Orchiectomy: Is It Right for You?

Dr. Jeremiah Mountjoy, M.D.

Within the past few years there has been a dramatic increase in the number of men requesting a bilateral orchiectomy. Interest in this minor surgical procedure has increased largely as a result of an Internet site, which began operation shortly before the turn of the millennium. Members of the site discussed the pros and cons of the surgery and those who had it performed discussed their results. Notice of the site by the popular press gained it a great many casual viewers.

The long conversations on both the health and psychological benefits of bilateral orchiectomy led to a fad in the Los Angeles area, where in the first few years of the millennium nearly 1000 individuals requested the surgery for health reasons. The results were such that the fad has developed into a social movement in the western U.S., though one that has only recently begun to spread elsewhere. Although the Internet site began in the Midwest and the foremost surgical practitioner in the beginning was in Philadelphia, somehow the fad seemed peculiarly Californian.

Within a short while the medical profession in California began to take notice of the procedure and to see first hand the benefits, which it conferred, on those who underwent it. At least two California HMOs now fully cover the surgery and others are expected to. The health benefits they find more than pay for the surgery as a preventative measure. The fad has moved into mainstream medical practice, at least in some areas of the country.

Because of the clear health benefits of this minor surgical procedure, most men should certainly consider the advisability of an orchiectomy, both for themselves and for their sons. Women need to consider it as well for those they love and to advise them clearly of its benefits. If your physician does not already understand the benefits of orchiectomy, you should ask him to research it for the benefit of all of his patients.

While the health benefits alone are certainly reason enough to consider this minor surgery, there are a number of other important benefits as well. There is also a single, relatively minor, negative that each individual must carefully consider before electing to have the procedure performed.

THE SOLE NEGATIVE

The single negative result of bilateral orchiectomy is sterility, which is, so far, irreversible, although there is on-going research into ways to overcome this single negative result. Natural sterility is common enough these days that this may not even be a consideration for many readers of this article. Due to a number of causes, both physiological and environmental, nearly 10% of all males who have not had a bilateral orchiectomy are already sterile. They have no reason not to have the procedure performed in order to gain the significant benefits it provides.

For those males who are not sterile, they need to carefully weigh the benefits of long-term maintenance of their fertility against the shorter life expectancy and poorer quality of life that they will then experience. There are, of course, alternatives to maintaining long-term fertility. For males who are already fertile, it is very easy to bank sperm to be used at some future time in case a child of one's own biological heritage might be desired. This is frequently done and is very inexpensive; the cost of sperm storage being much less than the savings produced by the improved health which will result from the bilateral orchiectomy. Some health insurance even covers the cost.

It is now more than 50 years since the development of artificial insemination and several years since the perfection of in vitro fertilization. Artificial insemination makes it possible to use sperm from a male other than the father of the child. In vitro fertilization makes it possible to select an egg from someone other than the mother, as well.

Most well-educated adults feel that it is important to provide the best possible genetic heritage for their children and an increasing number of those born to parents who are both themselves fertile are produced from donated sperm and eggs of superior quality. The fertility of the parents is irrelevant to the production of children.

For parents who might be considering a bilateral orchiectomy for a son who is not yet old enough to be fertile and provide sperm for long-term storage, there are several factors to consider. First, of course, they need to discuss with each other how important they really feel it to be to have grandchildren who are the biological product of that child. If the son is the product of artificial insemination of in vitro fertilization, his fertility is certainly already of little or no relevance to the parents. The long-term health benefits of the surgery should certainly be paramount.

Parents who also have a daughter may decide that the daughter's biological child is sufficient for their desires and that the son's health should take precedence. Parents of more than one son ought also to consider whether or not it is important for all of their sons to remain fertile and to have the consequent health risks and lower quality of life. If one son is already old enough to be fertile, he could certainly provide or bank sperm for his brothers to use, should they so desire.

As we see, the single negative is a minor one that will in most cases be outweighed by the many benefits of bilateral orchiectomy.

