What can we expect when we visit the doctor regarding CASTRATION?
All visits begin with the same three steps, and then vary according to your reason for attending the doctor:
1. Your drug dose is calculated based on your size, so your nurse records your height and weight. Your nurse records baseline readings of your vital signs (temperature, pulse and respiration rates, and blood pressure) for comparison to your results once your treatment is underway, so that complications such as hypertension can be detected early if they occur.
2. Your doctor takes a history. Expect many personal questions about your health and sex life, or that of your child. Your doctor will enquire about genetic disease in your family. Your doctor will ask you to list previous illnesses, drugs (prescribed and street drugs for recreational use), and stressors.
3. Your doctor next performs a physical examination. Your doctor will feel (palpate) your groin and lymph nodes for testicular cancer and perform a digital rectal exam (DRE) to check for prostate cancer. If the doctor feels a swelling in your testicles, he or she will shine a light through your scrotum to determine if it is possibly a benign (non-cancerous) cyst.
Now the variations occur:
Cancer
If your doctor suspects cancer, he or she will confirm the findings of the physical examination an ultrasound of your testicles, and with blood tests for:
TESTS and VALUES
TEST: Serum alpha-fetoprotein – NORMAL VALUE: Less than 25 ng/ml
TEST: ßeta HCG (beta human chorionic gonadotropin) – NORMAL VALUE: Negative
TESTS: LDH (lactate dehydrogenase) – NORMAL VALUE: 90 to 200 ImU/ml
Your doctor may try to determine the type and extent of the cancer with tumor markers (CA125, CA15-3/CA27, CA19-9, carcinoembryonic antigen or CEA). Tumor markers can also be used to monitor the success of your treatment, to predict how fast the cancer will spread, and the outcome of the disease (prognosis).
If your blood tests and ultrasound are positive for cancer, your doctor will order a chest x-ray to find out if the cancer has spread to your lungs or kidneys. Usually, a doctor will not perform a biopsy because 95% of testicular tumors are malignant (cancerous). The doctor would have to dissect the entire testicle for definitive proof, thereby destroying it and possibly spreading the cancer to your kidneys through your lymph nodes (metastasis).
Testicular Torsion or Trauma
If you or your son has a swollen testicle with acute pain, then your doctor must assume it is caused by twisting of the testicle on its spermatic cord (torsion) until proven otherwise, because this is a serious medical emergency. Treatment must be within 6 hours to preserve the testicle. Otherwise, it is almost certain to require its removal in whole or in part. Twisting cuts off the blood supply to the testis, which causes the tissue to die from lack of oxygen. The doctor can perform an emergency
orchidopexy, which anchors the testis to the wall of the scrotum with 3 or 4 nondissolving sutures to prevent twisting.
If it is not possible to salvage the testis that has been subjected to torsion or trauma, then it must be removed and your son will be offered a prosthetic testicle in about 6 months, when his groin has healed.
Genetic Disorders and Side-effects of Cancer Treatment
You may be attending the appointment because you or your son has a genetic disorder that predisposes you/him to testicular cancer (e.g., Klinefelter syndrome) or you/he has already undergone radiation treatment for cancer and the testes are damaged. Explain to your child that he needs blood tests, x-rays, and a cardiogram. The x-rays and cardiogram do not hurt. The blood test is a minor prick. Accompany him during testing to make him feel secure. Maintain a calm demeanor.
Bring a treat as positive reinforcement for your child’s good behavior. Praise your child for his cooperation.
If your child is over 12 years of age, he may be asked to collect a semen sample by masturbation. He must return the semen to the laboratory within 2 hours after collection, or the test is invalid. If he has azoospermia (no sperm) or few sperm (oligospermia), then his testicles are biopsied. A ï¬Âne needle aspiration (FNA) biopsy in the doctor’s ofï¬Âce is the preferred method, and is just a pinprick. If an FNA is not possible, your son will be sent for open biopsy at a surgical centre. Antiseptic and anesthetic are applied to the scrotum. It is draped with a sterile cloth. A small incision
is made through the skin, and a tiny piece of the underlying tissue is removed. The scrotum is stitched closed (sutured).
