Seeking feedback

[JesusA]

An article about a 12-year-old castrated by medical error has recently gone on-line. It's very brief (2 pp.).

We pledged the boy's father that we would solicit feedback to pass on to him. The article is open-access at the link below the abstract. Please respond here or email us directly at the email address in the article with any comments you might have.

Thank you!

"My son was castrated as a result of a medical error. Is it OK to raise him as a eunuch?"

ABSTRACT: A 12-year-old boy lost both testes after testicular torsion. He is now 14, and his father wants to know if the boy should immediately start supplemental testosterone or if he might reasonably choose to live as a eunuch. The boy does not yet express any strong opinion except that he is embarrassed about his weight gain. We advised the father that there is no need to rush the decision as the boy could at least delay testosterone therapy until his teens or early 20s and still go through male puberty with little risk of adverse health effects. We seek to know if others endorse our endocrinological advice. The boy's father wants to be honest with his son about the social challenges the boy may face if he elects to delay or avoid puberty altogether and chooses to openly identify as a eunuch.

https://doi.org/10.1016/j.amsu.2021.102586 (https://urldefense.com/v3/__https:/doi. ... TBQKhk!GGY x4kz42JRPboU4soMZCPWCs29ZRbsxkUY9VbpwrleeC06nAz8FL-wHbFQwitk-_R3iIS4eUoMXnQ$)

[Valery_V (imported)]

1. I am a little confused by a question: "Is it OK to raise him as an eunuch?"

The answer is undoubtedly negative. You cannot turn a boy into an outcast. At the age of 12-14, he probably already considers himself to be male.

2. "

The boy's father wants to be honest with his son about the social challenges the boy may face if he elects to delay or avoid puberty altogether and chooses to openly identify as a

n eunuch."

It seems to me that the boy does not want to be an open eunuch, and in order not to gain excess weight, he will engage in sports exercises.

Testosterone therapy can be safely postponed until the age of 18. Of course, this must be decided by the doctor.

[Begoneboy (imported)]

At the age of 14 It's probably not up to the father whether or not the youth should start "T" therapy. It's up to the individual. By now "14 years" This teen has already heard just about every sort of peer pressure there is about his own body. And I suspect has given it a lot of thought. Let this youth decide for himself after receiving sufficient medical advice rather than family advice is my thought on the matter. It's truly about living our own lives rather than having other's choices forced down our throat.

[nutty]

disagree. 14 is too young to make such decisions which why they can't vote or serve on a jury, etc. When he is 18 he can decide what he wants, but until then the docs should minimize the damage they caused and keep him on T until he is old enough to decide what he wants to do. I don't believe anyone said he wanted to be anything other than male before the medical accident....

[Begoneboy (imported)]

disagree. 14 is too young to make such decisions which why they can't vote or serve on a jury, etc. When he is 18 he can decide what he wants, but until then the docs should minimize the damage they caused and keep him on T until he is old enough to decide what he wants to do. I don't believe anyone said he wanted to be anything other than male before the medical accident....

That's the beauty of discussions. And I like we are able to disagree. Thank you for your response. Personally I don't believe that a potential 18 year old high school student is mature enough to serve on a jury or vote. neither did the founding fathers when they set the age at 21. But that is another topic we shouldn't go into. You are correct in that the post didn't say whether or not the teen had any desire

to be anything other than male.

It also didn't say what the teen's desire was. Only the father wanting advice for somebody other than himself. A bit controlling wouldn't you think?

[erikboy (imported)]

When I was 13, I knew that puberty is about to start any minute. I certainly did not want to go through puberty despite most of my classmates had already their puberty started. And even after it started I still did not want to go through it. I did some research what was possible on stopping puberty. May be at 15 I would have had different idea about going through puberty, but it was too late by that time already.

Many important decisions must be done before 18. Like whether to start a sport career etc. By 18 you might be too late for many decisions.

[notsomanly (imported)]

I know a number of young teens who realized they were transgender, binary or something else and their parents supported their decisions. I know of no instance when this did not build healthy mutual respect between child and parents, although I'm sure there are counter examples. In this case, the young man should be offered the choice of what sort of hormonal treatments are available. He is actually in the position to pursue T replacement, then stop and try E or nothing. One of those options may feel best for him.

One option he no longer has is to become a father, but the rest is up to him. I had no idea how good I'd feel without T, nor the many benefits I've found by taking E and discovering my feminine identity. In a way I envy the boy. He'll get to experiment at a young age.

[fhunter]

disagree. 14 is too young to make such decisions which why they can't vote or serve on a jury, etc. When he is 18 he can decide what he wants, but until then the docs should minimize the damage they caused and keep him on T until he is old enough to decide what he wants to do. I don't believe anyone said he wanted to be anything other than male before the medical accident....

I think 14 is age at which the decision should be at least partly on the boy if not fully. It is their body, and their life.

Here 14 is the age at which responsibility for murder/grievous body harm and similar stuff starts. 16 for less severe things.

Also - for the most part it is starting T that is not reversible, but waiting out is perfectly reasonable strategy.

[JesusA]

A little more information, beyond that in the two page article available at the link above:

The hospital where the error was made, resulting in the boy's castration, is pushing hard for him to begin hormone replacement. They want to bury the incident as best they can. The boy wants as much information about pros and cons as possible before making a decision.

The boy is very intelligent, and while his English was only three years of middle school, he wrote and directed an English language skit for the school talent show. I watched a video of it and was impressed by his ability. He graduated near the top of his class and was the only boy from his middle school accepted at the top-ranked high school in the region. Classes began at the end of August. He now shares a dormitory room at the school with five other boys.