THE MOST IMPORTANT BENEFIT

The first, and most important benefit, is that males who have had a bilateral orchiectomy, on average, live longer and healthier lives than males who have not had a bilateral orchiectomy. The younger the age at which the surgery is performed, the more pronounced the benefit, though below a certain age the increased benefits are small. A male receiving a bilateral orchiectomy at just before or after the age of puberty will, on average gain ten to eleven years of life expectancy. If the surgery is performed at age six to eight the additional gain would be no more than a month or two. If you wait until your mid twenties, the gain is reduced to only six or seven years. Still significant, but certainly less than optimal. At age 40 the gain is only three or four years. Still important to most men, but much less than they could have obtained had they made the decision earlier. I had my own bilateral orchiectomy when I was 37. Much older than the optimal age, but I am certainly happy to have finally made the decision.

There are many health benefits that combine lead to this longer and healthier life. Lower blood pressure and reduced blood clotting lead to a lower incidence of both heart attacks and strokes. Reduction of testosterone levels leads to a much-reduced incidence of prostate and some other cancers. The possibility of testicular cancer is, of course, totally eliminated. For those who elect a bilateral orchiectomy at an early age, the reduction in testosterone leads to greater calm and a reduction in risky behaviors. The death rates from accidents and from violent behavior are both dramatically reduced, leading to the increase in life expectancy.

All-in-all, both the length and quality of life are significantly enhanced.

OTHER BENEFITS

The health benefits of bilateral orchiectomy have been known for centuries, but were long overshadowed by negatives that have now been totally eliminated by modern medical technology. Some of these earlier negatives have now been converted into positive results for, especially through the modern ability to provide the optimal amount of testosterone in the system, rather than allowing the body to produce an overabundance that causes serious side effects.

Without benefit of bilateral orchiectomy the body will naturally produce many times more testosterone than the optimum. Production begins to increase dramatically with puberty, spikes in the early 20s to produce far more than is good for physical health, and finally begins to decline to optimal levels only when you are in your 50s. The former advantages for this over-production are now lost with modern civilization. In ancient times, young men needed a vast amount of testosterone to perform heavy manual labor. They needed the aggressiveness produced by the testosterone to fight hand-to-hand combat to protect their group in the endemic warfare of the age. Today, none of this is necessary. However, this historic cultural need for males with high testosterone levels is the main reason for the disregard in which bilateral orchiectomy has previously been held. When referred to by the historical term "castration," it meant converting an individual from being ready to perform feats of strength and aggression required by primitive life to being a gentle and cooperative individual more suited for the present day.

Today, with the simple use of a non-prescription skin cream containing testosterone after each morning's shower, it is easy for any male to obtain exactly his optimal level. The health benefits of bilateral orchiectomy with none of the historically negative effects of "castration" can be obtained with approximately 10% of the testosterone that the body would normally produce for a 20 year-old.

In ancient days the loss of fertility after "castration" was either a positive or a negative result depending on the situation. In ancient times male slaves often underwent "castration" to render them sterile. This allowed their masters to sire more biological children, including those with female slaves. There was no ability to bank sperm toward future needs, so free men tried to maintain their fertility as long as possible.

Female slave owners might also have male slaves castrated to render them sterile. In ancient Rome, for example, wealthy matrons might select slave boys of 15 or 16 years of age and have them castrated to provide sexual service for their mistress. Removal of the testicles does not necessarily mean elimination of the ability to perform sexually. In fact, the length of time the male needs to reach orgasm is increased, leading to greater pleasure for both parties.

With the use of testosterone creams allowing men to optimize their sexual response, this has become a significant benefit of bilateral orchiectomy today. My wife and I both agree that our marital relations have become much more satisfying since my bilateral orchiectomy.

A significant reduction in testosterone also leads to a much greater feeling of calm. The individual becomes less aggressive and more social. My wife and my children all noted that I became a much better parent after my own surgery. I was more patient and a much better teacher of and role model for my children. My co-workers have also remarked on my improved personality and my greater ability to cooperate in group projects. These improvements have been noted by all of my own patients who have had the procedure.

COSMETIC CONSIDERATIONS

Many men seem more concerned about how they will appear in the shower in the gymnasium than in their own physical and psychological health. While a bilateral orchiectomy means the removal of the testicles, many men who have the procedure request prostheses such that their appearance is unchanged.

I have noted, however, that heterosexual bachelors seem to have discovered that there are many women who prefer the smoothness provided by lack of testicles. It is a visible sign both that they need not worry about accidental conception and that the male is likely to provide much more physical pleasure than a male who retains his testicles. Among my homosexual patients, I have discovered that some find the smooth appearance to be more erotic and some choose prostheses larger than the normal range of human size.

