Avoiding Hormonal Shock

[Beau Geste (imported)]

A number of posts on the Archive's message boards have described how a sudden change in the level of hormones--specifically testosterone--in someone's system can cause a variety of negative symptoms in a person, both physical and psychological. If I remember correctly, even people who are as reasonable, positive, and level-headed as the Fraj and IE, have reported that they had self-destructive psychological states for a time after their orchiectomies. This sort of effect seems to be sufficiently common, that it can be considered predictable. In terms of physical symptoms, hot flashes apparently are almost a universal symptom which occurs after a rapid reduction in someone's testosterone level. On the other side of the testosterone scale, I've read that people who take large doses of steroids get "roid rages" and also experience a variety of physical symptoms if they start their steroid dosages at high levels.

Since this Archive is, apart from the story section, devoted largely to the whole issue of managing hormone levels and dealing with the effects of them, my view would be, that the whole issue of orchiectomy and various hormone manipulation, is really, at bottom, a matter of controlling a person's level of hormones and finding the level with which he's comfortable. That is to say, orchiectomy is only part of a process which should be looked at as one of testosterone levels, and not simply a matter of surgery.

So, it would seem to me, that the basic goal of reaching a specific hormone level, is, in general, the main motivation for orchiectomy and also for using various pharmaceutical means to reduce testosterone levels. And if the goal of reaching a specific level can be reached without any sudden changes in hormone levels, that would seem to be preferable to a quick alteration in hormones. What would appear to be the best way to get to the desired level, if orchiectomy is the desired method, would be, for the individual who had decided on orchiectomy, to go to a pysician and determine what his original hormone levels are while he is uncastrated. Then a regimen of a testosterone replacement dosage which would approximate that, could be prescribed by the doctor. The replacement dosage could be started shortly before the orchiectomy, or immediately after surgery. Then the person could continue the dosage after his operation. This ought to forestall the development of distressing or dangerous symptoms.

Since the motivation for removal of the testes was to reduce testosterone levels, the individual could gradually reduce his dosage of testosterone over a period of several months, or perhaps more than a year. Whenever he reached a dosage with which he was comfortable, he could continue at that dosage. If he wanted to eliminate the use of replacement testosterone entirely, he could eventually taper off his dosage and stop taking the hormone. If I have read some of the posts correctly, the body adjusts to lower levels of testosterone over time, and I would think that a process of this type would eliminate much of the difficulty that people have in the past experienced after orchiectomy.

Of course, for those who have the testes removed as a treatment for prostate cancer, replacement testosterone is not, as far as I know, considered an acceptable option after surgery. But for those who have elective orchiectomies, as well as those who have had the testes removed because of testicular cancer, I would think that maintenance of testosterone would almost always be a possible course of treatment.

From what I have read, both Dr. Kimmel, and Dr. Spector before him, saw their roles in orchiectomy and hormonal change, primarily as surgical ones. That is to say, they saw their function as the removal of the testes, and they had discharged their responsibility as soon as the incision healed. There are actually several types of surgery where the surgeon more or less hands the patient off to another type of specialist after the surgical wounds have healed.

So I would think that someone who wanted to follow a process like the one I have described, in getting an orchiectomy, would probably have to find another physician to manage his care both before and after the surgery--but, since that physician wouldn't actually be involved in the orchiectomy, there doesn't seem to be any reason why any urologist or internist wouldn't provide that sort of care.

I'm curious as to whether anybody has actually followed a process, in getting an orchiectomy, like the one I've described, and whether it was less stressful than the experience of those who simply had an orchiectomy and then didn't take any hormones during the postoperative period. To me, as an observer, it would seem an entirely logical and sensible way to have the surgery done and to get to the desired goal by taking hormone replacements and then tapering them off. Of course, it might be more difficult than it looks to someone who hasn't studied the details of this type of surgery and hormone management.

[bobbie (imported)]

I was on androcur and found out that my hormones were only decreased about half after a year. I increased the dose and was at full shut down for a long time before my castration. I sort of eased myself into being an eunuch. I did not get many of the side effects that so many have. The physical effects were as predicted. The emotional changes were far more life changing then expected. Having no testosterone for many years has be good for me.

The lack of testosterone effects every one so differently. Having meet many eunuch's I see no real pattern on how it changes them. Many had to go on low levels of testosterone or estrogen to help them adjust.

My best advice to anyone is to try out castration by chemical castration drugs to see just how it will effect you. My experience have been posted as have many others on how castration effected their lives.

[kristoff]

You make some very large assumptions in your observations and conclusions. The largest of course is that the principal, presumably over-riding ambition in seeking orchiectomy is change in hormonal levels, i.e., reduction of them. In many cases that is undoubtedly true. There are a significant number of folks for whom that is NOT the ambition. For example, in the recently published work by Johnson and Wassersug, et al, fully 39% of eunuch respondents from the EA indicated their reason was not hormonal, but rather cosmetic and / or body dysmorphia. Those items do not imply hormonal concerns, though they may come into play at some point. They do concern issues of physical appearance (or lack thereof). See here:

http://www.eunuch.org/vbulletin/showthread.php?t=11449

Utilization of hormonal supplementation is always an individual and highly variable thing. In suggesting a "trial run" with chemical castration, often this provides an introduction to the hormonal issues for those for whom that is a concern. For those for whom dysmorphic concerns are at issue, it would play much less of a role, but may be an essential test (for example, if the dysmorphic does not use hormones, or cannot get them, or get them in adequate supply).

The bottom line is that there are always drawbacks in generalizations.... My own experience here over a number of years is that very few folks experience very many these things in any singularly uniform manner.

[Beau Geste (imported)]

I realize I was generalizing in my post. Mostly, I made the post because I was curious as to whether anybody had actually planned the pattern of taking testosterone over the period immediately after orchiectomy, and decreasing it gradually, to try to avoid the effects of hormone reduction. To some extent, Bobbie's experience would seem to have shown that that way of approaching removal of the testes, can forestall some of the physical and psychological problems that people have reported. But I would doubt that many people would have the patience to go through the extended process that Bobbie went through.