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Gender Dysphoria after prostatectomy

User
Posted 25 June 2016 19:58:48(UTC)

Hello everybody

As a 'Lurker' I've been following the conversations on this community since I was diagnosed with prostate cancer. Yet I hesitated before deciding to post this because it seems so unusual a topic for the majority of contributors. It's not really about the cancer per se. The feelings I have experienced seem more to do with the effects of surgery, but they're not  the usual 'I want my erection back' . 

In a nutshell, the effects of surgery have led to me acknowledging, exploring, and developing  my feminine side. But I haven't had any hormone treatment. There is  a sense of giving in to feelings that were previously repressed ( that is to say, not consciously acknowledged, but at the same time, I have always been aware of feeling that I was 'different'). What has  surprised me is the sense of contentment the acknowledgement of these feelings and behaviours  has brought about. I guess this might be seen by some as just another crisis in middle age. Maybe some might say it might have happened without the cancer and treatment. I doubt it. Maybe, whilst grappling with post op erectile dysfunction/ never being able to ejaculate again etc, I had enough ammo' to allow myself to give up.  I guess there will be many on this site who will try to explain that being a man is not just about erections and ejaculation.. Yes, I already know that..

So rather than continue to  actively pursue recovery of my erectile function, I am increasingly drawn to live as a woman, even though I am currently in a conventional male/female relationship. My erectile function is something I now have less interest in. Before the prostatectomy I was not in the least bit effeminate, and engaged in typical masculine behaviour. Now I am drawn to wearing make up/wig/ dressing, and at the same time, am wrestling with the complexities of how far I should pursue the gender role/changes.

I have already been in touch with online networks for support in issues relating to gender dysphoria. I'll probably find my way to one of the Metro Walnut meetings I've heard about- I'm mostly OK with the new me, not really trying to repress it, even if it raises a lot of difficult social issues...I'm posting this on here, thinking I'm probably not the only person to have experienced this following a prostatectomy. Even though a reply acknowledging the shared experience is perhaps unlikely in the present, posting this  might  just help a future reader when they're feeling isolated.... 

 

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User
Posted 25 June 2016 19:58:48(UTC)

Hello everybody

As a 'Lurker' I've been following the conversations on this community since I was diagnosed with prostate cancer. Yet I hesitated before deciding to post this because it seems so unusual a topic for the majority of contributors. It's not really about the cancer per se. The feelings I have experienced seem more to do with the effects of surgery, but they're not  the usual 'I want my erection back' . 

In a nutshell, the effects of surgery have led to me acknowledging, exploring, and developing  my feminine side. But I haven't had any hormone treatment. There is  a sense of giving in to feelings that were previously repressed ( that is to say, not consciously acknowledged, but at the same time, I have always been aware of feeling that I was 'different'). What has  surprised me is the sense of contentment the acknowledgement of these feelings and behaviours  has brought about. I guess this might be seen by some as just another crisis in middle age. Maybe some might say it might have happened without the cancer and treatment. I doubt it. Maybe, whilst grappling with post op erectile dysfunction/ never being able to ejaculate again etc, I had enough ammo' to allow myself to give up.  I guess there will be many on this site who will try to explain that being a man is not just about erections and ejaculation.. Yes, I already know that..

So rather than continue to  actively pursue recovery of my erectile function, I am increasingly drawn to live as a woman, even though I am currently in a conventional male/female relationship. My erectile function is something I now have less interest in. Before the prostatectomy I was not in the least bit effeminate, and engaged in typical masculine behaviour. Now I am drawn to wearing make up/wig/ dressing, and at the same time, am wrestling with the complexities of how far I should pursue the gender role/changes.

I have already been in touch with online networks for support in issues relating to gender dysphoria. I'll probably find my way to one of the Metro Walnut meetings I've heard about- I'm mostly OK with the new me, not really trying to repress it, even if it raises a lot of difficult social issues...I'm posting this on here, thinking I'm probably not the only person to have experienced this following a prostatectomy. Even though a reply acknowledging the shared experience is perhaps unlikely in the present, posting this  might  just help a future reader when they're feeling isolated.... 

