Newbie, castrated by cancer, considering nullification

[Robin Lee (imported)]

Hello! I'll try to stick to basics here, as this is just an intro. I have not had any testosterone for five years now. Also no sexual thoughts nor even an erection. My right testicle was injured and removed ten years ago. Then four years later I was diagnosed with advanced prostate cancer, had a prostatectomy and was started on Lupron (androgen deprivation therapy). Surprisingly, none of my doctors ever tested my T level, even though I had inquired about it. Anyway, it was a crazy time time in my life and I became depressed. Plus the hot flashes were driving me crazy. After doing some research I asked my GP for venlafaxine, an antidepressant that stabilized my moodiness and helped with the hot flashes.

Ultimately I required an artificial urinary sphincter implant in order to under adjuvant or "salvage" radiation. The device has a limited lifespan and requires periodic replacement. The prosthetic which was hurriedly implanted so that I could undergo radiation leaks considerably, and I must wear an absorbent pad. Because I am damp all the time, the folds of my scrotum and shriveled penis are always moist and I sometimes develop UTI's.

The Lupron ended several years ago, but my testosterone never rose above 50 (normal is 300-1100). My single remaining left testicle never survived the cancer treatments. This apparently happens in about 5% of advanced PCa cases involving ADT. My urologist recommends that I NOT take TRT as it could potentially feed the cancer. There are divergent opinions on this topic (i.e., Morgentaler saturation theory, etc). Basically I cannot become erect, ejaculate, or even become aroused. I find beautiful women attractive but it's more like my envy of their "hotness" rather than a desire to engage in sex or even affection.

My wife has been very understanding through most of this. She is also a cancer survivor and has some crippling bone degeneration that causes coitus to be uncomfortable. Now that I am unable to satisfy her I have told her that I would understand if she wanted to seek a lover, but she is not interested in that either. We are affectionate with each other and have two grown sons so there are no issues with procreation.

I will be speaking with a genitourinary surgeon next month regarding replacing the artificial sphincter. In addition, the bladder and urethra have been subjected to radiation, which damages their elasticity. I hope to also speak with the surgeon about also removing my atrophied left testicle, the remaining wrinkled scrotum and possibly also my penis. Essentially I will never use them again. Presently I must sit to urinate because I never know which way or how far my stream might go when I release the urinary sphincter. Without the penis it would be much easier to keep a pad in place. This is assuming that the replacement device will leak as much as the old one has. The surgeon may say that it won't leak, but so did the previous surgeon about the existing appliance.

I figure if the surgeon is going to be cutting into my nether regions that maybe he could remove some of the excess tissue in the area. I've already read a few threads here, plus the very excellent "Eunuch Blog" and have learned that the terminology is a penectomy with nullification (I think). I'd like to sound as though I've done sufficient research when I speak with the surgeon to make sure he understands my situation, concerns, and wishes. Can some of you perhaps give me some guidance in how to approach the subject with him. Though my wife and I have experimented with bisexuality, BDSM and such, there is no gender dysphoria on my part, nor any desire to become a female (though without any T I have already developed gynecomastia).

Thank you for reading!

[Losethem (imported)]

Thank you for your thorough explanation of what has been your experience so far. I'd say the main concern would be with there is no gender dysphoria on your part, at least as far as the reaction to surgeons regarding a request to remove your penis. I'll also not it's not unheard of for a guy to lose his penis outside of that, but it's not common if the tissue is otherwise healthy. In your case, I'm reading it may not be, as you have the urinary issues you've identified above.

It could be considered a cosmetic procedure by many insurance companies here in the US, despite the fact it involves a need to create a perineal urethrostomy (read: new pee hole on your crotch) if it were to be done. This is not said to discourage you from pursuing this if it is what you want, just a simple reading of the tea leaves with how many surgeons will likely see such a request.

It sounds as if you proceed you would be what we would call a nullo (as I am). I think you've made a great attempt at the various classifications of men who have different surgeries down there, but generally those only wanting the penis gone do not seem to have a title of any sort, other than they've been penectomized. Eunuchs (testicles) and Nullos (testicles and penis) have their titles. Ultimately, we're all whomever we wish to be, so the titles are largely irrelevant other than identifying the type of surgery one has had, unless one wishes to directly identify their gender as eunuch or nullo.

Gee, it's getting complicated.

Best of luck as you navigate to what's next for you. I can imagine it's been a difficult journey so far.

[Origen22 (imported)]

Robin,

I wish you well after such a horrible experience. I am sure that each of those intrusive surgeries was painful and required considerable recovery time. I am not a eunuch, so have nothing to say about your choice, but I hope whatever you do is a path to a healthier, life

[WheelyCurious]

Welcome to EA, though I am sorry for the unfortunate series of events that brought you here.

