Can anyone relate? On answering Why?

[guy26 (imported)]

Hi Hash,

I have wanted to write back for a while, but I'm just now getting around to it. The joy of procrastinating.

you're really psychoanalyzing yourself, which isn't a bad thing, but you can over do it.

I suppose I am doing a kind of psychoanalysis on myself. Writing has a way of refining my thoughts and giving them a bit more order and structure. Sometimes it is a way for me to make sense out of how I feel and what is going on in life. And sometimes it is a way for me to be able to articulate to others on what I'm experiencing. It is rarely obvious to others what is going on inside of me. LoL. It could be a scary thing if we could read one another's minds. I have no idea what that world would look like!

Maybe ultimately why I have written over the years about my desire for castration is I simply don't understand it. It seems irrational, illogical, and self destructive on the surface. And yet, no amount of logic, contemplation, or time dealing with it seems to make it go away. If there were a way to just wave a magic wand and not feel driven toward that end, I would so take it. It isn't happening, so I continue to write and give it thought.

I've yet to really understand or know why in my mind I had to be castrated, but I was and I am now a eunuch. Sometimes I think about becoming a nullo but the compulsion to remove my penis isn't near as strong as my compulsion to be castrated.

How do you feel about having acted out on a desire that is life altering and yet you don't have a clear understanding of why you did it? My impression is that it doesn't bother you too much and have accepted it and moved on in life.

I mostly understand my drive toward castration. Maybe ultimately it isn't something that I can entirely grasp. The drive may be somewhat outside the reach of consciousness. Who knows? I don't. LoL.

It's been an interesting journey, I think it would make a good movie, but who would make it?

You never know. There are a LOT of people on this planet with different needs and desires. I have often wished that I could play music so I could better articulate my feelings in a way that other people could relate to on a deeper level. Words seem to only get me so far.

[guy26 (imported)]

I am finally complete

Hi Riverwind,

Do you know what the basis for your desire was? Maybe BIID or a kind of GID issue or maybe something else? When you say, "I am finally complete," that makes me wonder if it was more of a BIID issue.

[guy26 (imported)]

My pharmacy finally got my

prescription for leuprolide acetate

in yesterday. It was WAY more expensive than I thought it was going to be. I'm willing to pay that kind of money once, but not twice. It took some investigation to find out why it was so much more than I expected and what I priced online. Right now there is a shortage of the 14-Day kit. ( http://www.ashp.org/Import/PRACTICEANDP ... spx?id=737 ) There are three manufactures of it: Caraco, Teva, and Sandoz. Teva sells the kit for $130, but the other two sell it for TWICE that amount. As of Feb 25, 2001, Teva has manufacturing delays and has not announced an estimated release date. So I'm not for sure what I'll do at the end of the month. I found an online Californian pharmacy that has it in stock, so maybe I'll try them if things seem to go well.

For now I prefer the daily form since I feel more in control and it is possible to either stop right away or more quickly make adjustments. There are options of taking leuprolide in 1, 3, 4, and 6 month increments. I don't think it is well understood on how much you should be taking if you aren't wanting to go ALL the way down and with the long acting forms that might not even be possible. The only possibility I could imagine is trying the monthly 3.75mg dose. After a few days from the intramuscular injection, levels can be found in extremely small quantities... in the single digit ng/dL. It takes very very little of this stuff to act on your pituitary. leuprolide acetate is engineered to be 80 times more powerful than your own GnRH and have a longer half life. The idea is to overwhelm the pituitary and get it to radically down regulate its sensitivity to GnRH.

I suppose with the long acting stuff you could go all the way down and just add testosterone back. But that seems more expensive all the way around. The 1 and 3 month form seem to be the least expensive long acting versions, which are around $330/month at best. Yikes. I'm hoping that if I can secure the daily form with Teva, I will be able to use a 14 day supply over 1 to 1.5 months. That would make it reasonably priced. For this month, I am obviously headed down to at or below castrate levels. I'm pretty sure this will be a new experience and excessive, but I'm willing to test the waters. I've taken depo provera twice and while I never got my testosterone levels measured, I never got hot flashes either. So I'm fairly sure this is going to be a lot further down and in uncharted territory.

I did a bit of research before I committed to trying this and it seems that leuprolide is one of the safest ways to lower testosterone, but it is by no means the cheapest. It is the most expensive from what I can tell! It is not hard on your liver like cyproterone. But like cyproterone, it is way more effective than depo provera if you REALLY want to be down to castrate levels.

I also found a few interesting factoids that I'll share with you. When you first start taking leuprolide it will generally result in a remarkable 50% increase in testosterone of your base line levels. It is referred to as a testosterone flare. But by the end of the week two it should be headed down hard and fast. By week 3, 98% achieve castrate levels, which is considered less than 20 ng/dL. Castrate levels use to be considered less than 50 ng/dL but the availability of more sensitivity testing and comparisons to physical castration made them rethink the acceptable level for prostate cancer victims.

You can take a look at this link for more interesting facts and figures. ( http://www.dovepress.com/six-month-depo ... t-of-a3232 ) It is about a study on the 6 month leupron formation. If the powers that be want me to cut and paste this whole article into this thread, I'm more than willing to do that. But please don't delete this post. LoL.

I thought the two most interesting quotes were:

"Historically, the FDA had established the castrate threshold, or the testosterone level consistent with that obtained after surgical orchiectomy, to be 50 ng/dL.41 However, this was largely based on the sensitivity of available laboratory assays at the time. With the development of newer assay techniques, substantially lower testosterone levels (15 ng/dL) have been observed in men after bilateral orchiectomy, which has led to reassessment of the historical threshold level by the medical community. The National Comprehensive Cancer Network amended its guidelines to suggest that serum testosterone level < 20 ng/dL reflected optimal control of testosterone after surgical or chemical castration, and several other expert opinions have been published on this matter in agreement."

"There was an initial rise in testosterone level, which increased to a mean level of 588 ng/dL by day 2. By day 28, 108 patients (97%) had achieved a serum testosterone level at or below the castrate threshold (50 ng/dL), and 92 (83%) had achieved optimal control of testosterone (<20 ng/dL). After 12 months, 102 of the 103 (99%) patients who completed the study had testosterone levels below castrate threshold, and 91 patients (88%) had optimal control of testosterone. Median time to reach castrate level was 21 days."