 

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User
Posted 26 June 2016 01:37:46(UTC)

Hi,
how interesting - I can't remember anyone else having shared these thoughts on the forum I am afraid but there may be men who will recognise the emotions. I had a friend who went through a similar experience not as a result of PCa but when his children left home. He eventually began the process of transitioning although after some years on hormones he cancelled the surgery at the last moment. One of his theories was that once he didn't need to be the father and provider, he felt free to acknowledge an aspect of himself that he had never been able to before. Perhaps it is similar for you - not that the RP caused a change but that without the pressure to conform, your mind has been freed.

I do some work to help schools supporting children that are transgender - the numbers in primary schools particularly have risen sharply over the last year or so, and Stonewall has written teaching resource packs to support children identifying as trans or non-binary. How we have progressed; until recently, social norming would overwhelm all but the most determined children, young people and parents. Perhaps then, it is no surprise that some adults find a huge life change is finally the permission to explore who they are or could be?

One thought though ... It is not clear from your post whether or not you have shared your thoughts with your partner, family and friends? If not, it may be a good idea to change your forum name (unless of course you had already been wise enough to choose a pseudonym) as members will tend to use the name you have here in their replies to you; as you have already discovered, what we write here is open to google and curious onlookers, one of whom may recognise you :-( I also feel for your partner who may struggle ... for many of us wives and partners, there is a dearth of emotional support anyway and many of us grieve for the lives and intimacy lost. I suspect that solid counselling (in its broadest sense) for a woman whose OH has been through cancer treatment AND begins to identify as female will be hard to find. It goes without saying that many of us here would do what we can but that there may not actually be anyone on here that can share that story with you or her.

Final thought - if you have been lurking a while you may already be aware of research and a report published last year by PCUK into the needs and experience of gay and bi men with PCa? The report acknowledges that understanding of trans women with prostate cancer is yet to be developed so I imagine that men questioning or transitioning while recovering from treatment is even further down the line :-( I hope you find shared experiences - if not here then on a larger site such as YANANow or Malecare?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 26 June 2016 08:04:15(UTC)
P
I can add very little to Lyn's beautifully thought out and worded post.

I would only agree involving your partner early might be key to saving at least a wonderful friendship.

I wish you all the very best
Mo


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User
Posted 26 June 2016 01:37:46(UTC)

Hi,
how interesting - I can't remember anyone else having shared these thoughts on the forum I am afraid but there may be men who will recognise the emotions. I had a friend who went through a similar experience not as a result of PCa but when his children left home. He eventually began the process of transitioning although after some years on hormones he cancelled the surgery at the last moment. One of his theories was that once he didn't need to be the father and provider, he felt free to acknowledge an aspect of himself that he had never been able to before. Perhaps it is similar for you - not that the RP caused a change but that without the pressure to conform, your mind has been freed.

I do some work to help schools supporting children that are transgender - the numbers in primary schools particularly have risen sharply over the last year or so, and Stonewall has written teaching resource packs to support children identifying as trans or non-binary. How we have progressed; until recently, social norming would overwhelm all but the most determined children, young people and parents. Perhaps then, it is no surprise that some adults find a huge life change is finally the permission to explore who they are or could be?

One thought though ... It is not clear from your post whether or not you have shared your thoughts with your partner, family and friends? If not, it may be a good idea to change your forum name (unless of course you had already been wise enough to choose a pseudonym) as members will tend to use the name you have here in their replies to you; as you have already discovered, what we write here is open to google and curious onlookers, one of whom may recognise you :-( I also feel for your partner who may struggle ... for many of us wives and partners, there is a dearth of emotional support anyway and many of us grieve for the lives and intimacy lost. I suspect that solid counselling (in its broadest sense) for a woman whose OH has been through cancer treatment AND begins to identify as female will be hard to find. It goes without saying that many of us here would do what we can but that there may not actually be anyone on here that can share that story with you or her.

