Smart Sex, Smart Love with Dr Joe Kort
Psychotherapist, life coach and author, Dr Joe Kort is breaking through the taboos of the most intimate of subjects, to bring leading experts together to talk all things sex and relationships. There’s always room for improving sex and together, Joe Kort and his guests delve deeper into the most personal of human behavior, getting right under the covers to discuss the different paths we take towards pleasure. #pleasure #sex https://www.facebook.com/joekort/ https://twitter.com/drjoekort www.JoeKort.com
Smart Sex, Smart Love with Dr Joe Kort
From the Early AIDS Crisis to PrEP Today with Dr. Paul Benson
Dr. Paul Benson is the founder, owner, and Medical Director of Be Well Medical Center in Berkley, Michigan, a family medicine practice established 45 years ago. He is proud to share he was the first LGBTQ physician to open a medical practice in Metro Detroit, creating a safe, affirming space for patients of all backgrounds, especially those too often overlooked or mistreated in healthcare. While he did not set out to become an HIV specialist, the timing of opening his practice in 1980 placed him at the very beginning of the AIDS epidemic, when fear and stigma kept many providers from treating gay men. What began with caring for friends quickly grew into a trusted medical home for LGBTQ patients and a lifelong commitment to HIV medicine and advocacy.
In this candid conversation, Dr. Benson and Dr. Joe Kort reflect on the early years of the epidemic, the loneliness many patients endured, and the enormous changes that arrived as treatments evolved and prevention became possible. Dr. Benson explains why HIV care is an intellectual challenge, not just medically, but emotionally and psychologically, because great care requires seeing the whole person, including mental health. They also discuss today’s realities. PrEP is highly effective, but many people who could benefit from it still are not using it consistently. Dr. Benson shares optimism about long acting injectable prevention options and the future of cure research, and he gives a clear, reassuring answer to a question Joe hears often. If someone is not having intercourse, do they need PrEP or other HIV prevention medications? His answer is no.
The episode also dives into gender affirming care and what responsible, ethical transgender healthcare actually looks like in a primary care setting. Dr. Benson talks about his decades of experience providing hormone therapy, why careful lab monitoring matters, the risks of using higher than recommended dosing, and his measured approach to puberty blockers and surgical interventions for adolescents. He closes with a message he wants every listener to hear. Mental health is a vital part of total healthcare, and patients deserve a strong support team, including providers who collaborate and patients who advocate for themselves, and who cancel appointments when they cannot make them.
Listen to this Smart Sex, Smart Love episode as Dr. Joe Kort talks with Dr. Paul Benson about LGBTQ affirming primary care, the evolution of HIV treatment and prevention, the reality behind transgender medicine, and why mental health support belongs in every healthcare plan.
Hello everyone, and welcome to Smart sex, smart love, where talking about sex goes beyond the taboo and talking about love goes beyond the honeymoon. My guest today is Dr Paul Benson, the founder, owner and medical director of be well, Medical Center in Berkeley, Michigan, a family medicine practice established 45 years ago. He is proud to say that he was the first LGBTQ physician to open a medical practice in Metro Detroit. He and his team have taken tremendous pride in their history of creating a safe space for people of all backgrounds, particularly those who traditionally have been neglected by the healthcare industry. When he started his career, Dr Benson did not anticipate HIV medicine would become one of his life passions. Dr Benson has been on the forefront in the battle against HIV even before the terms HIV and AIDS existed. He is accredited as an HIV specialist by the American Academy of HIV medicine, and has published extensively in the medical journals, serves as a national speaker on several health related issues, and has been the principal investigator for dozens of therapeutic drug trials in the HIV field. Today, Dr Benson will talk about how he started his LGBTQ practice, his clinical research on HIV, drugs, transgender care and the importance of mental health services in primary care. Welcome Paul,
DR. PAUL BENSON:Thank you, Joe. A pleasure to be here. It's a pleasure to have you here. I've known you all those 45 years. I've been in the field, well, 40 years, but I remember hearing about you before I got in the field. Yes. Time goes by very quickly.
JOE KORT:It goes by really quickly, and you've always been, you know, I always remember people saying, I have my regular doctor and then I have my gay doctor. And you were their gay doctor because they weren't comfortable talking to their regular doctors about gay stuff.