One of the most fascinating articles I found was titled "Depot-leuprolide acetate for treatment of paraphilias: a report of twelve cases." You can find the article here. http://www.ncbi.nlm.nih.gov/pubmed/11446201 . (You probably won't have access, so I'm more than willing to just cut and paste the whole thing into another post in this thread. Just let me know moderators.) I kept thinking "Um wow..." as I read the whole thing. I'm not for sure what was more striking--the content of the article or the author's ability to write serious things with no emotional context at all.

For example here is one case... "Patient #12 was a 25-year-old male with a history of exhibitionism, frotteurism, voyeurism, public masturbation, psychotic disorder NOS, and multiple rapes of women, who had been found not-guilty by reason of insanity for the crime of sexual assault. After incarceration for 3 years pending trial, he was committed to a state mental health facility. He reported continual preoccupation and sexual fantasy of raping and exposing himself to women, which was not affected by fluoxetine intake of up to 80 mg/day. He was started on leuprolide acetate 7.5 mg intramuscularly and maintained on this for 12 months. He reported a loss of all sexual functioning and interest, and in particular of the deviant sexual fantasy and arousal. However, he developed unilateral gynecomastia and complained of the loss of sexual functioning and discontinued the depot-leuprolide acetate. His testos- terone went from a pretreatment level of 525 ng/dl (normal being 286-1511 ng/dl) to a posttreatment of 41 ng/dl at 1 year of treatment. It took 3 months after discontinuation of the depot-leuprolide acetate before the patient's sexual functioning fully returned. His gynecomastia had not returned 5 months after discontinuation of leuprolide."

I thought this point raised in the discussion part of the paper was interesting too.

"Although long-term treatment with anti-androgens might be necessary to continue reduced sexual arousal (Thibaut et al., 1996), the use of leuprolide acetate for a shorter duration of treatment with a focus of helping an individual obtain control of his sexual impulses and behavior and make use of other treatment modalities is illustrated by some of the cases discussed previously (Patients #1, 2, 5, 8, and 9)."

[guy26 (imported)]

I might mention that my mood has been noticeably up for the last couple of weeks. I'd say that it is above base line and I'm in hypomanic territory. The mild hypersexuality lately only adds to my impression.

I'm really not for sure how my mood is going to react or change to this trial of leuprolide. My intuition is that it will kill the mild hypomania as soon as my testosterone levels start falling. My only hope is that it doesn't trigger ultra rapid cycling. That would make for a very bad time.

I took my first dose yesterday. It is easy to do after some instruction. I'd say it is much easier than giving oneself an intramuscular injection on the back side. It certainly hurts less! I have a slight reaction at the injection site that lasts for about 30 minutes to an hour. It isn't anything bad and it just happens to some people.

I noticed that toward the evening yesterday I felt unusually relaxed, chill, and satisfied in life. I'm not for sure how to better describe it or whether it was really associated with the injection or not. There are all kinds of possibilities for psychosomatic effects as I proceed with this. This morning I woke up with the hardest morning erection that I can ever recall. And my cardio workout felt easier even though I kicked it up a notch.

I'll try to post as I notice things or if I have something interesting to say. Feel free to ask anything too. Who knows, maybe I'll be less motivated to write as this progresses. LoL. I have seen too many people disappear after they start something like this. But in my case I still have a desire to write when *interesting* things are happening in life.

[Caith721 (imported)]

Here's hoping the T flare doesn't severely impact you. At best, it could give you some insight into what higher T levels would be like for a few days. Just remember if it becomes too intense during the period of flare, that it's strictly a chemical cause of any new thoughts and impulses, and it should pass within days. Don't obsess on it too much, because you're aware in advance what's causing it.

I wish you great results with your lupron treatment.

[nullorchis (imported)]

guy26,

Copy and paste your postings into a word processor. You have the makings of a journal that might wind up being a book or major motion picture some day.

You write well, and a lot. It is interesting reading. Some of which I can relate to when I was young. For some people going from young to old is like going down a slide. For others it is like slogging through a field of mud.

Hopefully drugs, therapy, both, or something else will help you to work through these thoughts so that you can go about each and every day just enjoying life, not struggling through it. If I had a magic wand I would wave it and give you the peace of mind you seek, and deserve.

But I have no magic wand. If I did can you imagine the line of people at my door? Guys wanting to look like Matt Damon or Brad Pitt and wanting 19 inch cocks and ball as big as lemons. Wow, could that get boring.

[guy26 (imported)]

Thanks nullorchis,

I have had a journal for a little over 5 years now. It is quite hefty as is. It is around 130,000 words by now, so it could be turned into a book of sorts. It is a mixture of both my struggles with bipolar and the surrounding issues of being driven toward castration. I generally copy down everything that I post on the eunuch archive. But obviously my journal contains writings from a number of sources that I've written else where.

It even has numerous dreams. I post practically all of my dreams that I recall on Facebook and in my journal. I started having sleep issues for the first time in life last year. They started about a year ago when I entered rapid cycling for the second time ever. Despite getting over the rapid cycling and the sleep issues, I continue to wake up to nightmares and weird dreams at least once a week. They are more frequent when I have transient mood issues, especially right before bed.

At first I started posting my dreams just to get them out of my head. Sometimes a bad dream could negatively affect my mood throughout the day. And somehow sharing it with others allowed me to let go of it. It's strange but people tell me in real life that they really enjoy reading about them. And I've even had some of their friends add me on Facebook just so they can read them too. I've asked others rather they wish they could recall their dreams regularly, but few seem to like the idea of remembering them especially in such detail. And virtually no one would post them on Facebook because somehow they seem too personal. Mine are bizarre and really I would be hard pressed to make up such strange things without the help of drugs. LoL

I have decided to create a book once I get 356 interesting dreams recorded. I want to have my other half illustrate some of them. It seems like a cool project to do. I don't know if I will continue to have such interesting dreams and dreams that I can remember, but I hope so. Otherwise, I won't be able to complete the book. If I have to have so many nightmares, I want them to have a purpose besides soaking the bed sheets with sweat and irritating the hell out of me. LoL

Getting back to what you were saying... I've wondered at times whether my life story is really all THAT interesting or not. It is certainly uncommon, but is it really worth the attention of a large number of people to be made into a book or movie? That I don't know. LoL. If I thought so, I would think I was being conceited or hypomanic. For now I settle with sharing my castration related journey on the eunuch archive in hopes that someone else benefits from it.

