ER Doc Needs Help With Gay Slang
June 17, 2023 7:45 AM   Subscribe

Specifically, among urban gay men, what does the term "Straight Acting" mean? I co-chair the busiest emergency department in Washington DC. We're located adjacent to the two main gay neighborhoods in the city, and provide care to virtually the entire gay population of the city. "Straight Acting" is a term I often gay men used to describe themselves and other gay men. I don't really know what it means. Please explain. Thanks
posted by BadgerDoctor to Society & Culture (39 answers total) 2 users marked this as a favorite
 
Response by poster: Typo: "I often hear gay men use to describe..."
posted by BadgerDoctor at 7:45 AM on June 17, 2023


Response by poster: Sorry for thread-sitting, but one thing I'm specifically curious about is whether "straight acting" is synonymous with "Closeted." Thanks.
posted by BadgerDoctor at 7:49 AM on June 17, 2023


Not necessarily synonymous— “straight acting” just means not displaying “stereotypical” gay/effeminate behavior.

It’s a loaded term in many ways but that’s the essence of it.

“On the DL / downlow” (if anyone uses that anymore) is/was men who have sex with men on the side / while usually having women partners.
posted by profreader at 7:53 AM on June 17, 2023 [3 favorites]


I don’t think it is necessarily the same as closeted, I think you could be straight-acting (I think it used to mean, you wouldn’t necessarily know they were gay by the way they act/dress/talk) but still be out of the closet. It’s a bit of a controversial/problematic term I think.
posted by iamsuper at 7:55 AM on June 17, 2023 [2 favorites]


It doesn’t mean closeted. It means that they are likely to be taken as straight in casual encounters out in the world - ie they’re not “stereotypically” gay in any visible way. You’ll see it in mlm classified ads (on whatever app) as a self description so people know what to expect. It can be tetchy to apply it to someone, so definitely only use it if someone has self identified in that way.
posted by Bottlecap at 7:56 AM on June 17, 2023 [3 favorites]


I imagine there’s some regional variations in how language is used, but for whatever an opinion from experience somewhere else is worth, no, it doesn’t necessarily mean closeted. It means the person is describing themselves as not looking or behaving like a stereotypical gay man. It may suggest the person has some serious baggage around what it means to be masculine and/or to be gay, such that they feel a need to so explicitly differentiate themselves from other kinds of gay people.
posted by Stacey at 7:56 AM on June 17, 2023 [4 favorites]


With respect, I would ask the men you hear use it what they mean, as they are the best authorities on their language. If you make it clear you're asking in order to provide optimal care, not out of idle curiosity, I think they'll be happy to tell you. (I am a social worker working as a therapist; this is how I ask my clients about terms they use that I don't know.)
posted by epj at 8:08 AM on June 17, 2023 [24 favorites]


Copied from the Urban Dictionary in case you’d prefer to avoid it yourself:

Straight Acting:
1. Conventionally masculine. Describes a homosexual male whose behaviour resembles that of the traditional heterosexual or straight male stereotype. Often considered politically incorrect (or even homophobic) as a label, but can be used facetiously. May apply to gay males who exhibit conventional masculinity out of a genuine predisposition, as well as to those who affect it out of insecurity (sometimes to remain in the closet).

2. The gay male equivalent of the lipstick lesbian. As a social phenomenon, the "straight acting" homosexual breaks from gay stereotypes in a way comparable to the metrosexual's defiance of straight stereotypes. (Both labels rely on stereotypes in order to be understandable, even as they describe non-stereotypical behaviour.)


posted by Tell Me No Lies at 8:09 AM on June 17, 2023 [5 favorites]


Oh this is rather a can of worms but it's also more or less what it says on the tin. To me, a gay man out for 30+ years, it's a term gay men with some non-negligible degree of self-loathing have long used (but you hear it a little less often these days) to differentiate themselves and the kind of men they're looking for from a perceived standard of gayness usually associated with feminine appearance/behavior. To the people who use it, it is of course just a neutral description, just a preference, bro.

It is not synonymous with closeted, but it's about a step from it. You may very well encounter an out gay man who considers himself straight acting but if he actually uses this retrograde pair of words, chances are good he's deeply conflicted about his identity. (Ask someone who identifies as straight-acting what "gay acting" would look like...)
posted by less-of-course at 8:24 AM on June 17, 2023 [9 favorites]


Response by poster: Profrader: It’s a loaded term in many ways

1) Could people expand on 'loaded'? To gay men, what reading-between-the-lines/ connotations/subtext does the term "straight acting" come with?
posted by BadgerDoctor at 8:38 AM on June 17, 2023


does the term "straight acting" come with?