He notes that he's enjoying his classes and that the teachers are better than he had in middle school. I've asked him to take notes on his roommates and other boys at the school as they go through male puberty. He can put off the decision for a while with no ill effects. I expect that he will eventually begin hormone replacement, although possibly not until after he takes the university entrance exam (annual, national, and 12-hours over a two-day period). He says that his roommates do not know that he is without testicles, although he does plan to tell them at some point as his lack of puberty will eventually raise questions.

He's commented that his roommates smell bad and don't wash often enough. They're slovenly and their shared room looks like a pigsty. I'm currently working on a detailed response to the most recent four-page report about his experiences in school and will note that his roommates were probably overly pampered by their mothers and never needed to learn to pick up their dirty clothes off the floor. The smell is testosterone plus unwashed boy. They will eventually learn, but it may take a while.

[Losethem (imported)]

I read all of this and think to myself that something is missing... What does the child want?

Does the child wish to be like all the other boys, or is he happy being without all the smells and disorganization he describes in his classmates? At the end, it is ultimately the boys life, and what his present desire is should be the significant input. Without knowing what country they are in, I would be hesitant to say he could identify as eunuch. Even here in the US identifying openly as a eunuch would likely be met with stigma, but would probably be better received than, say, if the child lives in Russia.

[NovaMike]

I can't help but wonder what motivates the father to have his son live as a eunuch. I am not sure what I would know about eunuchs if I wasn't personally interested in castration.

My personal opinion is that unless the child specifically questions the need to undergo hormone, that he should be on testosterone.

From watching the news, it seems like youth in the United States are starting to "pick" their gender while still minors. There was a story in the news about a gym teacher who said he would not refer to students by their preferred gender if it does not match their biological gender. That would seem to indicate that by the time a child becomes a teen, they are going as either non-binary or starting to transition. If a girl can decide if she wants to be a boy at 14, then why shouldn't this boy be old enough to decide for himself if he wants to be on testosterone or to remain in a pre-puberty state.

[JoeGreenParadox (imported)]

A friend of mine had been a Juvenile Court Judge. Among other things,there were cases where he had to decide which parent received custody of a minor child. The Judges in the circuit had a rule-of-thumb about the child's own request for placement, the ten to fifteen rule. The child's apparent maturity mattered. Still, the ten years and a day little girl, holding her dolly, got only a polite acknowledgement. The fifteen-going-on-sixteen year old, who said "my mother beats me for no reason. If you place me with her, I will run away to live with my father, every chance I get." got placed with her father.

Fourteen or fifteen years old is old enough to ask the kid what he wants, and, within reason, give it to him. The difficult part is persuading Judges or doctors to go along if he wants something else.

Most likely, he wants to be a boy. Not judgmental on my part, just noting typical behaviour. Most people don't want to be "different".

If he wants something else, he needs counseling with a competent counselor immediately. Not to change his mind, but to validate that what he wants is both his own decision, and that it is an educated and informed decision, free from coercion from others.

This is not six years of weekly psychotherapy. More like three or four 55 minute sessions over six weeks.

He will probably then be prepared to make choices that will profoundly affect the rest of his life. The counselor should be able to assess and explain the kid's level of maturity.

I knew guys that were not mature enough to make such a consequential choice until they were twenty.

I also met twelve and thirteen year-olds who were completely prepared, because they had been their disabled mother's sole caretaker for five or six years, and understood consequences. I cannot imagine how they pulled it off, but they had. I couldn't have done that.

[Valery_V (imported)]

The boy is "nerd" and "clean". At about his age I had to be in similar conditions (in the summer school of the winners of the regional mathematical Olympiad). Six of us lived in one residential part (bedroom + kitchen and bathroom) of the hostel. Nobody gave a damn about smells and stuff. But the attendants regularly came, checked and forced us to clean up after ourselves and keep everything clean.

It seems to me that no one would pay attention to physical disabilities. True, it was still a specific company, consisting of "nerds".

[Paolo]

You have my input and opinion on the matter from our chat tonight!

But for the readers here, my thoughts are that the boy should do what HE wants to do. It's likely that he will turn out/is male "between the ears", which is where it matters - not with what's between the legs.

Whether he (they?) decide on Non-binary, agender, gender-fluid, whatever - the decision should be left to "Our Friend, Jack", and no one else.

Is "Jack" too young to make this decision? I don't think so. It sounds as if he's quite intelligent.

I just hope that whatever decision he makes, he makes it for HIMSELF, and not out of some sense of hoping to please others.

[notsomanly (imported)]

You have my input and opinion on the matter from our chat tonight!

But for the readers here, my thoughts are that the boy should do what HE wants to do. It's likely that he will turn out/is male "between the ears", which is where it matters - not with what's between the legs.

Whether he (they?) decide on Non-binary, agender, gender-fluid, whatever - the decision should be left to "Our Friend, Jack", and no one else.

Is "Jack" too young to make this decision? I don't think so. It sounds as if he's quite intelligent.

I just hope that whatever decision he makes, he makes it for HIMSELF, and not out of some sense of hoping to please others.

I agree completely. If it were me, I would present the boy with the opportunity to explore all the possibilities for his future, including remaining free of testosterone and transitioning to female. The problem is that the hospital seems dead set on testosterone replacement as the only option. Sadly, this is the only option available to any of us by the medical community. My own endocrinologist is a good listener and hears my desire to be given a prescription for estradiol, but this option is "not indicated" for someone identified as male at birth. I think the hospital should offer any option, ultimately chosen by the boy.

[seanthomas (imported)]

This is like trying to solve the murder two minutes into an Agatha Christy movie. Simply insufficient information to render an opinion.