I'm not for sure that I will ever escape the struggle in life. Without medication to control bipolar, I highly doubt it will spontaneously get better. If I'm lucky, I will get a few years of reprieve here and there. If I could be rid of the castration struggle, that would be worth just as much to me as getting rid of the bipolar. Having both problems can be a nightmare at times. Sometimes there is nothing to do but face reality and deal with the situation as painful as it might be. You can run away from a lot of things, situations, and people. But you cannot run away from yourself. I actually tried that once! LoL. After 40 miles I realized that that was a stupid idea. It was a critical moment in life and I was at my breaking point, so you can't fault the ridiculousness of it too much.

Sometimes I wonder how different my life would be if I was some other guy--straight, normal mood and emotions, and no castration fixation. All of these have led to huge struggles in life. I'm completely fine with being gay, but holy hell did it take a lot of struggling during my teenage years. If I'm lucky, the castration fixation is something that I will eventually resolve.

There isn't much reason to think about it, other than as a thought experiment. No amount of wishful thinking can make you be someone you are not. Life would most likely be a whole lot easier, but it would come at a price. I feel that many of the struggles I have had in life have allowed me to better understand myself and my place in life. Without serious struggles, people can become so complacent that time passes them by and much of their time is spent without really enriching them or having spent the time well.

Don't get me wrong. Everyone has problems. It is just a matter of what kind, how many, and how extreme. When I went to Guatemala for three weeks, I didn't go as a tourist. I went there and lived like they did. Maybe part of my problem is that in the absence of any real difficulty in life, my mind takes up the slack with its own special concoction of suffering and pain. LoL. I may be forever screwed if that's the case.

So maybe it is good that you don't have that magic wand after all. You probably would have already broken it off in some guy's ass anyway after he pressed you too far to grant some wish. LoL. I mean how many 19" inch cocks can the world have?

I'm glad that you can relate to some of what I write about. I don't know where I'm going with this reply, so I better stop now.

[experiment (imported)]

My inlaw was on leuprorelin for 2 years with the injections every three months. I accompanied him during the initial doctor visits and injections. The doctor told him he would experience an increased sexual ability for about two weeks followed by a sudden crash. As the doctor said, you can forget about the Playboy pictures after that. The leuprorelin was intended to shrink the prostate as well as supplement the radiation treatment. He was not a candidate for surgery.

While I did not discuss my inlaws actual experience, he did complain about frequent hot flashes and discomfort. He started on radiation for 13 weeks about a month later and continued the leuprorelin injections until this past Sept.

During the two year period he also gain a lot of weight in the midsection, although that may also have been a partial result of a sedentary life style, which could also have been a result of the hormone treatment.

Now that he is off the leuprorelin, it reamins to be seen if he will lose any weight. The hot flashes seem to have become less frequent.

[guy26 (imported)]

Hi experiment,

Thank you for relaying your in laws experience with leuprorelin. From everything that I have researched, it sounds spot on. Today I finally found what I was looking for on pubmed. I knew that there was an increase in testosterone levels followed by a crash, but I didn't know exactly what that curve looked like. If you go here,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC

1472892/figure/F1/ , and look at the picture on the left you can see what a typical course of leuprolide will look like. (If you want to read the corresponding article it is free and can be found here, http://www.ncbi.nlm.nih.gov/sites/ppmc/ ... MC1472892/ .) You should note that this is the average response. Sometimes it takes longer before the crash happens and some guys don't see a large spike in testosterone levels.

From what I have read there is virtually no difference between the daily injections and the monthly or longer intramuscular injections. If there was a difference, I'm sure the treatment protocol for prostate cancer would favor one over the other. The larger reason for the monthly or longer injections has to do with compliance and convenience.

It is noteworthy that the amount of leuprolide acetate typically prescribed is a LOT more than is actually necessary to cause a profound down regulation in LH/FSH, which causes testosterone levels to fall at or below castrate levels. It has even been given in the 20mg/day range without problems. But because of the expense of leuprolide acetate, it has been studied whether it is necessary to give as frequently as initia

lly approved for treatment of prostate

cancer by the FDA. http://www.ncbi.nlm.nih.gov/pubmed/17509298 . From the abstract, you can see the frequency could be reduced by as much as 40% to get the same effect. And since I'm not REALLY wanting to go all the way down, it's likely that we will need to cut the amount I'm taking by a significant amount. The reason I'm on the daily injections is so that we can adjust the amount of down regulation. That isn't really possible or as flexible with the longer acting intramuscular injections. Initially with those, a large amount of the GnRH agonist is in the blood stream, but it falls to just a constant trickle in the low ng/dL. With the daily injections there is a large rush of it in the blood stream and it is cleared from the body in hours. I have not found a protocol for what we are trying to do in my case on pub med, but everything I've read suggests that it is possible and reasonable. The GnRH agonists given in nasal spray form are typically given in the least amount necessary to delay puberty in children with central precocious puberty. My wild guess is that I will need to go from 1mg/day to between .25 and .5 mg/day or maybe just increase the time between doses. The plan thus far is to start at castrate levels and work up to what I feel is right. I have a feeling this is going to take a while to get right.

[guy26 (imported)]

Today is day 6 of being on 1mg/day of leuprolide acetate. I began to notice some changes, but not because of low testosterone. The most prominent thing that I have noticed is waking up at 3 to 4 am with a very hard erection and being excessively aroused. I'm not kidding. I pretty much have to take care of business right then and there and it doesn't matter rather I'm tired or not. I would almost describe it as an overwhelming drive to relieve the sexual tension.

Two days ago was remarkable. I felt beyond great. I physically felt as young and vibrant as a 15 year old. I truly can't convey to you how great that felt. I was filled with joy, but it didn't feel like any kind of hypomania. I've been there enough times to know what that is all about. Maybe my testosterone levels were simply beyond normal--125% of the high end of normal? I would trade a lot if I could feel like that every day. I have not felt that way in well over a decade. If it was because of more testosterone, having less certainly makes me go, "hmmmm." LoL

As a reminder, I was hypomanic and had a bit of hypersexuality before starting the leuprolide acetate. The hypersexuality has surprisingly NOT gotten any worse. This is despite my testosterone levels having most likely gone up significantly since starting the GnRH agonist. I went from reaching climax 2-3 times a day down to about once a day when initially starting treatment. Then it went back up to 2-3 times a day. And yesterday and today was an exception with only climaxing once. I don't think this means much, but now you know anyway.