The idea that there is a set of stereotypical behaviors that define "straight" and "gay" behavior. It's loaded/problematic because the entire premise of the term is built around stereotypical ideas.
posted by kbanas at 8:51 AM on June 17, 2023 [12 favorites]


A similar term is "masc" (masculine) and that is more problematic than "straight-acting" IMO. Both terms are basically used to mean cis men that do not exhibit stereotypically gay behavior but are mostly used to privilege these gay men over more fem (feminine) ones.

I do not like or appreciate any of these terms but it's what we've got to work with.
posted by rhymedirective at 9:04 AM on June 17, 2023 [2 favorites]


I think it would be useful to know in what context you're hearing the phrase and how it relates to your work in the ER? Is it something you'd like to know more about because it might mean additional tests for your patients or a different approach to care (maybe taking care not to out them to friends or wives)? Or is this just idle curiosity? I'm interested in the framing of this question, since it seems as though you're approaching this as something which will help you care for the gay men in your community (which is commendable!) but I'm not sure where knowing the context here comes in.
posted by fight or flight at 9:31 AM on June 17, 2023 [8 favorites]


Best answer: I'm straight, but I work in (what I'm guessing is) that neighborhood and interact with a lot of gay men. If these men are volunteering this information in a health care context, I would guess that they're trying to make sure you have all the information you need to make a decision on care and that you're not stereotyping them as people from a lower risk population. While I would assume that your department's screening questions are written in such a way as to find out the answers to potentially sensitive questions without making patients or doctors uncomfortable, I would also assume that gay men are used to having to be strong advocates for themselves in a healthcare system that has often been biased against them, and thus that as a population they may be more forward about that communication in order to get the best care.

For a specific example that I'm sure you know, gay men are at higher risk for mpox. If somebody comes into your ER and there are no obvious indicators to you that they're gay, are you as likely to ask questions about possible exposure? If the patient you're treating appears to be traditionally masculine, would you fear a bad reaction from that patient if you asked certain diagnostic questions about mpox? I think in that scenario it's possible a patient who self-identifies as a "straight-acting" gay might be trying to set your mind at ease about asking questions that might make some people (patients or even some doctors) uncomfortable.
posted by fedward at 10:03 AM on June 17, 2023 [22 favorites]


One reason that the term “straight-acting” is problematic is that it assumes the existence of “gay-acting”.

“Gay-acting” would likely tend to encompass behaviour like using more feminine-coded behaviours, such as speaking with a more melodic vocal range, or using feminine Black American slang (like starting a sentence with “girl”), using bigger hand gestures and having the hands higher when speaking, showing more enthusiasm and emotion, wearing flashy, colourful, tight, or more skin-baring clothing, careful grooming and skin care, crossing legs knee-over-knee when sitting, etc.

“Straight-acting” would probably include things like using a deeper and more monotone vocal range when speaking, using less Black slang or more masculine Black slang (like starting a sentence with “yo”), small and low hand gestures, toning down enthusiasm and concealing emotions more, wearing looser clothing with less skin showing (for instance knee length baggy shorts and loose tank tops in subdued colours), more shaggy grooming with less skin care, crossing legs knee-over-ankle, etc.

All of these behaviours are or course actually neutral but we as a society have assigned genders to them. Just look at the bottles of body wash in your local drugstore to see how “feminine bath products” are sweet, light, branded with flowers and fruits, and emphasize care and softness… while “masculine bath products” are heavy, abrasive, and emphasize mechanical or even predatory imagery (“wolf bane” “axe” etc branding).

The thing about men who are proud to be “straight acting” is that they tend to think “gay acting” is bad and if you unpack that for two seconds it’s pretty clearly rooted in misogyny- if women are seen as worse than men, then acting like a woman is seen as shameful.
posted by nouvelle-personne at 10:17 AM on June 17, 2023 [9 favorites]


Stop with the 'idle curiosity' thing. It's like smacking a child for asking why the sky is blue.
posted by zengargoyle at 10:23 AM on June 17, 2023 [4 favorites]


Response by poster: I think it would be useful to know in what context you're hearing the phrase and how it relates to your work in the ER

I'm hearing the phrase from gay patients, who often use it to describe themselves and others

From a clinical perspective it's irrelevant to treatment protocols, algorithms, tests, treatments, etc

From a practical perspective, nomenclature is very important to case notes written by physicians in a patient's medical record. For me, the question is whether "Straight Acting" is an appropriate/meaningful way to denote--in writing-- specific biological and/or personality traits for gay men
posted by BadgerDoctor at 10:28 AM on June 17, 2023 [3 favorites]


I wouldn't use this phrase in case notes, no.
posted by potrzebie at 10:49 AM on June 17, 2023 [35 favorites]


I agree with epj above - ask them! We can tell you what we think but it might mean something different to your patient and in this context, their definition is what matters. Plus it’s a good opportunity to demonstrate humility and build a better relationship with the patient by showing that you know you don’t know everything. “I’m sorry but I don’t know what you mean by that. Can you explain?”
posted by kat518 at 10:51 AM on June 17, 2023


So how relevant would other expressions of homophobia be in your case notes? Do whatever you'd do then, I guess.

