BERKELEY, CA (UroToday.com) - This article was built upon information gleaned from interviews with male-to-female (MtF) transsexuals and prostate cancer (PCa) patients, all of whom were on androgen deprivation therapy (ADT); i.e., taking drugs that reduced their serum testosterone to castrate levels.
The MtFs also took estrogenic compounds to promote feminization of their bodies.
In this paper we showed that overall the transsexuals had a better psychological response to chemical castration than the PCa patients. Both groups experienced reduced libido and increased emotionality, but the transsexuals showed more enthusiasm about the changes they experienced; they more readily accepted their reduced libido and their elevated emotional responsiveness.
Different reactions to ADT in the two groups are hardly surprising given that they undergo androgen deprivation under very different circumstances. However, the fact that the transsexuals were able to conceptualize the psychological side effects as positive led us to suggest that some androgen-deprived PCa patients may benefit from exploring ways to reconceptualize the psychological impact of ADT within a positive framework. Implicit here is recognizing that for any PCa patient to do that he first needs to be well informed of the biological effects of ADT.
The genesis for this study came from my trying to make sense of anecdotal and inconsistent statements in the medical literature about how androgen deprivation affected the personality of PCa patients. I knew that individuals who were transitioning from male to female were also androgen-deprived as part of their medical care, so I started looking for information on MtFs’ reaction to ADT, to see how it compared to the PCa patients’ reaction to similar hormonal treatments. I was concurrently trolling through various online discussion groups for transsexuals and PCa patients when I came across postings from transsexuals who were frustrated by how little breast growth they had experienced from the hormones they were taking, and PCa patients, who were equally distressed by the gynecomastia they experienced from similar drugs. That was a eureka moment for me. I realized then that I could investigate the psychological effects of testosterone by studying the reaction of genetic males in diverse populations to androgen deprivation. Changes that they shared would likely be due to testosterone deprivation itself. Divergent responses would more likely be the result of cultural factors (i.e., expectation and placebo effects). Indirectly then, studying castration became a way of exploring the psychoendocrinology of testosterone itself.
Two things came out of this study. The first was the suggestion that the estrogen the MtFs were taking helped them avoid several of the more serious and distressing psychological side effects of androgen deprivation. It was already known that estrogen could help prevent hot flashes and osteoporosis in androgen-deprived males. Circumstantial evidence suggested that estrogen might also improve sleep quality and protect cognitive function in androgen-deprived males.
Those suggestions led to a more extensive review of the normal roles that estrogen plays in the brains of males, which indeed supported the idea that estrogen can help preserve libido in men on ADT (Wibowo et al., 2011). In that review, my colleagues and I go as far as to suggest that PCa patients on ADT might be better off psychologically if they took supplemental estrogen along with ADT. They would, though, then have to deal with gynecomastia. That concern, in turn, led to a paper exploring the psychosocial issues around the acceptance of gynecomastia (Wassersug & Oliffe, 2009).
The other thing to come out of the comparative Wassersug & Gray study was the realization that the estrogen the transsexuals took made them a less than ideal group for studying the pure impact of androgen deprivation. To get a clearer picture of how testosterone (or its deprivation) psychologically affected adult males, I needed a population of genetic males that was androgen-deprived, but not taking female hormones; i.e., not seeking body feminization. This led me to study the modern day voluntary eunuchs; i.e., men in the western world who wish to be emasculated but do not wish to be feminized. These individuals seek castration, but since they do not wish to present as female, they do not take estrogenic drugs. With many students and colleagues, I have now coauthored several papers on the psychological profile and health status of these men (e.g., Johnson et al. 2007; Brett et al. 2007; Wassersug & Johnson, 2007; Wassersug, 2010), and more are in the works.
A major conclusion from my studies of various androgen-deprived populations is that castration per se does not invariably lead to asexuality. Androgen deprivation in adult males reduces a man’s libido and commonly causes erectile dysfunction, but it need not obligate him to being totally asexual—unless that is what he expects or wants. Indeed, that conclusion from my studies of modern day emasculated males is consistent with information on the sexuality of eunuchs in history (Aucoin & Wassersug, 2006).
I want to thank my coauthor Ross Gray, who introduced me to qualitative psychosocial research, and did the heavy lifting to get our comparative project with the transsexuals and PCa patients off the ground. He wrote the grant that funded the project, organized the interviews, coded the transcripts, and did the first pass at extracting patterns from the many hours of interviews that we obtained. He even took the first pass at drafting the manuscript. All of the research that I now have underway on the psychology of androgen deprivation started with his mentoring.
References:
- Aucoin, M. and R.J. Wassersug 2006 The sexuality and social performance of androgen-deprived (castrated) men throughout history: Implications for modern day cancer patients. Soc. Sci. & Med., 63:3162-3173.
- Johnson, T.W., M.A. Brett, L.F. Roberts and R.J. Wassersug 2007 Eunuchs in contemporary society: Characterizing men who are voluntarily castrated (Part I). J. Sex. Med., 4:930-945.
- Brett, M.A., L.F. Roberts, T.W. Johnson and R.J. Wassersug 2007 Eunuchs in contemporary society: Expectations, consequences and adjustments to castration (Part II). J. Sex. Med., 4:946-955.
- Wassersug, R.J. and T.W. Johnson 2007 Modern day eunuchs: Motivations for and consequences of contemporary castration. Perspect. Biol. Med., 50:544-556.
- Wassersug, R.J. and J.L. Oliffe 2009 The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management. J. Sex. Med., 6:989-1000.
- Wassersug, R.J. 2010 On the invisibility of the emasculated. Anthropology Today, 26:1-3.
- Wibowo, E., P. Schellhammer and R.J. Wassersug 2011 Role of estrogen in normal male function: Clinical implications for patients with prostate cancer on androgen deprivation therapy. J. Urol., 185:17-23.
Written by:
Richard Wassersug, PhD* as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
*Department of Anatomy & Neurobiology, Dalhousie University, Halifax, Nova Scotia, CANADA, and Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, AUSTRALIA
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