I continue to feel a sense of inner peace and relaxation a few hours after injecting the leuprolide in the morning. This has truly been a reprieve from the inner chaos that I normally feel. In fact, this inner peace has finally opened up my mind to its full intelligence and focus to working on life, real problems, and not just trying to manage the internal craziness that I constantly feel. It has been a very long time since I have felt normal because of the bipolar. I would describe this chaos as always under my skin, boiling, and ready to explode at any moment. Or maybe I would describe it as a constant vibration that is distracting at best and reaches a harmonic that tears me apart at worst.

My hypothesis for this inner peace is that the leuprolide is causing the production of testosterone to continue to rise after it should normally be peaking in the morning. And this extra boost of testosterone really improves my mood. If I recall correctly, natural testosterone production peaks at around 8 to 9am. Maybe it is instead peaking around 2 to 3pm. The idea with this is that the injection is trigging the pituitary to again release more LH and FSH which in turn immediately triggers the production of testosterone. I really don't know how fast each system responds to the other, so this could be entirely wrong. I have found no support for this idea on pubmed, so I have no idea. It could easily be my imagination. Or maybe the leuprolide acetate is shifting my normal production of testosterone to a different time compared to my natural rise and fall in testosterone levels? Or maybe the time and curve of the rise and fall of testosterone is the same, but it is just reaching higher levels?

I'm kind of curious about the guys on the Eunuch Archive that have been castrated, but then gone on to use HRT especially as an injection of testosterone. Did you notice any change in your mood or sense of well being by not having the daily rise and fall in testosterone levels? Is this even something that someone could be cognitively aware of? And if you are aware of it, how does it affect you?

Having started the leuprolide acetate, it is has given me a lot of opportunity to reflect on what it is that I hope to accomplish. This isn't just a single injection that I have to build up the internal drive and will power to do. A single injection of depo provera has quite noticeable effects on testosterone levels for about 3 weeks for me. And once you do it, it isn't coming back out. You just sit back and let it do its thing. Instead with this, I have to actively do something every single day and that means I have to feel that this IS the right thing to do. So from that perspective, this trial of leuprolide acetate is much different than the previous intramuscular injections that I have done with depo provera. I think that this can be a good thing though. When my testosterone levels are much lower AND I continue to inject the medication, that will be a positive sign to me that I am doing the right thing.

My other half has been very supportive of me. He feels strongly that I should definitely not play my own doctor. I've been guilty of it way too many times. For once in my life, I have agreed to work with my doctor and follow through with what we both agree on. So that means I will take 1mg/day for 28 days consecutively and then re-evaluate what I am going to do.

I was really happy with the outcome yesterday. I suddenly had a bad case of anxiety and I was unable to inject the leuprolide acetate. I couldn't do it. It wasn't because I didn't want to. I just couldn't because of the anxiety of sticking myself with the needle. It doesn't hurt, so I don't why I couldn't do it. I gave my other half a quick run down on how to do it after he washed his hands. Everything was all ready to go but the actual injection. He was happy to do it and he didn't hesitate. He told me not to beat myself up over it. He attributed it to my mind being in conflict about really wanting to take it or not. He said he has no problems giving it to me every day if that is what I want to do. I may do that. It is an easy way for him to be an active part of this process too.

Hopefully I didn't wander too much in this post. LoL

[guy26 (imported)]

I should be working, but I can't stop thinking about my situation. It has been two days since ceasing the daily subcutaneous injections of 1mg/.2mL of leuprolide acetate. I went for the full 28 days without missing a single dose. My doctor wanted me to taper down, but I'm not sure he actually wants me to get off of it. He seems focused on the long term problem, whereas the short term problem has been resolved and I'm willing to let it become a stop gap measure for another year or two. If my goal is to get off the leuprolide acetate, I don't think it is necessary to taper down on the leuprolide acetate. Normalization of testosterone levels does NOT happen overnight or very quickly upon sudden

discontinuation of leuprolide

acetate.

Pubmed is my friend. It is obvious that GnRH agonists act far beyond their suggested efficacy at maintaining sex hormone suppression. In a 1999 study, a single 3-month LH-RH agonist injection was shown to maintain castration levels of testosterone for 6 months. And it took 13.

6 months for the men to return to ba

se line levels! (

http://www.ncbi.nlm.nih.gov/pubmed/

9783932 ) In a second study which looked at cessation of a GnRH agonist after 6 months, it took an average of 13 week to reach 50 ng/dL, which use to be the old standard for castrate levels. And it took 16.6 weeks for testosterone levels to get into the normal range at 212 ng/dL. I did not have access to read the full article an

d the latter abstract did not mention

whether levels were measured until base line levels were restored. (

http://www.ncbi.nlm.nih.gov/pubmed/1

5821487?log$=activity ).

If I stop right now, how long will it take for me to reach

normal levels of testosterone

for an adult mal

e? And how long will it take to get

back to *my* normal level of testosterone, which is about 2/3rds into the normal range? The other question is how long does this normalization take compared to the depo provera that I have taken in the past for one and four month trials, respectively?

Can I answer any of those questions? The answer may lie in whether the time to normalization after taking a GnRH agonist for only 28 days is comparable to taking a GnRH agonist for 3 and 6 months in the above referenced studies. I don't know. I can't find any studies that looked at a shorter time frame. GnRH agonists are typically prescribed on much longer time frames, such as for prostate cancer, precocious puberty, etc. The one exception is GnRH agonists used for 14 days during IVF (in vitro fertilization). It isn't too surprising I can't find studies looking at shorter time periods on a GnRH agonist and subsequent normalization of sex hormones upon discontinuation.