DR. PAUL BENSON:Yeah, I used to be a clandestine doctor. Many years ago, there was a larger population of bisexual married men. In fact, there was a bisexual, married men's group, and what you're saying is true. A lot of people had two doctors, and one didn't know the other. Thank goodness, it's improved over it's improved over the years, and that more people are now more comfortable identifying as being gay. Back in 2026 compared to the 1960s and 1970s and so there's less of that, and that's important, because a doctor should know everything about you to be able to keep you in the best health
JOE KORT:I used to always worry about that.
DR. PAUL BENSON:Doctors, I'm sorry I got a frog in my throat a lot of times. Doctors, you know, sweep the sexual health under the rug. They don't want to discuss it for a variety of reasons and and that's an important part of people's lives, especially when it comes to STI and HIV prevention, and especially nowadays, we have prep available, and the doctor doesn't know that somebody's having behaviors that put them at risk for HIV, they're not going to bring up their conversation proactively.
JOE KORT:Yes, I would think a lot of people make you their primary doctor today and not have to go to two anymore.
DR. PAUL BENSON:Yeah, they do. Many people, many of my patients, start with me as being that second doctor and then eventually convert the whole thing over to us for their primary care. I love that. It's probably part of the coming out process. Yeah. And, you know, years ago, I used to think that it was alright to have a doctor that was a specialist in LGBTQ issues, but I've done 180 degree turn on that, because really it's, better to have one doing everything, as long as that doctor is capable to do it.
JOE KORT:I agree. All right, we'll start with telling us how you chose the medical field as your career, and if you met with any opposition when establishing LGBTQ friendly practice.
DR. PAUL BENSON:Well, I never really planned to be an HIV specialist. But back in my training, HIV wasn't even in existence at that time. I always wanted to be a DR MARCUS Well, be a be well doctor, take care of families and just be a regular general practitioner. However, when I put out my shingle in 1980 that was right at the very beginning of the HIV epidemic, and at that time, a lot of doctors were afraid to see people living with with that time, they called it grit, gay related immunodeficiency disorder. And a lot of people started coming into me, started with my friends, and then my friend's friends, and then I just developed into an LGBTQ practice. It just, it just came out that way. It's not something I really planned on. I'm really fortunate that I came about when I did. I think coming in at the beginning of the AIDS epidemic made me a much better position, a much more empathetic position. Back in those times, we had zero treatments for HIV. It was basically taking care of somebody, and if they lived a year or two, we thought they were doing good. And there was a lot more stigma. Not to say that there's not any stigma now, there certainly is, but there certainly was a lot more of it, and I tend to look at the glass as being half full rather than half empty. But I can't tell you the number of times that I would have to call a family member and say, you know, your son is in the hospital. He just passed away, and they never knew he was gay. They never knew he had AIDS and I think that person died a lot in loneliness, and if they had supportive family, were out and open at that time, I really believe the results would be different than many of them could have survived those opportunistic diseases.
JOE KORT:I remember it vividly. I remember how horrible it was, but I also remember thinking because, you know, then reporters and newscasters would be in the hospitals, in the homes of these gay men who had HIV. And I remember thinking, wow, we're we're getting all this visibility. It was a horrible way to get it, but I feel like it added to people's comfort level of just seeing gay men. Would you agree with that?
DR. PAUL BENSON:I think, with some people, but I think, you know, a lot of people back in the 80s and the 90s, felt that people living with HIV, they deserved it. They were different. God, striking them down for being gay. So there was a mix of it. Yeah, I've had a number of families, one that you know, my practice today and back then is very eclectic. I have gay people, straight people, we all get along with each other, and I just love it. I love it that way. We're nothing unique. Somebody can come in the office and not be recognized as living with HIV, not being identified as LGBTQ, but just as a person, which is really how it should be, all over the place. But, you know, usually it's not. And I had one guy that I thought was really very homophobic his family, and he came to me after many years and wanted to donate a wheelchair to me, and, you know, told me that his brother was gay and had passed away living in a different city. And I was totally, you know, flabbergasted that this man, you know, congratulated me and thanked me for the courage of seeing HIV patients and LGBTQ and again, that's, you know, before it was more accepted, I've had other people, a very great family, back in probably 1990 that he was a police officer in the city of Detroit, him and his family came To me and he found out that, you know, that I was taking care of bottom, LGBTQ and AIDS, and you know, he had the courage to come to me and say, I don't feel comfortable coming to your practice anymore because of the people that you serve. And as much as I didn't like that, I, you know, I was happy that he at least had the courage to come and tell me that, rather than just go away in the oblivion and me never know what happened to him.