After a bilateral orchiectomy you may make your own decision about cosmetic appearance, secure in your knowledge of the other benefits you have obtained.

PERSONAL EXPERIENCE

I first encountered a patient requesting an elective bilateral orchiectomy nearly eight years ago. He was one of the very early adopters of this new fad in Los Angeles. I am a family practitioner in a small group practice of five M.D.s I was initially shocked by this request from a patient whom I known for some time, treating him, his wife, and their two children. I had read of the elective surgery, but had no thought that one of my own patients might request it.

I initially rejected his request and refused to perform the surgery for him. He made another appointment and brought his wife to help argue his case. He was of a family with a long history of heart problems and both he and his wife argued that keeping him healthy and alive was far more important than retaining his testicles. He had already banked sufficient sperm to allow for another child should they ever desire one. After discussing the case with my colleagues, I performed the surgery the following week.

Over the next three years, my partners and I performed the surgery a couple of dozen times, usually on men in their late 20s who already had two or more children and who wanted the health benefits of a bilateral orchiectomy. We also performed the surgery for a few men in their 40s and 50s who were at high risk for heart disease.

Seeing the positive results of the surgery on my own patients - their improved health and their higher quality of life - I finally asked one of my colleagues to perform a bilateral orchiectomy on me at the age of 37.

The results were far better than I had expected. There was significant improvement in my blood pressure that allowed me to eliminate many of the medications that I had been taking. I, too, have a family history of heart disease and that single improvement in my own health made me wish that I had elected the surgery years earlier. The greater calm and reduced feelings of stress that I now feel are of benefit both to my family life and to my medical practice. My wife and I enjoy a much more fulfilling sexual life with the very small amount of testosterone that I currently use. Again, I wish that I had elected the surgery years earlier.

After seeing the results on me, both of my sons began asking questions and doing extensive reading on bilateral orchiectomy. They considered me to have become a much better parent and wanted to know more about the various consequences of the procedure.

Eventually my younger son decided that a bilateral orchiectomy would be right for him. He is very bright, a fine athlete, and suffered from Attention Deficiency Hyperactivity Disorder (ADHD). His readings convinced first him, and then my wife and me, that a positive result of the surgery would likely be a great reduction in his need for medication. There would, of course, also be other important benefits, but this one was central to his decision.

After long discussion within the family and with my medical colleagues, my wife and I decided that a bilateral orchiectomy would be among his thirteenth birthday gifts. We created an ornate certificate representing the gift and give it to him at his birthday party. We thought that the reactions of his friends would be important in his final decision to proceed or not. When he unrolled the certificate, read it, smiled broadly and told his assembled friends what it said, there was first stunned silence, followed by applause and congratulations.

One of my colleagues performed the surgery a week later.

About two months later, my son asked if we could give a bilateral orchiectomy as a gift for his best friend's birthday. Since I had recently performed the procedure for the boy's father, I knew it to be a possibility. I discussed it with his parents and they agreed that it would be a fine gift. I performed the surgery a week after his birthday as well.

The two boys were the best players on their junior high school basketball team and over the summer their coach, on whom I had also performed a bilateral orchiectomy asked if I would be willing to perform the minor surgery for any basketball player who wanted it. Since I had already volunteered to be the team physician and planned to be at every game and spend as much time with the boys as possible, I agreed. As soon as the school year began and the team tryouts were complete, the coach sent permission slips to the parents of every team member. I'm certain that the coach clearly explained the advantages and disadvantages to all of the boys. I know that my son and his best friend visited all of their parents to describe their own experiences and the benefits that they had received. As the date I had set for the surgeries approached, the coach received signed permission slips form the parents of every member of the basketball team.

My colleagues volunteered to join me on a Saturday to perform all of the surgeries. The coach and my office staff organized a team party for all of the boys and, one by one, we performed a simple bilateral orchiectomy on each of them over the course of the afternoon.

Today the glass case in the main lobby of the junior high school proudly displays the large trophy that the boys won - the first all-state championship in the history of the school. Sitting next to the trophy is a decorative glass bottle containing the testicles of the entire winning team. The coach had asked me to preserve them in case any of the boys had later requested his. I had thought to preserve both my son's and his best friend's for the same reason.