I had my blood work drawn up yesterday to look at testosterone levels. I had to prod my doctor to do it as he thought it was unnecessary. I strongly feel that if we are going to run an experiment there should be at least some hard numbers to correlate perceived changes physiologically and psychologically. In all likelihood, my numbers should be at or around 20ng/dL. Based on other studies there is at least a 10-15% chance that I have not responded fully and have not reached below 50 ng/dL. Some men don't respond fully to leuprolide acetate and it is unclear what factors may be at play. It would be helpful to know for sure how well I responded to the leuprolide acetate. I am going to ask to have my blood work drawn up periodically until I reach my normal level of testosterone. The information may be of some benefit to others to make an informed decision on whether they would like to use leuprolide acetate as a short trial to suppress testosterone or whether to use depo provera or androcur instead. One data point is better than nothing. At the minimum it will help me make a more informed decision in the future on whether to go this route or not.

I have had a ridiculous amount of fear and preoccupation the last few days about the cessation of the leuprolide acetate. I am diagnosed with bipolar type 2 and I don't respond well to mood stabilizers. This presents a challenging situation to say the least. I have taken depo provera twice unsupervised by professionals. The first trial was a single injection. The second trial consisted of two injections followed by a single injection every month for a total of 5 injections. In both cases my mood was hypomanic before starting each trial. My mood became stable and normal while on the depo provera. However after one to two months upon cessation of the depo provera, my mood switched into ultra rapid cycling. This cycling took approximately 6 months in each case to run its course without much if any remediation with mood stabilizers. As the depo provera wore off, I experienced an indescribable feeling of puberty. It was uncomfortable, irritating, and ultimately a very bad experience given the excruciating pain of ultra rapid cycling that seemed to last far longer than the time needed to return to base line testosterone levels.

I have a lot of fear becauseI feel that there is an extremely high probability of entering rapid cycling again for the third time. This feels like deja vu all over again in the worst possible case. It appears that the slow gradual rise in testosterone somehow creates the perfect condition to enter rapid cycling. I have never encountered rapid cycling under any other circumstance; it has ONLY been in response to stopping androgen deprivation. I would love to know why, but I can only provide a conjecture on why this might be the case.

This is quite a conjecture, so bear with me. There is some evidence to suggest that hormones play a role in mood disorders. They are not the cause of the problem, but they may have pronounced effects on the underlying condition as hormone levels change. For instance it is speculated that during mania, levels of norepinephrine and dopamine surge. This could explain why I feel extreme levels of excitement and energy with evaluated levels of norepinephrine and why I experience euphoria with excessive amounts of dopamine in the synapses. To be clear, norepinephrine is both a hormone and neurotransmitter while dopamine is strictly a neurotransmitter.

Continuing with the conjecture... The body has three feed back loops when it comes to regulating sex hormones in the body. Levels of GnRH (gonadotropin-releasing hormone) are produced by the hypothalamus, which is affected by the amount of sex hormones in the blood stream. This sex hormone is obviously testosterone in men. Levels of GnRH effect the amount of LH (luteinizing hormone) released by the pituitary. And levels of LH affect the amount of sex hormones produced by the testicles in men. Both depo provera (medroxyprogesterone acetate) and lueprolide acetate monkey with these feedback loops in different ways to cause a net reduction in sex hormones. Once both of these prescription medications clear the system, the body recognizes that sex hormone levels are very low. The hypothalamus will begin pumping out supranormal levels of GnRH. This in turn triggers the supranormal levels of LH. It is likely that the supra levels are not pulsed in constant frequency, but in surges in an attempt to restart the production of sex hormones. LH surges are partially implicated in the phenomenon of hot flashes. LH and norepinephrine are somewhat linked together. With a surge in LH, norepinephrine in the hypothalamus rises. If norepinephrine does not fall during the night or surges during sleep, it may interfere to varying degrees with a person's ability to enter and maintain REM sleep. And changes in sleep are strongly associated with mood disorders; sleep deprivation can trigger changes in mood for those diagnosed with bipolar.

Last year as I entered rapid cycling, I documented the progression of changes in a lot of detail. What I noticed is that a couple of months after the last injection of depo provera, something indescribable changed. I knew that it was bad and yet there wasn't anything I could do about it. My mood initially remained stable, but slowly the oscillations in mood grew larger and larger until I was clearly experiencing ultra rapid cycling. Sleep problems led the initial onset of mood changes by about 2 to 3 weeks. The most notable problem was waking up from nightmares. There are two places in the sleep cycles where dreams may take place. Nightmares will almost always be found during REM sleep. It is plausible that a LH surge during the nighttime was the trigger for changes in sleep that cascaded into extreme mood instability.

Because I took a GnRH agonist, it will take some time for the pituitary to up-regulate the number of GnRH receptors. If the 3 and 6 month studies referenced above are relevant and offer any clue, FH surges will likely happen three months from now. I cannot find any studies as a reference and comparison for the depo provera that I have taken in the past. It would be helpful to find a study looking at changes in testosterone for men given medroxyprogesterone acetate (depo provera) and their subsequent discontinuation. But my intuition is that the FH surge happens sooner with medroxyprogesterone acetate compared to leuprolide acetate--around 2 months from the last injection of medroxyprogesterone acetate compared to 3 months from the last daily injection of leuprolide acetate. Anyone want to volunteer for this study? LoL

If you recall from an earlier writing, leuprolide acetate is a GnRH agonist. Initially it stimulates the pituitary into releasing extra LH which causes an overall surge in testosterone levels for the first week or so. You might think that these LH surges would cause notable problems with my mood. They didn't and I have an idea on why that might be the case. I definitely noticed a surge of something following the initial injections of leuprolide acetate. It was a very strong sensation at first and diminished over one and half weeks. The sensation began approximately 2 hours after the injection and lasted about 5 to 6 hours afterward. It is possible that the LH surge happened quickly after each injection and went away after several hours. The LH surge was gone well before I attempted to sleep in the evening hours. This is mostly likely why the daily injections are recommended to be given in the morning. Sleep problems are a known side effect of luprolide acetate. I also feel that the extra testosterone provided a stabilizing effect on my mood. It was dramatic and surprising how much my mood improved. I felt normal for the first time in years. My levels may have ventured some into the supranormal range, but not by gross amounts. (My back of the envelope calculation suggests that I peaked at 113% of the maximum point of the normal adult male testosterone range. I started out at 75% of base line. You can multiple by 1.5 to get a rough idea of where you peaked in testosterone levels during the initial exposure to leuprolide acetate. I would give a reference to this, but that would take some searching.)

Part of my fear is founded on experience with the cessation of androgen deprivation. The other part is founded on plausible conjecture. Rapid cycling is no joke. I'm serious when I say I'd rather have my fingernails pulled out than to go through that again for another 6 months. The price to pay for taking leurpolide acetate is looking to be extremely high--much higher than the money I paid for it.