If the testicles are not functioning, the doctor suggests removing them to prevent cancer (orchiectomy) and replacing them with prosthetics. Hormone replacement therapy will not cause testicles to grow where they did not exist before. Administering human chorionic gonadotropin (hCG) and measuring testosterone response may be helpful.
When your son is 11 or 12 years old, the doctor will commence testosterone supplementation. Testosterone treatment options include injections, gels and scrotal cream. Common testosterone injections options include:
DRUG NAME vs TRADE NAME
DRUG NAME: Testosterone enanthate – TRADE NAME: Delatestryl® Primoteston® Depot
DRUG NAME: Testosterone esters – TRADE NAME: Sustanon®
DRUG NAME: Testosterone cyprionate – TRADE NAME: Depo-Testosterone
DRUG NAME: Testosterone undeconate – TRADE NAME: Reandron®, Nebido® (Not available in USA)
Testosterone injection treatment (using short-acting injections) usually begins with a 50 mg dose on a monthly basis.
Testosterone cream (AndroForte® 2 and AndroForte® 5) can be applied to the skin of upper body and torso (transdermally), but preferably scrotally once daily.
The doctor will closely monitor your son’s growth and the development of male secondary sex characteristics. Your son will need to have blood drawn to check his gonadotropin hormone levels.
In years past, adult males with Klinefelter syndrome visited the doctor every two or three weeks to receive an intramuscular injection of 200 to 250 milligrams of testosterone enanthate, esters or cyprionate or at 6-monthly intervals for 600 to 1,000 milligrams testosterone implants.
More recently testosterone gels (AndroGel®, Testogel® and Testim®) have allowed patients to self-administer their testosterone requirements. Testosterone gels are applied to the abdomen, chest, shoulders and arms. Because testosterone gels are alcohol-based they cannot be applied scrotally, due to the sensitivity of scrotal skin.
AndroForte® 2 and AndroForte® 5 scrotal testosterone creams are the most recent and user-friendly advance in testosterone administration.
Scrotal skin is significantly more receptive to testosterone absorption due to its high blood flow, thin skin and low fat content. Testosterone cream applied to the scrotum achieves significantly higher testosterone blood levels than the equivalent amount of testosterone applied to other areas of the body. This represents significant cost savings to patients.
Unlike intramuscular injections and implants, the cream is painless. The daily dose you receive with cream is even. Injections produce uneven testosterone blood levels because they wear off and have to be replenished every 7 to 22 days.
Testosterone production increases when a boy enters puberty. Testosterone production decreases when a man turns 50. A good testosterone target range for an adult male castrate to maintain is
300 to 1,000 nanograms per deciliter (ng/dl) of blood serum (or 10.5 – 35 nmol/L). Applying 1 gram (50mg testosterone) of AndroForte® 5 natural testosterone cream every night to the scrotum will help maintain this target range. Allow the cream to absorb into the skin before dressing. Wash your hands well with soapy water after use.
Gender Reassignment
If you are seeking gender reassignment, your family doctor refers you to an endocrinologist (hormone specialist) and a psychiatrist to determine if you are a suitable candidate for surgery.
Castration as a Condition of Parole
Chemical castration is used in eight American states, Canada, Sweden and Denmark. Your decision to undergo castration cannot be coerced. It is between you and your psychiatrist. You can expect a lessening of your sexual arousal but not your habitual behavior, according to Dr. Stuart Byrne, director of the University of South Australia’s psychology clinic. You will have less frequent, softer erections and produce less sperm. Your prostate and seminal vesicles will shrink. When combined
with psychotherapy, orchiectomy statistically decreases your likelihood of reoffending to less than 3%.
What is male castration, why is it performed, treatment options
Why use testosterone after castration?
The information in this article has been taken with permission from the official Lawley booklet on Understanding Castration.