JOE KORT:Right, you like the directness.
DR. PAUL BENSON:Yeah, absolutely. So I, you know, I respected him for that, not for his decision, but I respected him for at least coming to tell me. And I'm sure, in the beginning, and maybe now as well, I lose a lot of you know, straight patients that come to my practice find out it's LGBTQ and decide it's, you know, not right for them. We probably have a, you know, LGBTQ flag hanging underneath the American flag, you know, probably displayed right on 11 mile road for everybody to see. And I've transformed too over the years. Back in the 1980s and 1990s I took care of a lot of transgender individuals. Had no problem doing it, but because my practice was so eclectic, sometimes I was worried I'd have a transgender that maybe did not have the body changes to go along with their desired sex. And, you know, looked look bad for the gender that they wanted to be. And my philosophy back then was, well, get them in Quick, take care of them, and, you know, send them on their way that we didn't want them in the waiting room that long for an image that it may spell and, you know, probably 1520, years ago, I said, the hell with that. I don't really care what anybody looks like. If somebody doesn't want to come to see me, we're way more busy than we need to be, then it's a free world. Go somewhere else, exactly. So, I mean, I've had a metamorphosis on that as well. Being a LGBTQ provider has really changed me in a lot of ways, and I'm really happy that I came to be a physician when I did, because it made me a much more empathetic and better doctor. People used to think that dying,
JOE KORT:I know people used to think that, because I specialize in LGBT, from the beginning, that my I would ghettoize my practice, but I never did. I always had more straight than gay, always, and I'm sure I, too, had people leave because it was I was promoting LGBT stuff. But I don't think it happened that much. It probably didn't happen as much as you think it did to you either.
DR. PAUL BENSON:I hope not. I hope not.
JOE KORT:When you say you call HIV an intellectual challenge, what do you mean by that?
DR. PAUL BENSON:I did? You know it's it's an intellectual challenge, because there's many facets of taking care of somebody. There are some doctors or providers that just concentrate on the physical symptoms or dispensing medications HIV, medications to treat HIV. But when somebody comes into the office, we see them as a snapshot of their lives and their whole people and how they identify as being gay, the psychological being is a very important part of their total health care, and a lot of doctors, you know, skip over that mental health thing. And we see far more patients than I'd like to that have mental health challenges, but they prefer to concentrate on the physical challenges rather than the mental health ones, and for a doctor, it's much easier to treat a sore throat or treat something else, prescribe medication and send them on their way, because it's quick, and it takes time to really get to know a person and understand their mental health and point them in that direction. And I think that's why it's important you know that we have mental health professionals such as yourself that we can refer to, because your model of care allows that time to have all that discussion where, in a busy medical practice, it's difficult, so it's, it's, it's very complex and intellectually challenging to provide good care to somebody living with HIV because they got all these other ancillary issues that a good healthcare provider really needs to delve into, because that's that's part of their total healthcare
JOE KORT:That makes total sense. What was it like for you when the meds started changing and people were starting to live longer, and then again, the meds changed and you could prevent HIV transmission? That had to be a mind blowing for you?
DR. PAUL BENSON:Yeah, I feel so fortunate to be around at the beginning of an epidemic, to being around at the end of an epidemic, and clearly we're at the end stages. There's some cure research going on right now. We've applied to do a clinical trial for cure research. I hope we get that trial HIV prevention is certainly there. For there to be eradication of AIDS, we need to have both great treatment, which we do have, and great prevention, which we do have. But the uptake of HIV prevention is far less than what we would desire to be. I've heard like 25 of individuals that are at risk for acquiring HIV are actually on PrEP. And maybe that could be, you know, young people, adolescents they live with, they have that underdeveloped prefrontal cortex, and they say, oh, it's, it can never happen to me. Always is going to happen to somebody else. And I'm surprised. We see lots of new patients with HIV that could have been preventive if they had taken that step to go on PrEP. PrEP works. Prep is about 99% effective. It works. But you got to take it. If you don't take the medication, it's difficult, and for a young, healthy person to take a pill every day is challenging. They have busy lives. They may not go to the pharmacy get the refills. Who knows what the reasons are, but you know, they stop taking them. They don't come in for their appointments, for follow up, to get a new refill. Thank goodness we now have injectable, long acting injectables for PrEP.