If LH surges during the night are what ultimately set off ultra rapid cycling, I feel my options are limited from a theoretical perspective.

Taking a mood stabilizer for 3 to 4 months and letting my hormone levels return to normal would seem like the best course of action, but I have yet to find any mood stabilizer that I can tolerate longer than a week let alone on the scale of months. And starting and stopping a mood stabilizer can result in even more damage, so this doesn't seem like a great candidate to even try.

I could taper off of the leuprolide acetate. This will almost certain require a LH surge to start the leydig cells up again with normal production of testosterone. At best, tapering off the leuprolide acetate would only delay what would be the enviable course of ultra rapid cycling.

I proposed to my doctor that I be given testosterone cypronate at levels representative of 50 to 75% of my previous testosterone levels. Then over several months the testosterone cypronate would be slowly dialed back until I am off of it completely. The hope is that it would avoid the slow and gradual rise in testosterone levels. As the exogenous testosterone would be lowered, my body would make up for the slack. The goal would be to minimize the gradual rise in testosterone. However, if my leydig cells are nearly shutdown, it is likely that I will still experience some LH surge initially as my body attempts to start things back up again. The hope would be that the LH surges would quickly be minimized. But honestly I have no idea if these LH surges would be the same or less in intensity and frequency compared to doing nothing. At a minimum, having extra testosterone available during significant increases in LH may be enough to stop the initiation of rapid cycling. It is conjecture, but is there anything better to go off of at this point?

Another option is to forego being on my own internal production of testosterone and start TRT indefinitely at my previous levels. I am driven to gain control over my testosterone levels, so this may eliminate the drive toward castration without the need for any periodic break in testosterone. This option would allow me to periodically take a break from testosterone if it were still needed. This could be accomplished by stoping the exogenous testosterone and, if necessary, resuming the leuprolide acetate or depo provera ahead of time. Once I achieved the necessary reprieve due to psychological reasons, I could immediately start back on TRT to previous levels. Even with the possibility of start and stops, this would disconnect the the hypothalamic-pituitary-gonadal axis and most likely avoid rapid cycling all together.

Being at a minimum of testosterone currently gives me access to a kind of clarity and a minimum of bias. I am okay with how I feel on a day to day basis with androgen deprivation. I feel complete relief from the incongruity that exists with normal levels of testosterone. However, the long term side effects of androgen deprivation are completely and unequivocally unacceptable. So while it is something that I seemingly need to experience from time to time, it is not a physiological state I should endure for long periods of time. If I do not experience androgen deprivation from time to time in my life from normal endogenic levels of testosterone, I have no doubt that I will eventually act out on the drive toward castration. I have fought against this for years and have yet to find any other reasonable alternative to manage and reduce the castration fixation. The million dollar question is how to take a testosterone break without rapid cycling upon discontinuation? Secondarily, how do I minimize the amount of time spent in testosterone deprivation?

If this experiment once again sends me into ultra rapid cycling, I will consider this an overall failure. I cannot and must not be allowed to enter ultra rapid cycling again and again. Any solution that repeatedly results in that is inherently a non-solution. The question is obviously what alternative is there? If this fails, it increases the likelihood that I will eventually act out on the castration fixation, especially if there are no alternatives. This experiment has likely bought me a year or two at best and I value that, but it is obviously a temporary solution. It may not be reasonable to repeat if it produces rapid cycling. Prolonging this experiment as my doctor suggests, likely won't noticeably delay the day when all of this comes to a head again. And if it is inevitable that I'm going to enter rapid cycling, I want to get it over with as soon as possible and move on in life.

In an optimal situation, I would discontinue the leuprolide acetate, in several months I would be back within normal levels of testosterone, and my mood would remain stable. Unfortunately, that is likely a fantasy. The idea of ultra rapid cycling is frankly terrifying and it's even worse that I largely don't have any control over whether it happens or not.

At this point it appears that I get to choose from stoping immediately or slowly tapering off the leuprolide acetate. I feel that both carry nearly the same risk of rapid cycling. Thus given the choice between the two, it is an obvious choice to me to stop now. I feel that doing nothing will almost certainly result in rapid cycling. And I feel that tapering down on leuprolide acetate will only marginally reduce the risk of rapid cycling, I will have

a great monitory expense, and it ma

y take MUCH longer to return to base line testosterone levels.

I feel that taking exogenous testosterone and cycling down over 3 to 4 months would provide a significantly reduced chance of rapid cycling and is the most reasonable option. This probably won't be given as an option. My therapist didn't seem overly supportive of this idea either.

The most likely idea to avoid rapid cycling is to skip any idea of returning to normal levels of endogenous testosterone and take exogenous testosterone indefinitely. I'm not excited about this idea, but my therapist is very supportive of this option. In fact, he would like to see me put at the very high end of the normal range unless there is some physiological reason not to do so. Self administered intramuscular injections on a weekly basis would not be cost prohibitive, but it seems somehow wrong. It only seems somewhat reasonable given that I'm likely to cause a permanent infarction of the leydig cells anyway in the next few years. And it is the most likely to avoid the rapid cycling.

G

iven everything, I feel that a stair steppin

g down of weekly injections of testosterone cypionate over 4 months is the best course of action. Start with 80mg/week. Hold that level for 2.5 months. Then reduce the dosage by an average of 10mg/week.

If given the option to taper down or just stop the leuprolide acetate, I will simply stop. There seems to be little if any benefit to be gained. If there is some physiological reason why this should not be done, I am all ears. I have yet to see any evidence to suggest that this is the case.

If I am given the option to just start and stay on a normal amount of exogenous testosterone, I would have to give it some serious thought. It somehow seems wrong. But it might provide the most straight forward way to give me control in the long run without inducing ultra rapid cycling. And I would have a much better informed decision on whether it is a bad idea to follow through with the castration fixation.

If I am given the option to try mood stabilizers, I will say no. Given my past experience with them, I feel that it actually raises the chance of cycling. The likelihood of needing to start and stop is astronomically high, so I can't imagine why it would even be recommended.

If I am given the option of staying on the leuprolide acetate at current levels indefinitely, the answer is no. My therapist and I are in concurrent that this is unacceptable. The long term side effects of androgen deprivation are not reasonable.

