When confronted by a patient who asks to be castrated, far too many surgeons immedately fall back on an extreme version of the Hippocratic Oath: "First, do no harm." They interpret that to mean that they should never remove otherwise healthy tissue. If testicles are functioning, they should not be removed under any circumstances.

If that extreme form were universally true, how could a surgeon remove a ruptured appendix since it involves cutting through healthy tissue? How could a physician prescribe a medication that had any known adverse side effects?

The answer is, of course, that they normally interpret the admonition to do that which produces the maximum benefit while producing the minimum of harm.

A recent article rather gently prods urologists to confront the question of voluntary castration on the basis of harm reduction:

The hidden world of self-castration and testicular self-injury

Thomas W. Johnson and Michael S. Irwig

Nature Reviews / Urology. advance online publication 8 April 2014; doi:10.1038/nrurol.2014.84

ABSTRACT: Eunuchs are biological males who have undergone voluntary castration
 for reasons other than male-to-female transsexualism. The term ‘eunuch wannabe’ refers to individuals who desire, or are planning, voluntary castration. Out of fear 
of embarrassment or rejection, many eunuch wannabes do not consult medical professionals regarding their desire for voluntary castration. Instead, they commonly resort to self-castration, castration by nonmedical professionals, or self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures. In particular, intratesticular injection of toxins is performed so that urologists will remove the damaged testicles.

<<oooOOOooo>>

I would be happy to send a PDF copy of the 4-page article to anyone who wants one. To receive your copy, send me a <Private Message> that includes an email address that will accept attachments. The article is a small attempt to make a difference.

That is a great article. It does rather draw attention to the archive and what we are up to! I guess that the damage done is so extensive that they will still have to remove them, even if they suspect otherwise. On the other hand if it helps to chip away at the edge of medical reason Hallelujah! I suspect it will be a good while longer before voluntary castration is an accepted routine procedure.

It may well be that before medical practice catches up with some of our desires there will have to be a place in our society for eunuchs and other sexually "non-standard" persons. I see the lack of social position or acceptance as the most restrictive barrier we have to face. --FLO--

The answer that most doctors come to when confronted with what they think is unusual or strange is not "first do no harm" . . .

That begs the question of what "harm"

Is the patient's psychological well-being harmed by inaction or is the patient's physical we-being harmed by inaction?

A man comes to his urologist and says "doctor, I hate my genitals and I'm going to destroy them" does the doctor merely answer that physically this is a not a socially or medically acceptable to remove or alter one's genitals for cosmetic purposes understand the statement?

Chances are not. "Do no harm" also means the psyche as well as the physical body.

If I went to a urologist or any doctor with that same attitude, I would phrase my opening this way: "Doctor, I have hated my life as a man since puberty and possibly before that time and wish more than you could imagine to become sexless or transgendered. AND, if you are incapable or unwilling of helping me with that goal then please advice me of a doctor who is capable or willing."

Do I think that's a harsh way to treat a doctor? No I do not.

Dave (imported) wrote: Sat Apr 19, 2014 6:03 pm The answer that most doctors come to when confronted with what they think is unusual or strange is not "first do no harm" . . .

That begs the question of what "harm"

Is the patient's psychological well-being harmed by inaction or is the patient's physical we-being harmed by inaction?

A man comes to his urologist and says "doctor, I hate my genitals and I'm going to destroy them" does the doctor merely answer that physically this is a not a socially or medically acceptable to remove or alter one's genitals for cosmetic purposes understand the statement?

Chances are not. "Do no harm" also means the psyche as well as the physical body.

If I went to a urologist or any doctor with that same attitude, I would phrase my opening this way: "Doctor, I have hated my life as a man since puberty and possibly before that time and wish more than you could imagine to become sexless or transgendered. AND, if you are incapable or unwilling of helping me with that goal then please advice me of a doctor who is capable or willing."

Do I think that's a harsh way to treat a doctor? No I do not.

Or be prepared for when I do it myself...?

...

JesusA (imported) wrote: Sat Apr 19, 2014 8:08 am self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures. In particular, intratesticular injection of toxins is performed so that urologists will remove the damaged testicles.

It looks as if the jig could be up for some Johnnies-come-lately.

As you all know, I have done injections of both alcohol and calcium chloride. I have also attacked myself in desperation and tried to hack them off. We all know that there are many who will follow this route using one method or another, usually failing, sometimes surviving and sometimes killing themselves in the process. My first reaction to the article was brilliant well said and thought out and then 'F**k, what if my urologist sees this before they remove mine.... Self preservation is always there. I don't want anymore obstacles.

They do need to prepare for 'when I do it myself', because if the desire is so strong we all know there are those of us who will try at least once. I can not believe that I did to myself what I did, I am shocked at what came over me.

In pure economic terms it would be cheaper to offer a service than clean up the mess of botched DIY attempts. I am afraid that generally the morality of the UK extends to the cost(we still have a free at the point of need, paid for by tax service). If there were enough cases in the UK they would change the law. But not until then. Unless the rest of the world led the way and we were forced (morally) to reluctantly follow.

I think, the US will probably lead the way here, you have more people than the UK and so the numbers are bigger. It just takes one well respected urologist to pick this up and run with it. It will probably also take for Eunuch's United to get out on the streets. Just as the LGBT community do or join forces with them.

Fortunately, I am now in the medical system getting tests and scans etc and hopefully this part of my journey will end soon. God only know what I would have done without the support of EA over the years.

unencumbered (imported) wrote: Sat Apr 19, 2014 6:24 pm It looks as if the jig could be up for some Johnnies-come-lately.

I doubt that urologists knowing about injections will significantly reduce the probability of a urologist not removing injection-damaged testicles; indeed, greater awareness of a person's sense of need can only, over the long run, be helpful, methinks.

For myself, in 1986, I was able to turn the tables, so to say, on "do no harm" by demonstrating enough cancer risk from my family history and my bioengineering graduate school work in pattern recognition methodologies for identifying risk from rare forms of cancer, my graduate school adviser's academic specialty.

What worked for me was being more informed about the relevant aspects of biology, as a Ph.D. bioengineering graduate student than was any physician that I consulted, along with a clear and convincing demonstration that, without proper surgical help, I would become a "do it yourselfer" because because I was unwilling to commit suicide by genetic cancer risk. The rare genetic cancer risk I have is now labeled attenuated familial adenomatous polyposis. It did in my dad and brother, but, thanks to sufficient, timely, surgeries, I have been able to live past the average life expectancy of someone born where and when I was, without developing cancer.

There are the burgeoning lawyer advertisements on TV for people who developed complications from testosterone supplementation. I understood the nature of that risk before 1986, through my grasp of human biology.

"the nature of that risk"? Both the risk from testosterone and the risk from the legal profession...