Final thought - if you have been lurking a while you may already be aware of research and a report published last year by PCUK into the needs and experience of gay and bi men with PCa? The report acknowledges that understanding of trans women with prostate cancer is yet to be developed so I imagine that men questioning or transitioning while recovering from treatment is even further down the line :-( I hope you find shared experiences - if not here then on a larger site such as YANANow or Malecare?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 26 June 2016 08:04:15(UTC)
P
I can add very little to Lyn's beautifully thought out and worded post.

I would only agree involving your partner early might be key to saving at least a wonderful friendship.

I wish you all the very best
Mo


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User
Posted 26 June 2016 09:50:59(UTC)

I'd also suggest you get counselling - not because you have a problem - it sounds to be like a natural process, and one that has given you some peace of mind.

But in the world we live in you will inevitably face problems among colleagues and friends, some of whom simply won't 'get it' - counselling will help you gain a deeper understanding of what's happening, and help you face these hurdles.

Good Luck!

.

-- Andrew --

"I intend to live forever, or die trying" - Groucho Marx
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User
Posted 11 July 2016 14:54:26(UTC)

Thank you all, for  the supportive replies, especially Lyn.

I have 'come out ' to my wife about these feelings , and at the moment, she seems to deal with them by blocking it out. As would be expected, initially there was shock, and talk of separation. We are (on the surface at least) more or less back to the asexual affectionate relationship  which existed before the surgery. She is not ready to consider counselling or online support, either alone, or as a couple, and has said that I'll have to do it ( dress) at times when she's not around. 

There are conflicting drives- Obviously I shouldn't do anything hasty, but the positive surgical margin ( no treatment yet with PSA remaining <0.1) makes me think 'don't put things off'. Yet the requirement before gender reassignment surgery to have lived in the desired role continuously for >1 year  is there. It is enough of an emotional limbo to recover from prostate cancer surgery without having to also live in another limbo for a year to address the issue of gender dysphoria which occupies my every waking hour.

But on the latter, I don't want to lose my wife and best friend. That would inevitably happen if I had to live as a woman for a year. So compromise is needed, which I feel would work. Now, if hormone therapy were indicated for cancer recurrence, most men would chose medication to reduce testosterone, as opposed to surgery ( orchidectomy), whereas I would jump at the chance of the latter.

I realise that for many on this forum, even the mere notion of volunteering for castration could seem like madness. Many men are undergoing immense personal struggles on HT. But personally, orchidectomy would alleviate some of the distress I feel in a male body. If I were on HT, my wife would accept this as necessary treatment for cancer, if however, I had a bilateral orchidectomy and cited the reason as gender dysphoria, she would be horrified. It is not that I wish biochemical recurrence, rather that such surgery could allow me to feel more feminine whilst hiding it under the guise of ongoing treatment. The business of taking oestrogen and dressing is another matter.

A bit of a mess. I wonder if anyone on here has begun HT/castration before biochemical recurrence has been demonstrated? I suppose the 'normal' desire to maintain things as they are is uppermost and it doesn't happen. Yet some women chose mastectomy  whilst healthy, when family histories suggest high risk...

 

 

 

User
Posted 11 July 2016 15:49:41(UTC)

No, you would need to look to men on the Indian sub-continent to find significant numbers of orchidectomy patients, and possibly some in Eastern Europe - again YANA is your best source. Members on here that have had orchidectomy tend to have been unable to take hormone treatments for various reasons. Be warned, the side effects can be fairly awful - the benefit of HT being that it is reversible, surgical castration isn't. Perhaps HT for a while to see how you get on before you make bigger decisions?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 11 July 2016 19:41:13(UTC)

Hi Patrick,

How are you getting on with the pump?

dave

Be content with your choice of treatment at the time you make it. Then make the best of every minute, every hour, every day.
User
Posted 11 July 2016 20:31:52(UTC)

Hi Dave

Using the pump is a strange experience, now that I am accepting of how I feel.

Part of me is happy to remain small, and with erectile dysfunction. Use of the pump is now less frequent  than it was. When I do push myself to use it and regain my pre- prostatectomy proportions, it's a bit like looking at a toy I used to play with, and although it brings back memories, the (transient) erection doesn't connect anything like as much emotionally as it once did. It's as if I've grown out of it. 

