats, counseling, and reading self-help literature. Find sources of inspiration for positive change.

Finally, don’t self-medicate your feelings away with drugs and alcohol. If anything will damage your sense of self, it is substance abuse. If you have a problem, get help TODAY.

Note: Dr. Leight conducts a group for gay men every summer entitled “Confidence, Self-Esteem, and Personal Empowerment.”

For more information, visit doctorleight. com/workshops.php.

A diagnosis of prostate cancer is a frightening prospect for both men and their partners. Unfortunately, most physicians treating for prostate cancer never inform their gay patients that the implications will impact gay male sex differently than for straight male sex.

The result can be uninformed, under-informed, or misinformed treatment selection. Prostate cancer is the second leading cause of cancer deaths in men. One out of every six men will develop prostate cancer, as compared to one out of every eight women who will develop breast cancer.

If you live to age 80, your chances are greater than 50 percent that you will develop prostate cancer. For a gay male couple, there is a 28 percent chance that one partner or the other will be diagnosed with prostate cancer during their lives together. If you have a father or brother who has had prostate cancer or if you are African American, your risk doubles. Diagnosis is always confirmed by biopsy, but PSA blood tests and digital rectal examinations are used for initial screening.

These are generally recommended for men over 50 (or over 40 if in a high risk group). If you take Propecia for hair loss or Proscar for prostate enlargement, your PSA may be falsely low. You want to double the number for accuracy. And gay-receptive partners should wait three days after anal penetration, as prostate massage can elevate the PSA. Your physician should perform a digital exam AFTER he or she takes your blood.

The most commonly prescribed treatment after a diagnosis of prostate cancer is prostatectomy, or removal of the prostate. This is major surgery with the potential for major residual, life altering implications. While considered the “gold standard” for curing prostate cancer, five to 10 percent of men remain incontinent, and for men under 60, 25 to 30 percent remain impotent. For men over 70, 70 to 80 percent remain impotent.

And sexual function tends to improve with time. Erectile rigidity post-treatment may be sufficient for vaginal penetration, but often isn’t sufficient for anal penetration. There are erectile treatments available that can help or even restore function, so consult your urologist for assistance in this regard. The other major change in sexual function is that ejaculation will now be retrograde (so the ejaculate will back up the urethra rather than forge out the penis). This can be disturbing, but men are still able to ejaculate even if they cannot attain a significant erection.

The other curative option that is generally recommended is radiation therapy. With radiation, less than two percent remain incontinent. Recurrence of cancer is three to 40 percent higher than with prostatectomy (depending upon the stage of the cancer). There is a risk of frequent urination, burning, and chronic bowel complications. Rectal bleeding is a problem in around five percent of brachytherapy (radiation) patients. Because radiation has long term effects, sexual function may not be impaired at first, but may decrease over time.

The rates of impotence are approximately the same as for surgery. There may likewise be penile shrinkage, and a decreased amount of ejaculate. Radiation can be problematic for men who enjoy being penetrated. Anal bleeding, diarrhea, and tightening and/ or spasm of the sphincter may make anal penetration uncomfortable or impossible. Psychologically, an overall sense of helplessness, anger, loss/grief, depression, and anxiety are very common.

Communication with partners about fears, embarrassment, and frustrations are critical. Patience is vital for the man with prostate cancer—and his partner—as recovery is often slow and uncertain.

You cannot pick up a magazine or watch a television show today without some advertisement for so-called “E.D.” treatment. Erectile disorder is often called erectile dysfunction or impotence and is the most common sexual disorder for men. Ironically, “dysfunction” and “impotence” inaccurately and often inadvertently contribute to a man’s feeling powerless over his erection.

As with most sexual disorders, the inability to attain or maintain an erection or complete erection may result from biological and/or psychological causes.

Low levels of testosterone, a natural part of aging, can contribute to issues with libido as well as erection problems. Testosterone supplementation is often sufficient to care for E.D., not to mention the benefits of increased energy and improved mood. Drugs, medication and alcohol are very frequently the cause of erectile challenges. Reducing or eliminating drugs and alcohol may be the solution. Ask your physician if any of the medications you are taking can contribute to erectile issues. These may include high blood pressure medications and anti-depressants.

