Clinical Chats: a Podcast for Sexual and Reproductive Health Professionals · Clinical Training Center for Sexual and Reproductive Health

Sexual and Reproductive Health Services for Adolescent and Young Males

March 30, 2023·25 min·1 clip

San Francisco Department of Health research on doxyprep reports a 62 to 64% drop in new infections.

The Family Planning Files opens with Katherine Acheson setting up the episode and the clinical context behind it. She frames the discussion as part of an April 2023 Clinician Cafe on reimagining sexual and reproductive health services for male clients. David Bell, MD, MPH, joins as the guest and brings the perspective of a pediatrician, professor of pediatrics, and medical director of the Young Men's Clinic at Columbia. The first question sounds simple enough. What counts as adolescence, and how should clinicians think about adolescent male patients? Bell answers by grounding the term in development rather than a fixed cutoff. He notes that many pediatricians and adolescent medicine clinicians think of adolescence as beginning around ages 10 to 12. He also points out that puberty timing and gender shape where that range actually lands for different patients. That matters because the episode is as much about service design as it is about terminology. Once that frame is set, the conversation turns to prevention. Bell is asked about HIV and about PrEP uptake in this population. He says PrEP uptake has been great overall, but also that it depends heavily on whether the provider workforce is willing and ready to offer it. Knowledge alone is not enough. Clinics need protocols that keep young men connected to PrEP services and prevention services over time. Bell pushes back on the old myth that offering prevention encourages sex or unsafe behavior. He treats prevention as part of care, not a moral compromise. He also places PrEP in the broader context of falling HIV diagnoses. In his view, the decline reflects more than one intervention. New PrEP use and starting people with new diagnoses on treatment right away appear to have worked together. He does not try to give all the credit to one change. Instead, he keeps coming back to the combined effect of prevention and early treatment. The episode then shifts from public health trends to the clinician-patient relationship. Bell says support has to feel collegial. The provider should be clearly on the young person's side. That means helping patients stay uninfected while also offering more than one option. He describes prevention as something fluid, not locked to a single plan forever. A young person may start with daily pills. Later, that same patient may want on-demand PrEP. At another point, injectable PrEP may make more sense because it removes the burden of remembering a daily medication. The point is not that one option is always best. The point is that care should adjust to the person and the moment. Bell's answer keeps coming back to practicality. Young people's lives change. Their risk, routines, and preferences change too. A good clinic response has to change with them. That gives the episode its shape: a serious clinical conversation that moves from definition to implementation and from policy to patient care. The overall tone stays steady and professional throughout. It is aimed at clinicians who need a usable way to think about adolescent and young male sexual health, not at listeners looking for broad general advice.

As heard by us

A practical, clinic-facing look at adolescent male sexual and reproductive health, with a clear focus on prevention and PrEP.

This episode looks at sexual and reproductive health care for adolescent and young male clients with a practical lens. It starts with how adolescence is defined and keeps the focus on care that can still work as young men's needs change.

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You want a clinician-focused way to talk about PrEP with adolescent and young male clients.

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