On a related topic, the use of cialis, if coinciding with erotic thoughts, gives a very satisfying regional sensation, a bit like a low grade version of the more female type of orgasm I now achieve, but this does not lead me to push for a full erection- although things have definitely become fuller there in the last fortnight.

....and on  another related topic, the subject of reduced libido:

This is commonly reported following HT among prostate cancer patients, yet there are Male to Female transgendered individuals who have had 'bottom surgery', where a bilateral orchidectomy is usual, and many report their libido has not suffered greatly.  Although I understand that the satisfaction reported by the people who have had gender reassignment surgery rests on more than libido, and that whereas the latter group desired certain psychosexual changes whereas the former group did not, it is odd how decreased  libido is only reported by the non elective group of patients. Maybe the gender reassignment  reports are attempts at positive propaganda?

 

 

 

User
Posted 11 July 2016 21:41:09(UTC)

But surely male to female trans take oestrogen which will raise libido?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard


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User
Posted 11 July 2016 22:30:55(UTC)

I like the direct response Lyn.

The oestrogen aspect is one I hadn't fully considered. I suppose that whereas oestrogen is dispensed widely in the treatment pathway of gender dysphoria, the little I understand about oestrogen and prostate cancer is that   things are not so 'straightforward'.

From what I have learnt, oestrogen is implicated in the spread of some prostate cancers, but is also used to treat prostate cancer....

So, whilst orchidectomy and low dose oestrogen may be common in gender reassignment MtF treatment,  I guess the current generation of of doctors treating the hormonal aspects of prostate cancer are rather trained into the chemical suppression of testosterone, then adding other drugs to counter the side effects. Orchidectomy seems to have fallen out of favour as a method of reducing testosterone levels here, even though some research suggests it may have fewer side effects, outside of aesthetic and psychosexual.

Despite this, I  guess that even if I might rationally argue for orchidectomy over chemical castration, if it were indicated, the dispensing of oestrogen is not likely to be as ready- Or am I displaying my ignorance here? Is it widely prescribed in prostate cancer treatment to minimise risks of osteoporosis?

 

User
Posted 12 July 2016 05:42:02(UTC)
Patrick,

I have not had a prostectomy but I am on Zoladex and have the usual side effects relating to that. I hope that what I'm about to say can help you in some way.

It must be a difficult time for both you and your wife and I wish you well for lies ahead for you. I worked with someone who chose to go through trans gender reassignment. From the outset this person was very upfront and honest about it all. He enlisted the support of our HR department and gave a detailed outline of what he would be going through and what he was entitled to do eg, use the female toilets. He handed out written question and answer leaflets relating to the procedures. Meetings were held with us all to enable us to discuss his situation. Work were very good and supportive, not only to him but to the rest of us too.
For the first few years after the procedures she encountered resistance from many of our colleagues and found the experience truly challenging, upsetting and felt very lonely. It was probably made worse that we knew his/her spouse ( who had also worked with us once) and their 2 young children.
Many of us didn't know what to say or how to approach her. Although we 'knew her', we didn't know this new person as such. I hope this makes sense. It was like having a new colleague.

However, some really good news. In time this person was able to overcome all these obstacles and is very much respected at work. She is now very popular and has been promoted to a managerial position with responsibility for some of those who initially hostile to her. She is accepted for who she is now and how she is. She is very happy and loves her new life. She was also very interested in my own hormone therapy treatment and explained to me all the various medications she takes and why they are needed. She has a good home life too and is very involved in the upbringing of her children.

On my last day at work as I retired last year we had a long chat about what we both were going through. Being on HT, needless to say it was a very teary time!

Whatever you eventually decide to do, I hope it works well for you and thank you for sharing with us where you are.

Best wishes,

John

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User
Posted 12 July 2016 06:42:45(UTC)

Hi Patrick,

Good idea to continue with the pump until you are certain what you are going to do.

dave

Be content with your choice of treatment at the time you make it. Then make the best of every minute, every hour, every day.
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