In your context, they're likely not trying to date you so what it might mean to another gay man (basically: I don't want to go to gay clubs or gay events or otherwise be associated with cultural gayness) is an entirely different thing than what it's gong to mean said to a doctor. They're assuring you they're "not like Those Bad Gays who are Obviously Gay In Public" and that they behave socially in ways that they think make them pass as straight men to a society that punishes people for seeming gay.

It's meant to assure you of their respectability and adherence to the perceived norm, and that is likely due to the fear of being mistreated by the medical institution for being assumed disposable (for which there is ample precedence). I can't honestly imagine why else they'd bother saying it so often to you that you've taken notice, except they're afraid you're going to hurt them or mistreat them on purpose where you might give a straight man better treatment. It's the exact same reason I have dressed up when I've had to go to the ER, lest I be mistaken for a poor fat woman instead of just a fat woman.

Consider that when you are opining on people's "personality traits" in case notes, as this is exactly what they get used for - calling out people who fail to meet the acceptable white male-dominated norm. Black people are combative or aggressive, fat people are non-compliant, poor people are just discharged. Write "afraid of being killed" instead maybe.
posted by Lyn Never at 10:53 AM on June 17, 2023 [18 favorites]


If you would not put “this person acts stereotypically gay” in case notes, there’s no reason to put “this person has assured me they do not act stereotypically gay” in case notes, no. If you do in fact ask them what they mean by that, and learn something clinically relevant about their behavior, that follow on detail could go into the case notes.
posted by Stacey at 11:00 AM on June 17, 2023 [13 favorites]


Response by poster: Lyn Never: So how relevant would other expressions of homophobia be in your case notes?

I didn't realize it was homophobic until now. It goes w/o saying homophobic labels have no place in medicine.
posted by BadgerDoctor at 11:05 AM on June 17, 2023 [3 favorites]


It means they think they would not get clocked. They are probably wrong.
posted by hworth at 11:08 AM on June 17, 2023 [2 favorites]


For me, the question is whether "Straight Acting" is an appropriate/meaningful way to denote--in writing-- specific biological and/or personality traits for gay men

If that's your question, I would leave that detail out of your case notes and writing about these patients. I don't see how it is useful in terms of medical treatment. It just means they don't act in a way that is seen as stereotypically gay. I wouldn't put "stereotypically gay acting" in there either for that matter.
posted by wondermouse at 11:12 AM on June 17, 2023


It reeeeeeeeeally depends on where you're hearing it--are men describing themselves this way to you, the doctor? If it's guys talking amongst themselves they may mean it as derogatory. Like, who the hell does he think he is? Or it could just mean that a guy is less stereotypically feminine. Which again, can be a negative or a positive depending on who's talking.

I wouldn't worry about it as a clinical term. It's just a way someone presents and it isn't a euphemism for any sort of sexual behavior pattern.
posted by kingdead at 11:23 AM on June 17, 2023


Mod note: One comment edited to remove a slur when quoting the Urban Dictionary. It's totally ok to leave such slurs out, even when quoting other sources. Another comment removed that was a bit judgemental. Please treat the question as an honest one that seeks clarification.
posted by Brandon Blatcher (staff) at 11:30 AM on June 17, 2023 [3 favorites]


From a clinical perspective it's irrelevant to treatment protocols, algorithms, tests, treatments, etc

Context is important. If these patients are using "straight-acting" to make you aware of their sexuality, it's because gay men do have different health concerns than straight men that are relevant to differential diagnosis, testing, treatment protocols etc. But if that doesn't seem to account for why patients are telling you this I agree that you should just ask - perhaps there's some other relevance to their health care. I don't think it's appropriate to use in documentation unless the patient is explicitly tying it to their presenting problem.
posted by fox problems at 11:47 AM on June 17, 2023 [3 favorites]


It’s not a euphemism for “I’m not out” or “I’m in a hetero relationship but I also have gay sex” therefore it’s not something you need to record in notes IMO (though of course I’m not a Dr and don’t know what these notes are used for. Just doesn’t seem medically relevant.)
posted by kapers at 12:26 PM on June 17, 2023 [3 favorites]


Clinical notes wise: recent homosexual activity.

Presentation or either side doesn't matter.

(Not a doctor, but audited nursing notes for people (mostly children) who needed daily care..)

Medical professionals need to communicate directly and precisely all things that could lead to a diagnosis and treatment.

