Meeting Notes

[JesusA (imported)]

Now, after the teasers on paraphilias and on the proposed change of terminology from Gender Identity Disorder to Gender Dysphoria, the important part.

Richard Wassersug and I were in Norway and Sweden to propose that Male-to-Eunuch be added to the DSM as a category that needs and deserves proper consideration from professionals – including surgery by a properly licensed surgeon, where indicated. The response at both meetings was quite positive and our proposed DSM wording was accepted by the chair of the appropriate sub-committee for transmission on up the line to the final editor. (This is not a guarantee that it will be in the final edit, but it bodes well for it.)

This would not, of course, mean castration-on-demand from a surgeon such as Murray Kimmel, but it would mean that there would be many more surgeons willing to perform castrations and/or penectomies with proper letters from professional counselors. And, it means that counselors would be more willing to provide such letters.

What we proposed is mostly parallel to what is required for Male-to-Female or Female-to-Male Gender Dysphoria. The major difference would be that there would be no requirement for a year of “real-life experience” of living in the target gender. (How does one dress and present publicly as a eunuch?) Instead, there would be a requirement for a year of chemical castration. Ultimate diagnosis and treatment would depend on the person’s response to chemical castration:

1) If the person was pleased with the results and still wanted surgical castration, he should, as soon as he demonstrated that he fully understood that it was irreversible and fully understood the long-term side-effects, be given a letter and helped to obtain surgery.

2) If the person was pleased with the results and did NOT still want surgery, he probably was most interested in libido control and should be provided with chemical castration on a long-term basis.

3) If the person was NOT pleased with the results of chemical castration and still wanted surgery, he probably has a Body Integrity Identity Disorder or a Body Dysmorphic Disorder. He should continue counseling and may, at some point, be referred for surgery. Research on BIID is in its infancy, though there doesn’t seem to be any “cure” other than amputation at this point. Since BIID will probably be in the next DSM, surgery may become the treatment of choice, after proper counseling.

4) If the person was not pleased with the results of chemical castration and no longer sought surgery, he may still need some further counseling, but he will have certainly been saved from an irreversibly mistake.

It will, of course, take time for all of this to happen, but I think that important progress has been made. There are now many more professionals out there who are ready to take all the varieties of eunuch-wannabes much more seriously and who are ready to help.

In talking with several of them, it was fun to see their shock of recognition as they realized that some of their “Male-to-Female” clients who had disappeared after getting an orchiectomy were really Male-to-Eunuch. I even recognized some of the clients whom they spoke about and could add information to help them understand that MtE is real and deserving of appropriate care.

Two more articles on the subject have been provisionally accepted for publication (pending rather minor revisions). One should go back to the journal next week and be in print by the end of the year. The other is for a special journal issue scheduled for next spring and will be revised in light of the other articles accepted for that issue. We don’t expect to begin our revision until the fall. There are more articles targeted for a variety of professional journals at various stages of construction. I will post abstracts and a way to get copies as each finally sees publication. Remember that the four articles based on the first Eunuch Archive survey are available in PDF format for anyone who sends me a <Private Message> requesting them and gives me a return email address that will accept attachments.

Those with whom I have spoken on the telephone in the past week know that there’s also an exciting extension of the survey data that may help prostate cancer patients. We’re working with a young neuroanatomist on the findings. I will keep you all informed as his research begins to jell.

I want to again thank all of you who took part in the Eunuch Archive surveys. The data you provided should provide long-term benefit for a great many people.

[Losethem (imported)]

Jesus--

I like you, but this particular path for people with BIID, of which I consider myself one, is a rather terrifying prospect. If I still had my balls, chemically castrating me for a year before going, "yup, unhappy with this, so he must be BIID" would be hugely counterproductive and likely set me on the path to sucking on a gun.

I hated my balls, they were a foreign growth on my body, and I wanted them gone. I knew this for 20-years or more, and the solution that made me absolutely happy with my body was to get my testicles amputated.

Is the medical establishment going to chemically castrate all BIID sufferers, regardless of the type of limb/tissue removal they seek? (IE people who want to lose limbs) Yes, I know that is a ridiculous question, but that's essentially what you're doing. Giving a type of treatment to a person that is counter to what they are ultimately seeking. Why not just euthanize BIID eunuchs at that point, it would be more humane.

Chemical castration will work if you're testing a person that is interested in lowering their libido decide if physical castration is right for them (and it sounds like you would insist they remain chemically castrated but not physically castrated indefinitely), but doing this to a person with BIID in my opinion would do more harm than good.

This said, I'm glad someone is at least taking up this project and presenting it to people, but I'm afraid as presented, if I still had balls I'd do the same thing I did before - go to a cutter. And isn't that what you're wanting to prevent?

Just my $.02 worth.

--LT

[kristoff]

Jesus--

I like you, but this particular path for people with BIID, of which I consider myself one, is a rather terrifying prospect. If I still had my balls, chemically castrating me for a year before going, "yup, unhappy with this, so he must be BIID" would be hugely counterproductive and likely set me on the path to sucking on a gun.

I hated my balls, they were a foreign growth on my body, and I wanted them gone. I knew this for 20-years or more, and the solution that made me absolutely happy with my body was to get my testicles amputated.

Is the medical establishment going to chemically castrate all BIID sufferers, regardless of the type of limb/tissue removal they seek? (IE people who want to lose limbs) Yes, I know that is a ridiculous question, but that's essentially what you're doing. Giving a type of treatment to a person that is counter to what they are ultimately seeking. Why not just euthanize BIID eunuchs at that point, it would be more humane.