JOE KORT:Yes.
DR. PAUL BENSON:For patients can come in every two months. There's going to be one coming out, because you can come in every six months for treatment. Actually, that that is out. There's another one that we're actually doing clinical research on. There'll be a once a year injection. So those are going to be game changers. We need prevention with good treatment. That's the way we're going to get eradication.
JOE KORT:I get this question a lot, and I'm so glad to have you to ask here on this podcast. But you know, I'm a side. I coined the term side, and I talk about and promote helping people who feel shame about just engaging in outer course, if, well, people will often ask me is, do I need to be on PrEP? Do I need to be on Doxy? Do I need to have anti a, anti HIV, transmission drugs if I'm not having intercourse? Well, how do you answer that?
DR. PAUL BENSON:The answer is, the answer is, No, you do not those behaviors are not putting anybody at risk.
JOE KORT:That's so helpful, because I absolutely believe that's probably why I'm alive today, because back in the day, I had hundreds of partners, hundreds but it was all outer. Course, it was all side behavior, no no intercourse. I think if I had done that, I would have probably contracted it.
DR. PAUL BENSON:Sure, I count my blessings, because I came out in the 1980s and I spent a six month rotation in 1980 in San Francisco at the Haight Ashbury free medical clinic. That's really where I got my foundation for learning about treating STIs and learning to treat the LGBTQ community. If I had been out in 1980 living in the in the epicenter for HIV San Francisco in 1980 I'm sure I would have contracted it as well.
JOE KORT:Well, we were both lucky, really,
DR. PAUL BENSON:Yeah, and that's all it is, is luck.
JOE KORT:I know.
DR. PAUL BENSON:You know, people have the shame of thinking they're, they're dirty or something's wrong with them, if they're, if they get infected with HIV, you know, it's, it's just bad luck. You know, it's just really not that you're a bad person, right?
JOE KORT:I love that you're saying that. So let's go back to transgender care. You know that's a big deal these days. Talked about in politics and you know, our in the culture, will you talk about the services you provide in the philosophy of be well, your practice regarding the decision to transition.
DR. PAUL BENSON:I have been practicing gender affirming hormone therapy with patients since early 1980 and we've always had a smattering, not too many, probably 95% of them were transgender women, biologic men, transgender women. And boy. Has that changed in the last year or two? We are seeing many transgender men now. We're seeing young individuals, teenagers coming in with their parents support, with their parents in the room. I don't quite understand why there's such a huge influx? Are people feeling more comfortable being transgender now that they can come out? I think it's probably multifactorial. I have had some young individuals coming in believing they were transgender, then changing their mind shortly thereafter. So one patient that's probably one of my favorites is I call my little droogie. Was a transgender male, and when, when he came in with his mother, as I tell everybody, they thought a contract so they know what we do and what we don't do. And this was a 16 year old, and one of the things I tell them is, I will not support any surgical reassignment surgery of any type until the age of 19. That's just what I do. And they came in to me. I'd known them for about a year, and droogie wanted to get a mastectomy, a bilateral mastectomy, and I said, Remember, I told you, I'm not going to support it. You're only 17. I said, You've got plenty of time. Well, they yelled at me, and the mother yelled at me, and I thought I was going to lose him as a patient, but I steadfast. They came back three months later, and my little droogie decided not to be transgender and found a boyfriend, and, you know, decided, you know, not not to be transgender anymore. So there are so many reasons for why some people, especially young people, choose to be transgender. For many of them, it's not a choice. They're born that way. It is innate. I get it, but there are some where there really is a choice. And sometimes they see some of their friends are transgender, and they, quote, unquote, decide to be transgender too. So on a young person, we make sure that they see somebody such as yourself or mental health, I tell them that being transgender is something that comes from your heart and that we don't have to go on a hormone affirming therapy right away. And I let them explore. I mean, I get older people that are coming in, maybe they're a little bit confused too, but most individuals that come to me, they clearly know that they're in the wrong phenotype of their body, and they clearly know they're transgender, and, you know, we prescribe hormone affirming therapy for them and surgical intervention after everybody feels comfortable that this is a permanent thing. But on children, it's it's a little bit more challenging and and I just don't believe in rushing to surgical intervention. I just don't hormonal affirming therapy. Yes.