One thought that occurs to me is that if you have difficulty directly making a case for what you want with the surgeon, then you might be able to get help from a Transgender center if there is one near where you live... While they seem primarily interested in cases of people with gender dysphoria, it seems that you could make a case for wanting the surgery because of the discomfort and difficulty of dealing with your current situation... I think you could make a case that you have dysphoria due to your medical issues that have left things non-functional and causing problems... My personal situation is arguably less severe, but similar in that I've been rendered non-functional by my SCI, and this argument seems to be working for me.

What you describe sounds very much to me like a few folks I know that have had limbs amputated after accidents or other damage where the efforts to do surgical repair haven't been sufficient to get function back, and / or left them with to much pain.

I would push very hard on the idea of how your current situation is causing you quality of life issues and how your desired surgery would help them... You could also possibly wave the ADA at the docs arguing that the leakage and related issues would count as a disability....

WheelyCurious

[Robin Lee (imported)]

Thank you everyone for your comments. I'm glad that I was able to find this forum as it has already been a tremendous source of information. As far as what I see as my present sexual identity I would have to say that I am asexual, in that I have no inclination toward any sexual thought or activity. But as I said, I do find beautiful women to be very attractive, such as the hottie that I chose for my avatar. I'm definitely straight, but can no longer even fantasize about sex.

Having the artificial urinary sphincter is already a delicate balancing act, as the pressure from the device erodes urethral tissue, and the replacement must be located at a different spot along the urethra. So eventually one runs out of viable urethra. Because of that, the true nullo penectomy would shorten my urethra and thus reduce the length of viable urethra for future placement of the sphincter device. But I may ask about "tightening up" the loose skin, sort of like circumcision. But I will ask about removing my one remaining and non-productive testicle and have the scrotectomy, for reasons of hygeine, that is, reduction of accumulated dampness. I may breach the subject with the surgeon by asking if he does gender reassignment surgery.

I would be able to pay for some of the work that might not be covered by insurance. All this adds to the anxiety and decision making required by any medical procedure, especially those that involve life altering treatments. The surgery itself is not a major concern, as I've had eighteen already over the years, and know that I already have two more just waiting for me to make the decision when.

Thanks again everyone. Wheely, I understand about your SCI, as my wife was a rehab nurse. I couldn't imagine having sexual urges and be unable to satisfy them. I too would be looking for castration. As it is, I occasionally have erotic dreams that "would" become wet dreams, if only I had that capability. They are usually frustrating, as my impotence and incontinence follows me into my dreams.

[Losethem (imported)]

The viable urethra tissue part of your post gave me pause, I could see where this would be problematic for you regarding having the penis removed. One thing the male apparatus has is extra urethral tissue, so while inconvenient, the artificial sphincter seems a more viable option for males than females, long term. The choice in your case seems to keep the penis so you have that tissue, or eventually a life of complete incontinence. I do not envy the decision you have to make, I can imagine, again, it's quite a difficult one.

I think bringing up the surgery in context of asking the surgeon about their performance, or not, of gender reassignment surgeries as a good door for opening the conversation. Though I'm guessing at this point you're not shy about bringing up potentially sensitive subjects with your care team as you've had enough experiences at this point doing that.

I remember when I finally got over it all after I had my genitals removed. Now I just blurt it out to care providers. Once they blink a couple of times in my general direction, we move on with the rest of the appointment. Sometimes it's good comic relief, that blinking. I do remember having one young medical assistant blush when she told me I needed to swab the end of my penis before giving a urine sample. My response to her was, "You didn't read the chart, did you?" It's a little difficult to swab what one does not have on their body. I did tell her it was fine, as I've had the situation come up more than once. LOL

I do wish you the best as you navigate this. I can imagine it's a field of difficult choices with some more so than others.

[Robin Lee (imported)]

The viable urethra tissue part of your post gave me pause, I could see where this would be problematic for you regarding having the penis removed. One thing the male apparatus has is extra urethral tissue, so while inconvenient, the artificial sphincter seems a more viable option for males than females, long term. The choice in your case seems to keep the penis so you have that tissue, or eventually a life of complete incontinence. I do not envy the decision you have to make, I can imagine, again, it's quite a difficult one.

In support forums, I've only encountered one female who has the artificial sphincter. I had previously understood that (biological) women's urethra was too short to allow placement. And when I asked where the pump (control valve) was located, she said in her labia. Who's have known.

Anyway, having cancer was the most anxiety inducing and depressing thing I've ever been thru in my life. There are so many unknowns, possible treatment options, SE's and outcomes that it seems one is constantly faced with life altering decisions, and there is only one chance to get it right. I have now developed a somewhat cavalier attitude toward surgery.

BTW I've changed my avatar. I wanted something that stood out, which the hot chic certainly did. But she appeared to be mocking me. The tattoo I switched to mean "neutered".