Chemical castration will work if you're testing a person that is interested in lowering their libido decide if physical castration is right for them (and it sounds like you would insist they remain chemically castrated but not physically castrated indefinitely), but doing this to a person with BIID in my opinion would do more harm than good.

This said, I'm glad someone is at least taking up this project and presenting it to people, but I'm afraid as presented, if I still had balls I'd do the same thing I did before - go to a cutter. And isn't that what you're wanting to prevent?

Just my $.02 worth.

--LT

I have raised the same objection. I concur that there needs to be some form of "testing" protocol for diagnostic purposes for BIID, but a year of chemical castration is definitely not the answer, in my opinion. A much shorter period may be facilitative in conjunction with other approaches to diagnosis and treatment.

[Uncle Flo (imported)]

I, also, see this as a flaw in the process for most of the reasons expressed in the foregoing two posts; however I sense this may be a necessary provision in order to gain acceptance from therapists who may not be willing to go along with anything less. It may be useful to emphasize the inherent shortcomings of this approach to the relevant therapists and surgeons who will actually be dealing with real people in this situation. --FLO--

[JesusA (imported)]

While I understand the objections here to a bout of chemical castration for those who are certain that they have BIID, I would still argue its importance. Not only do we have the data (still being analyzed and yet to be published) from the second Eunuch Archive survey, but there is also an important RAT project that is currently underway. Both point to the necessity of the “test run” of chemical.

The rat study is looking at the impact of castration, followed by HRT, on adolescent male rats. They have achieved full sexual maturity and functioning and have all of the rat mounting behaviors and observable sexual behaviors before they are castrated. Some are left with no testosterone. Others are given full rat-level HRT. Those on rat-level HRT have an AVERAGE return to full sexual functioning of about three-quarters. Some higher; some much lower.

The data from the Archive survey is that those who go back on full replacement level testosterone after castration have an average reported return to prior sexual functioning at about that same three-quarters level. (The data is fuzzier and the sample size much smaller. There’s certainly no ethical way to directly observe human sexual behavior before and after castration!) Some eunuchs on HRT return to the same self-reported level of sexual functioning as they had before. Some achieve only a MUCH lower level.

The testicles provide more than just testosterone. HRT doesn’t replace everything.

Chemical castration provides a worst case scenario. Are you willing to risk the lowered sexuality in order to have those parts removed? No ethical surgeon would operate unless he was certain that the patient understood the risks involved.

A competent counselor would not push someone through an entire year of chemical castration once it was clear that it was BIID, and not something else. BUT, a competent counselor would certainly want to ensure that the person fully understood the risks involved, no matter how small the risk, before providing a letter recommending surgery.

[devi (imported)]

How about a term like "dermaphilia"? The man that who had once assaulted me and had tried to force me into the cellar and was threatening to rape me (I scream very very LOUD) cited that I had very soft SKIN and a beautiful voice and that if I didn't have all the right holes for him he would use something to make another hole blah blah blah.

[tugon (imported)]

I have never thought of myself as BIID but as one who desired reduction of libido. Maybe I had situational BIID and the only time they bothered me was when someone wanted to do something with them. I was fine with them as long as they were ignored by others. After castration my desires to have a penectomy has faded.

If I had access to chemical castration I may never have had surgery. At the time it was easier to find a cutter than a great resource like the EA to learn of chemical castration. I may have still needed surgical castration because several members who have done chemical still need surgical castration. I do support the one year of chemical castration for those wanting libido control. Hearing of one's regrets over being castrated has convinced me a waiting time with chemicals and a letter from a therapist is a good idea and a change in my thought.

As several have posted it took them years to achieve their goals. I began to think about castration when I was about 23 and several years to realize this is what I needed. Before I knew of eunuchs I thought I might be happier as a woman. During those early years the guidelines and years to live as a woman would have kept me from making a mistake. I am glad that a delay might be put into place for MtE. Again this is for men who want to be eunuchs and not men who dislike their testicles and want to be male.

I am happy for these surveys and presentaions not for myself but for all the young folks and future generations that this may help. When BIID and MtE are widely known and appropriately treated many of us will not live with our torture for 18-20 years. I have achieved my goals but I would like to think some young male would not have to wait so long for diaganosis and treatment. I wonder how I would have lived my life if I had been a eunuch since 19 or 20 which I feel would be an ideal age for me. On the other hand I wonder how those for whom castration is not right might live their lives.

For myself doctor's who are more educated and aware of our needs might give better medical care after the fact. I am changing to a doctor who is comfortable with transgender patients. I may finally get some of my issues addressed. I think that this next step even though not perfect for all is a great beginning.

[chilliwilli (imported)]

Jesus's work is the basis for real change not only in the medical community, but society at large. While there is greater understanding of gender variant, doctors need science to form a basis for treatment.

I think three to six months of androcur is plenty of time. The true personality surfaces quite quickly once testosterone is blocked. The hard part becomes gaining acceptance and self awarness once testosterone is no longer a driving force. If someone does not enjoy living without a strong libido, that person would quickly stop the meds.

I did a stint for six weeks a few years back and it was awesome. The trick is getting comfortable in your job/community/family.

chilli-

[devi (imported)]

These meetings were a great step forward. You do great work, Jesus.