JOE KORT:How do you feel about puberty blockers?
DR. PAUL BENSON:I try not to use them. I've used them in some cases. Sometimes it could be irreversible. The other thing that I don't really like about it is that it closes up growth plates earlier, and so somebody could be of short statue. If you have a transgender man and you put on puberty blockers, their growth is going to be stunted. And should they choose at some point in time afterwards not to be transgender anymore. They're stuck with the effects of what the puberty blockers did. I'm just not sure the benefits exceed the risks of using puberty blockers. If a child is confused and you want to delay puberty for a short period of time, I could see using puberty blockers, and that's when I do use them, if there's not any evidence of any confusion or whatever. I just don't think that puberty blockers have a lot to offer, offer at a young age.
JOE KORT:You've noted also that there's improper use of hormone affirmative therapy, that it increases the risk for many medical conditions. Can you talk about that?
DR. PAUL BENSON:Absolutely, it's extremely important that anybody on gender affirming hormone therapy get blood work on a regular basis. For a transgender man, if you're giving somebody testosterone, it can cause liver disease, it can cause acne. It can cause we've heard of roid rage. It can cause behavioral changes. It can cause a stroke from from high blood pressure in trans women, estrogen could possibly cause cancers in the body. There's just no long term studies on that. It can cause strokes if you have somebody that's on estrogen therapy and smoke cigarettes, their risk for having a stroke or a heart attack is extremely elevated. So all these parameters need to be looked at with very little exception, most of my transgender individuals live with the motto that more is better and they want super physiologic doses of testosterone, testosterone or estrogen, thinking that more is better and they're going to get to their desired effect sooner. Well, more is associated with increased complications and side effects. There are many patients that listen to things on the internet and listen to their friends and they say, Well, my friend is on X, Y and Z. Why aren't you giving me that my goal in therapy is to make hormone levels the appropriate amount of the desired sex they want to be for that age. And one example is progesterone. I really don't approve of progesterone. I use it a little bit. Progesterone causes mood changes, and that's a hormone that surges in cisgender women before they have menstruation, it's an anti estrogen. It causes the uterus to slough cells, and that's why women, biological women have have menstruation, or menstrual periods, monthly. Well, a transgender female is not going to have a period. They don't have a uterus, and to give them progesterone, which is anti estrogen. All you're doing is adding side effects. And you're not really, you're not really, it's not really any benefit.
JOE KORT:I love how measured you are about all this. You know, what do you think when you watch the news or you hear all this buzz about, you know, doctors are being irresponsible and they're just cutting up children and mutilating. And what do you respond? How do you respond to that?
DR. PAUL BENSON:You know, Joe, I only hear what I hear on the news, and that's taken with a multiple grains of salt. I myself am not really familiar with that, but I don't believe in reassignment surgery for an adolescent, I don't, I really just don't think there's a rush and if, if, and I don't know this for a fact, but I've heard it the same as you, if young, pubescent children are having surgical intervention at that young age, I'm not in favor of it. You can be a full transgender individual and not have surgical intervention as a child. Wait, wait until you become adult that you're really sure I had a transgender woman that I'd taken care of for about 30 years. She wound up having a pulmonary embolism as a complication of her estrogen therapy. She was taken off of it. She did well. She came back in. I said, Well, I said, Do you want to restart the estrogen? I'm ready to restart on you. She goes, No, I don't really need it anymore. And that's true when you're when you're a biologic female, when you're in your 60s or 70s, your hormone level is low anyway, that's just a natural aging process. So there's really very little, I'm not going to say none, but there's little benefit of giving somebody extra large doses of estrogen that would be higher than what their normal age would require to be. So she's 100% a transgender woman, and she's not on estrogen. She chooses not to be. And I think that's great. And I think you and I both know that as an LGBTQ or as a transgender individual, it's what's in your heart that's really what dictate dictates it. It's really not necessarily your phenotype or what your body looks like. It's how you act and how you feel, and you can feel that without having to be on hormones
JOE KORT:100%. You have and we heard him bark a little bit ago. You have a golden retriever, Baxter, who's part of your team. How do patients react to the dog in your office?