My colleagues and I have since adopted all of the sports teams of that junior high school and the coaches send permission slips home after the tryouts each season. No subsequent team has had 100% acceptance, but we are always happy to provide the service for those who desire it.

After seeing the very positive results on his little brother, my older son also requested a bilateral orchiectomy. By then he was 16 and able to bank enough sperm for both his own future use and his brother's should he desire it. I insisted that with the increasing popularity of bilateral orchiectomy he should have enough frozen to supply others as well.

Our entire family is pleased with the results of this very minor surgical procedure. It has had profoundly positive results for all of us.

THE SURGICAL PROCEDURE

A bilateral orchiectomy is considered minor surgery and is usually done on an outpatient basis. The entire procedure takes only about an hour and the patient can go home immediately afterwards. Most individuals require a day or two of rest or light activity before returning to their regular routine.

One of my colleagues has put together a web page illustrating the very simple nature of the procedure. You can see it at

. http://www.beavercleaver.net/orchiectomy_slides.htm

I will briefly describe the photos on that site.

The first step is for the patient to shave any hair from the area where the surgery will be performed. This can be done the morning of the surgery before going to the doctor's office. The doctor, or his nurse, may elect do the shaving, but most males prefer to do their own.

Once you are in the doctor's office and have undressed, the doctor will use a piece of tape to hold your penis out of the way while he performs the operation. He will inject anesthesia into the area so that you will feel no pain whatsoever. This is the part of the procedure which most patients dislike most. They are more anxious over the few needle pricks of anesthesia than they are over the later cutting.

The doctor will then thoroughly wash the area of the surgery with an antiseptic solution and place a "surgical drape" over you. This is to isolate the area and prevent any contamination.

As you can see from the illustrations, a small incision is then made and the first testicle pulled out. The cord is clamped and then tied off before the cord is cut. The same is done on the other side before a few small stitches are inserted.

More antiseptic is painted on the stitches before a bandage is applied. At this point the patient can go home. If there is any pain or swelling a couple of ibuprofen should be sufficient. The area will probably remain somewhat tender for about a week, though you should be able to return to any activities other than the most strenuous within a couple of days.

CONCLUSION

The answer to the title "orchiectomy: is it right for you?" is obviously "yes." Most males would benefit dramatically from this minor surgical procedure, adding years to their life expectance and producing a much higher quality of life. Loving parents should seriously consider giving the gift of a bilateral orchiectomy to their sons. They will be grateful that you care enough to do so.

READER'S DIGEST, August 2017, pages 37 - 43.

**********

NOTE TO READERS:

I am an inveterate habitue of rare bookshops. Whenever I travel, I seek out shops to indulge my addiction to old books on the history of science and medicine. Two years ago when my wife and I were in New York, I arranged to spend a day at the Strand while she haunted Soho.

While I was exploring the rows of dusty volumes, I happened across a tattered copy of Reader's Digest. My first thought was that it simply didn't belong in the store. I was about to set it aside when I notice the date on the cover: August 2017. I read it again and decided that the magazine must be one of those joke editions that used to be produced by college humor magazines. Since I once wrote for one when I was a student, I decided to check it out. After reading the table of contents and reading a few short sections, I could find nothing humorous - other than the usual ancient jokes that have long been a staple of Reader's Digest.

It was then that I noticed the ads. They seemed very real, not jokes, but they also advertised products that I knew did not yet exist. They were also too real to be part of a humor magazine. I bought the magazine, together with enough other things that the clerk took no special notice of it.

I'm convinced that it IS an August, 2017 issue of Reader's Digest. In the two years since I bought it, several things mentioned incidentally in articles have come to pass and one of the products advertised has come on the market.

I originally discovered the Eunuch Archive through trying to track down items mentioned in the issue and I thought that the readers here would be interested in the article through which I discovered them.

This is, however, the ONLY part of the magazine that I plan to release. I've planned my investment strategy around the ads and should be able to leave a reasonable estate to my children and grandchildren. I have no plans to be greedy, but the strategy might fail if too many knew it.

I've edited the article slightly to take out a couple of mentions of future events and I've changed the name of the doctor. The real author of the article recently began his practice not too far from where I live now. Since my current doctor is planning to retire soon, I may switch to this new young one in anticipation of what he will be doing in the future.

In anticipation of the world to come, I hope you enjoy this small insight.

------Jesus Azevado