I castrated over a hundred men

I just hosted an extraordinary guest in my home for two days, Professor of Urological Surgery, Dr. George Yu. Of the many profound conversations I enjoyed with this modest gentleman, none could be harder to forget than the one that started with “in 1978 I castrated over a hundred men.”

With over thirty years of clinical experience, Dr. Yu understands in a way few people can the effect deprivation of testosterone has on a man. He has watched hundreds of patients rapidly change from healthy, robust men with a zest for life into thin-legged, sparsely muscled, pot-bellied, hunchbacked shadows with little interest in anything. This experience affected him deeply, motivating him to radically alter the focus of his practice into one that cares for patients in ways that enhance and enrich life.

For over sixty years, castration (surgical or chemical) has been virtually mandatory for men with prostate cancer. Only recently have we come to realize that this drastic choice may only be beneficial in certain cases of advanced metastatic disease, and then only to ease intolerable bone pain. It doesn’t cure the disease. It doesn’t even extend the life of the patient.

He and I will have much to say about the management of prostate cancer in our book, but what struck me this weekend was how essential our sexuality is to our sense of self, how fundamental it is to who we are.

If Nature has one command, it is this: “Live long enough to procreate.” This ancient dictum, codified in the Scriptures with the imperative to all creation “Be fruitful and multiply,” is all that really matters. We are all going to die, whether we procreate or not. But if reproduction fails, all life on the planet – which has survived for hundreds of millions of years – ceases to exist.

It should not be surprising therefore that our so-called sex hormones – testosterone, estrogen and progesterone among others – would govern our entire being. Not just our sex lives, but every aspect of our physiology. Receptors for these steroid messengers are found everywhere, from our muscles and bones to our internal organs and even in our brains, influencing how we think, feel and act.

Look at what our so-called sex hormones do in addition to supporting reproduction. They keep our bones and muscles strong. They keep our insides healthy. They reduce our risk factors for disease. They keep us mentally sharp, happy and motivated. Beyond physical and mental health, they also play an essential role in bonding with our mates, our children and our friends, which is the glue of a healthy society. Who can fail to see the destructive consequences of sexual denial and frustration in societies where Eros is despised instead of honored?

Our sexual identity is not merely one aspect of our lives. It is a fundamental characteristic of every facet of ourselves. This is not an easy concept to embrace. We live in a culture that despises sexuality. Erotic pleasure is allowed only under strictly limited conditions. Indeed, our traditional belief systems frame it as a necessary evil. Some mainstream religions go so far as to demand celibacy from their leaders – to require a vow of disobedience to the first commandment of the Creator.

What should we do with our sexuality if we want to live the second sixty years (or even the first sixty) in harmony with nature? What does it mean to thrive in vibrant health when producing children is neither appropriate for our stage of life nor even good for the planet?

So here is the challenge: We must confront, recognize, welcome and own our sexuality as part of the intrinsic goodness of all life. We must learn to treasure, adore, enjoy and harness our libido as the engine of health and wellbeing.