Often there are other medications available that can be substituted without the same sexual side effects. Diseases such as diabetes and coronary artery disease are also associated with erectile disorder.

Viagra, Cialis, and Levitra can be effective medications for Erectile Disorder of physical origin. Other treatments including penile implants, and injections into the penis are also available for E.D. that originates from medically-related conditions. Vacuum aspirators (penis pumps) and venous retention rings (cock rings) offer varying degrees of success for E.D., as well. I tend to recommend trying a cock ring as a simple first choice for E.D. or for increasing the firmness of erections.

While there are multiple physical reasons for erectile disorder, the primary cause is performance anxiety, not uncommonly related to lack of erotic desire for one’s partner. Viagra, Cialis, and Levitra are not aphrodisiacs, and they do not produce desire.

Trying to overcome desire challenges with one of these medications will not work. When the underlying cause of E.D. is psychological, a cognitive-behavioral sex therapy approach works best. E.D. can be rapidly cured by using the mind to redirect the focus of attention during sex. While a man who ejaculates prematurely does well to direct his focus away from the object of erotic desire, a man who has difficulty achieving erection or ejaculation does well to direct his focus toward the object of erotic desire.

Performance anxiety is essentially a misdirected focus of attention on matters other than an object of sexual desire. When you are concerned about your ability to satisfy your partner or you are self-conscious about your body, or your mind is thinking about some problem at work, you are not focused on the sexual stimulus—the partner or fantasy in your mind. Similarly, when you move out of the moment of sexual connection and pleasure you are no longer focused on the sexual stimulus. Redirection is necessary in order to be sexual. One of the most enjoyable aspects of sex is losing yourself in the moment with your partner. Worry, anxiety, concern, and fear take you out of the here-and-now of sexual experience.

Because sexual challenges are multifaceted and may include medical, biological, psychological, and/or social factors, they may not be a simple matter to address. Taking matters into your own hands may or may not work for you, which is why diagnosing and treating sexual problems is sometimes best accomplished by licensed health professionals. Working with your physician, (sex) therapist or clinical sexologist, your diagnosis and treatment can be most effectively accomplished.

I received a text message last week from a friend with whom I haven’t spoken in years. It was an ultrasound image showing an unborn baby girl. The message that accompanied it conveyed all the joy and happiness that I imagine must have been registered on the sender’s face. “Cliff,” it said, “this is my daughter. I’m excited that I’m going to be a dad and starting a family of my own.” The sender—let’s call him Jim—and I haven’t spoken in several years: the last time was when he was moving out of the one-bedroom apartment we shared upon my return to South Florida about six years ago.

What I doubt Jim’s baby’s mother will ever know is that Jim and I once enjoyed a brief intimate relationship before both he and I came to the conclusion that our “deal” was “just one of those things,” and that Jim was really straight. (Please hold the rolling of your eyes until the end of this piece.)

Fast forward to sometime last summer, and a conversation I had with an otherwise forward-thinking and progressive heterosexual male with whom I am happy to be acquainted.

Walking in during the tail-end of a chat about human sexuality, I heard my friend say “I don’t care: a guy who takes it up the *** is gay.” I am not mentioning his name so as not to embarrass this normally open-minded and thoughtful guy, because I know what many “straight” men, and not a few “gay” men, already know: The words “gay” and “bisexual”—and now, heaven help us, “Questioning”—have lost all meaning.

The April 5 issue of the Agenda featured a thought-provoking LEIGHT REFLECTIONS column in which Dr. Arlen Leight discussed a person’s Sexual Template. Like many gay men “of a certain age” who spent their formative years growing up among the straights, a large number of my early post-adolescent “relationships” were with (generally) straight guys.

For the most part, these were short-lived, but there were a couple of instances where something akin to feelings developed. This worked best when I was in a single frame of mind, since realistically there was an expiration date on these “relationships” from the get-go. Too, years ago, I realized the futility of pursuing the emotionally unavailable, and have been fortunate in my loving relationships with involved partners over the intervening years.