If I am given the option of staying on the leuprolide acetate indefinitely but at much lower levels that allow my testosterone levels to stay within the lower normal range, I will still say no. For one thing, it is predicated on the idea that the desire won't persist if my testosterone levels are left in the lower range. I don't know if that is true or not. And secondly, it is way too expensive and I'm not for sure there is a low enough level that permits some reduction of testosterone but a reduction within the normal adult range. It would have to be an extremely small amount... maybe on the order of .2 to .4mg/day. Or maybe even spreading a fraction of a partial dose to every few days. It would still require frequent injections to allow some kind of titration. This was the original plan. But now that the castration drive has been eliminated, the desire to do this indefinitely has dropped to zero. The fact that it is extremely expensive makes this a definite no. I cognitively knew that this would happen, but it is easy to ignore when you are on the verge of castrating yourself.

And although the option is not on the table, it is worth at least pondering. If there were ever a clear headed moment to critically think about this option, now would be the time while I am at castrate levels. What about the idea of following through on actual castration in a sa[quote="g

uy26 (imported)" time=1296073740]
fe ma

nner? This would be done with every intention
[/quote]
of going on TRT (testosterone replacement therapy) afterward. And it would require getting silicon replacements for my other half's sake. The appearance is important to him. This is a really bad idea since I don't know with any certainty how I will feel on exogenous testosterone. It is possible that exogenous testosterone will interact with my mood in unpredictable ways or maybe there will be some aspect of TRT that is undesirable compared to my natural production of testosterone. I won't know this until I have explored this option first hand. And I refuse to use illicit sources to explore it. Maybe this is a good reason to trial it now anyway for a short period of time? What is the worst that could happen? I enter rapid cycling? There is already a high probability of that as it stands. It's possible that I could have some regret about the actual physical loss of my testicles. Even with the drive completely eliminated, I safely feel that this will not be the case. But I will never be 100% certain until I'm actually faced with it. Because of this struggle, I have never felt that my identity is tied to whether or not I have testicles.

In short, the idea of castration should really be the last option of resort and it should only be remotely considered after experiencing exogenous testosterone. The real advantage to this solution is I would absolutely have control over my level of testosterone. So long as it didn't create a physiological problem, such as too high of red blood count and I stayed within the normal range, I would have control of where I stood in the range.

In conclusion, I strongly feel that now is the time to restore androgen levels to the normal range. Taking leuprolide acetate was ultimately predicated on the risk of following through with castration. As was expected and based on previous experience with depo provera, that drive has been entirely eliminated with androgen deprivation.

The internal drive for castration generally rises over time largely independent of my mood. The drive for castration can and does reach critical levels with hypersexuality during periods of hypomania. How well I am able to deal with the sudden increase in the fixation depends on where the base line levels started out. Once the period of hypersexuality is over with, the level generally returns to its prior base line or slightly above where they were before the episode of hypomania. The most recent trial of leuprolide acetate has not permanently eliminated the drive toward castration. It is likely that it will resolve the castration fixation to manageable levels for the next year or two.

The trick is to return to

normal levels of testosterone

without entering rapid cycling.

If someone, anyone, has better information that is relevant, I am eager to hear what you have to say. As it has always been, I am stuck between a rock and a hard place. And right now I'm simply struck with fear.

[kristoff]

Sent you a PM

[guy26 (imported)]

I was just going to provide a small update on the state of things, but it seems a bit longer. It is pretty obvious that I was flipping the f*ck out a few days ago. In some ways it was entirely justified, but on the other hand it isn't overly productive to flip out either. At least, not when you can't do anything about it.

Anyway, I have accepted my fate of rapid cycling and will just take it day by day. I have no idea why, but my mood is already deteriorating. Nothing should be happening this early, so I don't know idea why this might be the case. Maybe it is simply in response to freaking out? We'll see if normalcy returns before things get wildly out of control.

Since I stopped taking the leuprolide acetate, it feels like my testosterone levels have dropped even further. It subjectively and ironically feels like I was only getting a boost of testosterone after each injection of leuprolide acetate for the last week of the trial. Maybe it was the only thing that was capable of signaling the pituitary to release luteinizing hormone and consequently

the production of testosterone?

It is an GnRH agonist after all. Right now I feel like I am running on empty and I have never experienced anything quite this extreme before.

Unlike w

hen I have taken depo provera in the past,

there now seems to be a disconnect between my body and mind. I entered minor hypomania and hypersexuality a couple of weeks before starting the leuprolide acetate and

was averaging a climax of 2 to 3

times a day. Once I started the leuprolide acetate, I climaxed slightly less--once to twice a day. I have basically continued to masturbate even though I no longer have any real drive to do so. I do it mainly because it seems like a good thing to do for my mood. At the tail end of the leuprolide acetate trial, ejaculate volume was down some, but the consistency was the same. My climaxes were very low in intensity and I had a small desire to climax. However, now ejaculate is becoming clearer, the drive to do so has completely disappeared, BUT my climaxes are returning in intensity. The last part is weird don't you think? Not too surpassingly I never get spontaneous erections and it requires physical stimulation to achieve an erection. Unlike depo provera, it doesn't take any effort to achieve an erection and it is just as erect while being sexual. Depo provera completely kills the desire in a more natural way. This however feels pretty unusual and unnatural. Maybe it is because I have no hormones whereas depo provera IS a hormone? That is my guess.

Honestly, right now I just want testosterone.

I crave it in such a bizarre way. I don't know how to describe it. At the end of the day, I am still very driven to gain control over my testosterone levels, but it needs to stay within the normal range with the exception of a very small break if and when it is necessary. It has crossed my mind that in the past I may have been under estimating the intersection between my mood and levels of testosterone. Who ever would claim that testosterone is mood neutral is crazy.

Part of the reason that this trial got off to a bad start is that initially I didn't want to go down all the way. It was pretty much at my doctor's suggestion that I go all the way down and then work back up to a level that I felt comfortable with. This had somewhat to do with how this medication works. I went with the plan largely because I was hell bent on castration. Originally I wanted to try maintaining the low end of normal. We blew past that and now I am probably sitting at castrate levels. LoL. I can't help but laugh. The original idea was just to stay within a normal male adult testosterone level, but at a lower level. Instead my testosterone levels were boosted right past the maximum of the normal range and then immediately right past the floor of the normal range. Physiologically rapid changes in testosterone levels felt confusing but it didn't cause any mood instability. At the high end it radically and maybe paradoxically improved my mood dramatically. And even more oddly the rapid changes didn't feel particularly bad.