'Straight presenting' doesn't really matter besides the homosexual.
posted by zengargoyle at 12:55 PM on June 17, 2023 [3 favorites]


Just for clarity, nothing about "straight acting" necessarily implies sexual activity, recent or otherwise.
posted by quacks like a duck at 1:31 PM on June 17, 2023 [11 favorites]


I will try to rephrase this in a way that won’t court deletion: as a gay person, I am unsettled by the idea that I might visit a doctor who takes my self-description of my sexuality and presentation as something that makes me biologically distinct from other types of people. I would urge you not to mentally other queer people in this way, and instead consider what they might need from you as individuals. Your curiosity about this isn’t a problem, far from it in fact, but the use of the word “biologically” in this context is something I found personally upsetting.
posted by showbiz_liz at 2:32 PM on June 17, 2023 [14 favorites]


Hmm honestly I am surprised how many people think that the term is homophobic or implies self hatred. IMO there's no need for it to be included in case notes. It might cause people harm in the ways that outing people in medical contexts can.

I think some people say it with self-awareness. Personally, I act gay. I know that, I joke about it, it's funny to be a stereotype sometimes. I have some friends who I refer to as "culturally straight" in the same way that I talk about some people being WASPs (mostly people who can't take a joke). I think being self aware about these things is good, and discussing yourself in these ways is neutral. Discussing others is sometimes neutral and sometimes rude, or it can even be affectionate. I think this kind of speaks to some cultural differences about taking about cultural differences.

Also, I don't know how seriously I would personally take women's opinions on gay men's self-ID.
posted by Summers at 3:27 PM on June 17, 2023 [13 favorites]


Sorry, I should have said "cis women or straights men's opinions"
posted by Summers at 4:15 PM on June 17, 2023


Best answer: I did my epidemiology PhD at GWU in the early 2000s while working nights at the Crew Club. You should do yourself (and your department) a favor and take this question to the folks at Whitman Walker. You're in a position that calls for more than insight from internet strangers. WW will be able to give you the trianing you need to understand the language, mores, routines, and practices that are relevant to the hyper-local population you serve. I mention Crew Club because, for the years I worked there, it was apparent that my knowledge was insufficient to address medical care and concerns of other men who have sex with men, even in the context of a bathhouse. Taking care here and consulting professionals who work on this question for a living is the difference between someone seeking medical consultation or avoiding it because the terminology/approach is so uncomfortable.

I worked with/at Whitman Walker for a very long time. They have the insight and training you're seeking. Good on you for asking.
posted by late afternoon dreaming hotel at 6:37 PM on June 17, 2023 [37 favorites]


For me, the question is whether "Straight Acting" is an appropriate/meaningful way to denote--in writing-- specific biological and/or personality traits for gay men

To answer this question for you (if you haven't already gleaned it from the above): no, it is not appropriate or meaningful, nor does it denote any sort of "biological" traits (I'm with showbiz_liz on that score). If someone uses it to define themselves and their experiences, that's totally fine, but it has no place in clinical documents. As you yourself pointed out, it doesn't have any impact on a person's medical treatment.

If you had actually asked this question up front, you would've had a very different set of answers here. Something to consider for next time.
posted by fight or flight at 3:08 AM on June 18, 2023 [3 favorites]


There's a lot of good discussion here on the problematic term. Seconding the comments understanding it sounds important in your practice and hope you learn what you're trying to. Just wanted to say one specific thing relevant to a medical care context:

"Straight acting" does not really describe a man's sexual practices. It's more of a cultural / social thing, not a description of favored sexual acts. I don't think anyone in this discussion has said that it might but it's a mistake I've seen people make when trying to understand gay language.

You might think "straight acting" implied playing a role like a heterosexual man while having sex. Never sucking cock, for instance, or never getting fucked up the ass. But I've seen plenty of Grindr profiles of people advertising themselves as "masc" or "straight acting" who are also "total bottoms" or are really looking for some dick to suck. Sometimes men-who-have-sex-with-men convolve "straight acting" with "all about penetrating with his penis" but it's by no means consistent or exclusive.
posted by Nelson at 6:28 AM on June 18, 2023 [3 favorites]


Great suggestion to get an expert to do an in-service, grand rounds, brown bag, or something for you and colleagues. Feel free to ignore well intended but harsh feedback from folks here who lack deep connection to gay men.
posted by latkes at 9:23 PM on June 18, 2023 [1 favorite]


Response by poster: 24 hours on and still digesting this thread, the following is nevertheless crystal clear:

You guys answered my questions in ways that reveal how much I don't know. That's rare. I can't thank you enough.
posted by BadgerDoctor at 8:29 AM on June 19, 2023 [6 favorites]


In addition to Whitman Walker, which is an excellent local resource, you can also avail yourself of the AIDS Education and Training Centers, both the national clinician line and the regional center. They can answer questions and also provide regular trainings for you and other people on your team who may have similar questions. They do not have to be HIV-specific but can include broader sexual health questions like this one.
posted by gingerbeer at 11:06 AM on June 19, 2023 [3 favorites]


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