My point here is that despite the occasional brief gay “episode” (or what an earlier era might refer to as a “fling”), there was no question in my mind—and clearly not in their minds—that these guys were straight. I say that with the confidence and assuredness of a gay man who has—like many gay men since the time of Alexander the Great—on several occasions enjoyed the intimate company of a member of the opposite sex.

I want to be clear that these were all of them crimes of opportunity (often, I am half-embarrassed to admit) accomplished through the agency of the right wine and the right music. I know this seems like a story about how cool I am, however, I only make reference to it to illustrate this point: I am not bisexual and I am certainly not straight. I am a gay man just as sure as is my boyfriend, and just as sure as Jim is straight.

Regardless of whether or not there is a genetic basis for homosexuality—even though science seems pretty cut and dry on this—there is a difference between what it means to be a “homosexual” (whatever that is) and what it means to be “gay.” The designation MSM (“men who have sex with men”) is a clinical one, which reflects nothing of the lifestyle choices we make as gay men.

I say “choice” because some of us are able to choose to live openly as gay men, in a community that enables and supports our individual identities. My friend Jim was homosexual (for all of three months), but I can’t envision him being “gay:” that simply isn’t how he identifies. Someone once told me “you are what you fantasize about.” I would offer that while all gays are homosexual, not all homosexuals are gay. Said differently (and with regrets to Sen. Santorum): “Gay” is to “homosexual” as “man” is to “monkey.”

By ARLEN KEITH LEIGHT, PH.D.

Everyone gets a chuckle out of saying, “He’s going through a mid-life crisis” as if it is some childish phase creating an excuse for extra-marital affairs, buying a Harley, and going bungee jumping. The fact is, midlife course correction is an integral part of adult individuation, the process of becoming a complete and wholly unique individual.

The midlife experience in our social structure today usually takes place in the 40s, but can come as early as 35 or as late as 55. The period is characterized by a reevaluation of the life decisions made as a teenager or in one’s 20s. At this time there is often a realization through life experience that those early decisions were made for external factors rather than internal drive.

The decisions regarding career, home, and even life partner are often made to satisfy parental, church and/or societal expectation, or other persons of influence. For example, a gay person may choose to marry someone of the opposite sex because that is the expectation of his parents and the society-at-large.

The realization that one is entrenched in a life that does not allow for full individual expression of self can be very frightening and confusing. There may come a tipping point at which time the individual realizes that in order to grow into him/her-self, change is necessary. This is the mid-life “crisis” as we have come to understand it. Discovery that a relationship is not working after 15 years despite love, realizing that a lucrative career brings no passion or joy, and/or looking around at one’s environment to see that it does not reflect the person one has become–or wishes to become–can be devastating.

A few choose to go into therapy as a tool for sorting out the feelings of confusion, loss, and fear. Driven by a will to thrive and not merely survive, some will risk everything and choose to change all aspects of life in an effort to come to terms with the self. Others will choose to stay at the job or in the marriage and attempt to bring more of themselves into their current situation. Still others will simply accept stagnation, often living in despair and depression that is frequently accompanied by substance or alcohol abuse.

The argument is often made that leaving a relationship or job or other situation is unfair and selfish because it adversely affects others. There is no question the result can be traumatic to others of significance, hence the word “crisis.” I often ask clients struggling with coming out in mid-life and struggling with the prospect of leaving their families, what advice they would give their own children should they be facing this same dilemma? Would they like to see their children follow their hearts, be fully themselves, live their passions and realize their dreams, or would it be better for them to stay in relationships or careers or some other life situations that are not working and not allowing them to be all they can be?

Do all mid-lifers go through a crisis? It appears most adults who have met the basic needs of life—i.e., food, clothing, shelter, health care–find themselves asking if life is all it can be. Often precipitated by seeing others live out a dream, surviving the death of a parent, or becoming an emptynester, mid-lifers may ask: Is this all there is for me? Have I made my life all it can be? Am I living my life honestly and completely in alignment with an authentic sense of self? Many, if not most of us, push aside any thoughts of change realizing the risks, fearing the response of others, putting the needs of others first, or deciding the known is more comfortable than entering the unknown despite any possible self-actualization.

Whatever the life choice, it needs to be respected and honored as the path of unique choosing for each individual.