Hindsight can be a real bitch. You just can't use that new found knowledge to help you avoid a mistake that you just made. I don't think that anything was done inherently wrong given the situation that I faced. I was on the fast track to castrate myself and this experiment was a good option to avoid that. The mistake was not coming to an agreement ahead of time between my family doctor, myself, and my therapist on an exit plan should it be needed. No one seemed to question that I might change my mind about taking it long term. I might have been willing to take it long term if we had stayed within the boundaries of what is considered normal levels, but that didn't happen.

I have taken a train to the desert and now my throat is parched. They say that you can imagine the concentration of testosterone in an adult male by imagining an olympic sized pool and adding a pinch of testosterone. LoL. Wow. What a difference such a small amount of testosterone makes on both the body and mind. If it were legal to buy testosterone cyprionate, I would do so right now and overnight the shipment. I want it that bad!! I can't state it more clearly enough. Somehow I don't think that I will be allowed to go on exogenous testosterone and make periodic adjustments as I feel necessary with the requirement that I stay within a normal range. The irony is the current situation with very low testosterone is again driving me toward castration. The drive is to choose how much testosterone that I need and want, but because of the opposite reason--I want more. That's just messed up! No, that is just fucked up!

When I was flipping out, it was difficult to put things into perspective. I'm not lying when I say that rapid cycling is painful. It sucks in a way that is hard to imagine without having experienced it. But it is something that I can recover from. I just need to make sure that it isn't a destructive force in my life. It often is for those who experience it in terms of a job, relationships, family, etc. Six months is an eternity to play sane to everyone that you have to.

A long time friend of mine was able to help back down my level of fear. And he helped me to figure out what next steps I should take. I am going to wait this week out. I should get my test results some time this week. It would be helpful to at least know where my testosterone levels are before doing anything. I'll see if my family doctor calls me back this week with any options. I'm not holding my breath. He actually didn't give me any options when I visited him last week. He didn't even offer to write another prescription for the leuprolide acetate because of how expensive it is and he didn't see any immediate alternatives. I am going to come up with a short list of endocrinologists in this general area that would be covered by my insurance. Then the following week I am going to discuss with my therapist if he will use that list, give me a referral, and help setup my first appointment with the endocrinologist.

I don't expect to see the endocrinologist in time to really deal with this immediate problem. This is more of a long term thing that needs to be setup. Because no matter what I end up doing, this overall problem is not going away and I need someone who directly understands the full range of options and what the full consequences are.

Any thoughts and/or questions are welcomed.

[guy26 (imported)]

One minor thing that has changed is that I am slowly losing body weight. I'm not 100% certain as to why. I normally weigh 141lbs +- 3lbs. And it is super stable. My weight has dropped to 133lbs. I haven't weighed this amount in years. I don't think I have changed my eating patterns, so I'm not sure what to think about this. I guess I'll try eating more and stabilize my weight at 137lbs. I'm guessing that as my testosterone levels return so will my weight. I generally try not to let my weight fluctuate any, but I have been distracted the last month and a half.

[gjvr2001 (imported)]

You are a very fortunate man to be able to have the ability to recover from this ride. I am not so lucky. I was down to a T = 32 level. My brain still remembered that I love sex. This sucked with no energy, no desire or ability to climax without extremely long stimulation, hot flashes, memory loss, depression and weakness in muscles among other symptoms. My testes are both unfunctional. On 2/14 I began hormone treatment with Testim 5mg which helped some but I was starving for more T and allowed to double dose for 2 weeks and return to original level of 5mg thereafter. Subsequently by 3/23, my T rose to 777 but my pocket book decreased by $10 to $20/day. I went to a different urologist who gave me T Cyp injection which is considerably more affordable. I had labwork done on Friday and I see him on wednesday to discuss any adjustments that are necessary. I still feel a little weak and memory loss is improving but I certainly am not having a decent libido at this level. I hope that he will up the dosage a bit but who knows. I am trying to minimize the cost while obtaining a liveable T level. Don't put yourT factories out of business or you will wish you hadn't.

[guy26 (imported)]

Hi gjvr2001,

Yeah, if you don't have insurance than injectable testosterone is WAY cheaper. If I recall, a 10cc bottle is about $60 or so. At an average of 1cc/week, it is reasonable in cost especially if you do the intramuscular injection yourself. It really isn't that hard to do an intramuscular injection. I have given myself both intramuscular and subcutaneous injections. Are you going to go with every other week or weekly injections? You will cycle less with once a week or so.

From what I understand it takes a while before the really undesirable things start to kick in at castrate levels. The biggest problem that I have right now is my mood is ALREADY going to hell in a hand basket. I have already cycled 3 freak'n times today. This sucks. This REALLY sucks and there is nothing I can do about it. I don't know if the mood instability is corresponding to LH pulses or what, but it comes on hard core and then vanishes without a trace.

[guy26 (imported)]

I wanted to provide a short update. Yesterday went MUCH better. It is likely that my mood will be entirely unpredictable, but a near perfect day is great. I had one minor hallucination that lasted about 5 seconds. It was kind of funny. I was leaving a long 2 hour meeting with a bunch of my coworkers. As we left the building, I saw our school mascot walking up the entrance of the building. I was just about ready to say something to my coworkers when it disappeared and I realized what happened. LoL. I laughed out loud. If the brain is going to play tricks on itself, it might as well be funny. I also had a mis-recognition event, which startled me. I crawled into bed and for some reason I thought that a bunched up section of covers was a dog. Mis-recognition events usually last no more than a fraction of a second. I'm hoping for a perfect day today! And I'm just going to take this day by day. I know from experience I cannot predict or plan how I am going to feel.

On a different note, this morning as I drove to work I suddenly had a decent spontaneous erection. It literally took my breath away for a moment. LoL. For a fraction of a second I didn't know what it was and I had a small endorphin rush. I have no idea why I reacted like that. I'm not complaining though.

gjvr2001, are sure it is legal to import a testosterone containing product into the USA? Testosterone

is a controlled substance. It

shouldn't be, but too many people abused it.