Maintenance of sexual function in a castrated man treated with ovarian steroids

Sexual function, mood states, and endocrine levels were studied in a 48-year-old man who had been castrated bilaterally because of severe post-vasectomy orchialgia and who habitually uses oral estrogen and progestin. He reported satisfactory sexual behavior with a usual coital frequency of at least twice per week while on treatment with Premarin and Provera. Though his nocturnal penile tumescence (recorded on a portable home monitor) was very low while on this treatment, psychophysiological tests showed that erectile responses to erotic film were well within the normal range for control subjects in this laboratory. A double-blind experiment was performed to assess his sexual functioning and mood states during treatment with placebo, testosterone enanthate, and estradiol valerate, with and without progesterone (one injection of each, with 4-week intervals between treatments). All treatments generated prolonged changes in circulating hormone levels; testosterone treatment was associated with elevated estradiol levels, and estradiol with massively increased plasma prolactin. Coital frequency was highest with the estrogen-progestin treatment and lowest with placebo. Testosterone precipitated a very high frequency of spontaneous erections and severe negative affect. The subject also reported low sexual drive and poor mood states while taking Provera alone. It was concluded that the preferred estrogen-progestin treatment of this patient, probably in conjunction with minimal androgen levels from his adrenal, are most likely responsible for maintaining his satisfactory sexual functioning. There is no evidence that other castrates would necessarily benefit from a similar hormonal regimen.