Arlen Keith Leight, PhD is a Licensed Psychotherapist and Board Certified Sex Therapist in private practice on the drive in Wilton Manors. He can be reached via email at DoctorLeight@aol.com, by phone at 954-768- 8000, or online at www.DoctorLeight.com.

The short-lived relationship was rocky at best. You initially thought this man was really for you. Thinking about him made you feel whole, happy, and hopeful. He showed great interest in being with you.

He had some great qualities, but right from the start you knew there were some “issues.”

Being the eternal optimist, you figured you’d work at it in hopes of true love, romance, and relationship. You almost immediately felt a total emotional commitment. You found yourself thinking about him often–maybe obsessively–and projecting a life together way into the future. When the problems became greater than the “relationship” satisfaction, it ended with a feeling of relief mixed with disappointment.

But now it is time to move on, and before you can blink an eye, someone appears with great qualities and, well, some “issues.” Despite these, why not see if this new man is “The One?” So you wholeheartedly invest again, only to find weeks or months later you are ready to jump ship–again. Within days of its ending, another “true love” comes along.

This pattern of obsessive-compulsive behavior is complex and multi-dimensional. The likelihood is that you often feel empty and lonely if you aren’t subject to the attention and “love” of a potential partner. The pain of each break-up is avoided by emersion into the next “relationship.” At its cause, you may have been subjected to childhood emotional neglect and/or abuse. By ignoring red flags or lacking the filters necessary to make wise choices, you are essentially “asking for” a repetition of that childhood abuse, neglect, and/or emotional pain. Unconsciously, you are repeating the “family-of-origin” pattern, which is both familiar and, ironically, comfortable compared with the prospect of true intimacy.

The repetitive dating pattern is an unconscious attempt to heal the wounds of childhood, believing that any friendly interest shown upon meeting is an indication that this new person will fully love you. It is this initial apparent interest that is so alluring, bypassing your rational mind, which might otherwise realize the prospective partner is not really a good match. The limerance (the initial excitement phase of a relationship) provides a dopamine (brain chemical) response that creates a high which has the potential to be very addicting, and covers up any feelings of loss or grief associated with the last “relationship” or childhood pain. Despite the near-desperation to be in a relationship, the pattern actually sets you up for future loneliness–the very feeling you are trying to avoid.

To remedy the behavior pattern, you need to take some major, often painful, steps. These include, but are not necessarily limited to:

1. Finding a therapist who is not invested in your desire to be in a relationship.
2. Taking time off from dating to be by yourself. Feel the pain of loneliness if that comes up. Be with the anxiety. Time and your therapist will help you process these feelings and understand them–and yourself–better.
3. Working on feeling good about you. Fulfillment does not require partnership, and, indeed, to be a good partner you need to feel and be complete by yourself. Self love and acceptance are critical ingredients to bring into intimate relationships.
4. After a sufficient period of time, entering the dating world slowly. Don’t jump into a relationship with the first potential partner who shows you some interest. Have in mind what is important to you in a partner, and do not sacrifice Self at the altar of relationship.
5. Experiencing dating without “relationship” in mind. Don’t limit yourself to one person. Allow yourself to experience all different kinds of people. Have fun and take your time. Interest from others should not be confused with love.
6. If you are going to date someone more than a few times, be sure they are emotionally, intellectually, and sexually available and compatible. Learn to say “no” if there are red flags, if the person is not right for you, or if you find you are giving up parts of you for the sake of a potential partner.
The revolving door of hopeless romanticism keeps you going in circles, never realizing your desire for true intimacy. Get some help and start moving in the direction of your dreams.

Arlen Keith Leight, PhD is a Licensed Psychotherapist and Board Certified Sex Therapist in private practice on the drive in Wilton Manors. Dr. Leight has written and lectured extensively on the topic of gay male intimacy, dating, human connections and relationships, and has been on the faculty of several universities.  He can be reached via email at  DoctorLeight@aol.com, by phone at  954-768-8000, or online at  www.DoctorLeight.com.

Watch for his new book, “Sex Happens: The Gay Man’s Guide to Creative Intimacy,” due out this summer