DR. PAUL BENSON:They love him. Unfortunately, Baxter may Rest in Pieces in doggy heaven.
JOE KORT:Oh.
DR. PAUL BENSON:He passed away three years ago, but he was clearly the mascot of the office. He had an innate ability to know who he should see and who he shouldn't see. And so many times I would go in a room and he'd be getting a belly rub from a patient. But I do have Bowie, who's around here somewhere, that Bowie comes to the office every day. The patients love him. He's three and a half years old, a little bit in the wild side. The Golden Retrievers usually are until they're about five. But he's a good boy, and he's developing to be a good patient ambassador as well.
JOE KORT:How long did Baxter live?
DR. PAUL BENSON:Baxter lived to just under 12.
JOE KORT:Okay.
DR. PAUL BENSON:And he had a good life.
JOE KORT:What would you that we did? What did we not talk about that you want to leave listeners with, that you want to say on the final thoughts?
DR. PAUL BENSON:That mental health is an important part of total health care, and that many patients are resistant To getting mental health, and especially when they come in with quote, unquote, psychosomatic symptoms all the time, and get test after test after test, and you mention it to them that you know, maybe you should see a therapist. A lot of times, there's resentment, like you don't believe me, well, it's not a question, not believing it's a question that every individual should assemble for themselves a good health care professional team, and that may include your dentist, your doctor, your primary care doctor, maybe an infectious disease specialist, a mental health therapist, whatever else it should be, surround yourself with a good a good team, also a patient advocate. There's nothing wrong, and I think it's healthy when a patient goes to see me or any doctor that they bring a significant other in the room with them, if anything else, in all honesty, the person the patient then gets more respect and time from that provider. It's just the truth of the matter, if they have somebody else in the room with them, that makes sense.
JOE KORT:Where can people find you?
DR. PAUL BENSON:Um, I'm in Berkeley, Michigan, on 11 Mile Road, Be Well Medical Center. I'm in a lot of the magazines, the LGBTQ, between the lines, etc. I'm in the phone book. I know you have my number. I have your number. I'm glad that we can really partnership, because that is really great when you and I share the same patient, that we can collaborate together, that everybody really knows what's going on. I like that difficult to find.
JOE KORT:Yeah, no, you're not. And we're going to put up all your, you know, your website and all the internet information as well. And I want to full disclosure to everybody. I go to your center too. I see one of your pas Calib, am I saying his name? Right? Caleb, right? I don't know why I was thinking, Caleb, I love him. He's been with you a long time.
DR. PAUL BENSON:Yes, Caleb's been with me for about 15 years. All my providers have been with me for a while. We're growing. We just brought in another physician assistant because we're getting larger and larger, and we don't like it when somebody wants to come in for an urgent same day visit, we have to tell them no because we're booked. Yeah, one other thing I can't say, Joe, since I want to take any venue, I can to say this. It's extremely important for any person that's seen a healthcare provider, provider, whether it be psychologist or primary care, if they cannot make an appointment, to call and cancel it. The health of the health of the be well Medical Center is really being compromised right now because patients just don't show up for their appointment. They don't give that courtesy. And we have a waiting list of people every day that we can get in last minute for an urgent care visit. So I'd like to take this opportunity to let people know, regardless of who your provider is, if you can't make an appointment, we understand stuff happens, but if you can't make an appointment, call and let them know you need to reschedule or cancel, it really makes a big difference.
JOE KORT:I'm so glad you're here as a local referral and a local resource, and thank you so much for being on my show.
DR. PAUL BENSON:My pleasure. It was fun.
JOE KORT:All right, so you can hear more of my podcast at www.smartsexsmartlove.com, and you can also find me and follow me anywhere on the internet. If you're on Twitter, TikTok, Instagram, Facebook, LinkedIn, it's all @DrJoeKort D, R, J, O, E, K, O, R, T, and also, you can find me on my website, www.joeort.com. Until next time, be safe, stay healthy, and I'll see you next time.
DR. PAUL BENSON:Take care, Joe.
JOE KORT:All right.