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Testicular Cancer

Masculinity and self-image after testicular cancer

Previous research suggests that men who have had a testicle removed may feel less masculine immediately after surgery or chemotherapy, but once they have had time to adjust and make sense of what has happened, they no longer feel that their masculinity is threatened. This may be because men who have lost a testicle are usually able to have sex and return to work quite soon after surgery, and they take up sports and other normal activities as soon as the incision has healed (see 'Sex' and 'Work').

Some men said that they never even considered that masculinity might be affected by what they considered to be a 'minor' operation. 

 

Says that he did not feel that his masculinity was threatened when he lost a testicle.

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Age at interview: 25
Sex: Male
Age at diagnosis: 22
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Did you have any sort of feelings at that time that it might affect your masculinity or anything?

No, not at all. At the time I weighed almost 18 stone er I was pretty big and I was known for being big and I was, I was a bouncer at the local university and I didn't, I still didn't, I felt almost invincible. And this minor operation, what I felt like, well it is I think a minor operation hadn't affected me whatsoever. I was actually back training lightly a week after the operation, much against obviously medical advice (laughs) but I was.
 

Some men, however, said that just as women who lose a breast might feel their femininity is threatened, men might feel that their self-image is affected by the removal of a testicle. One man said that the removal of a testicle was initially a 'tremendous blow' because it went to the core of his sexuality.

 

Suggests that masculinity and self-esteem may be affected by the loss of a testicle.

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Age at interview: 46
Sex: Male
Age at diagnosis: 44
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Do you think the whole business of testicular cancer affects men's sense of masculinity, of being a man?

I think so yes, yes, I think anything that affects men in the, down below in that way can have an effect on their sort of what's the word, what's the word, self esteem I suppose, their self image as men is suddenly affected isn't it. I suppose I relate it very much to a woman losing a breast you know she may feel that she's lost her femininity and that's widely understood. It's the same for men.
 

Explains that he felt a tremendous blow when his first testicle was removed.

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Age at interview: 50
Sex: Male
Age at diagnosis: 39
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With regard to my story, going back to my story with the removal of one testicle you know it was a tremendous blow. I can understand now why women get so really uptight about cancer that affects, goes direct to your sexuality. If I'd have had a tumour in my lung or in my leg or another part of my body I don't think it would've affected me as much as something that goes to the core of my sexuality. I mean you hear on television some of the expressions about men brimming with testosterone or whatever and it comes as a shock. 

One man, whose self-image was affected, and who opted for a false testicle, suggested that gender identity isn't only about body shape, but about state of mind and how others see you.

 
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Suggests that gender identity is not only about body shape but more to do with a state of mind.

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Age at interview: 46
Sex: Male
Age at diagnosis: 42
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Can you say a little bit more about how the whole experience affected your sort of feelings of self identity and masculinity. You mentioned you wanted to have a prosthesis because you thought it might be better from that point of view?

Mm, I didn't feel I was any less of a man because you know, because of what was done, I think if I'd lost both testicles I'd feel that would be a considerable loss, relying on hormone injections and so on. But I don't think gender identity is about body shape anyway, it certainly isn't purely about that.

What do you think it is more to do with then?

It's very much more a state of mind and it's about how you see yourself and how other people see you. Again my wife was probably the most important part in this, was very emphatic that from where she was standing it wouldn't make any difference. I talked to her about the question of prosthesis and what would she think about it, whether I should have a prosthesis or not, and she said it wasn't an issue for her but if it was an issue for me then may be that would be a good idea. But you know I don't think, I don't think her perception of me as a man is, has a great deal to do with appearance.

Threat to masculinity may be greatest immediately after surgery. One man said that he felt “a great sense of loss” for about ten days. He regretted losing a body part and also felt a loss of masculinity. However, he soon realised that sexual function wasn't impaired, and quickly got used to living with only one testicle. Another man also said that initially his sense of masculinity was affected, which may be why he chose to have a false testicle. (See 'False testicles').

 

Recalls that he felt a great sense of 'loss' for a short while.

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Age at interview: 55
Sex: Male
Age at diagnosis: 40
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Arthur Frank said' Well after that I had surgery which was really not much of a problem. I mean er an orchiectomy as we call it in Canada is about like having your appendix out in terms of surgery, it's just not a major operation. The loss of a testicle was a big thing for about a week and a half may be. I mean at first there was this great sense of loss and particularly because your pubic hair is shaved, you've got this scar, you've got surgical dressings. I remember the scrotum just kind of hanging there and I did feel a definite sense of loss. Again I would say that really lasted for you know no more than 10 days or so because the, the surgical site quit causing me any problem within 2 or 3 days and then very quickly I was moving onto chemotherapy and I had other things to worry about.

Before you go on can you just expand a little bit about your sense of loss, was it, I don't want to put words into your mouth?

Arthur Frank' Well

In a sense of your masculinity or part of your body or

Arthur Frank' Both, both I mean there's this common expression, at least in North America where you talk all the time about balls you know "that really took balls," or "he's really got balls," and all of a sudden you don't have balls, you've got ball and so there is a kind of threat at least to masculinity. It was important to me to realise very quickly that sexual function wasn't impaired at all er and really that the funny thing (laughs) is that once I got used to having one testicle which was really again very quick it all of a sudden seemed incredibly clunky to have 2. I mean the idea of "well don't they bump into each other/" and they do bump into each other and all of a sudden having 1 just seemed like a very natural and even sort of preferred way to go through life.
 
 

Suggests that he felt a loss of masculinity for a while, and that is partly why he had the...

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Age at interview: 45
Sex: Male
Age at diagnosis: 40
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What about sense of masculinity, do you think it affects guys' sense of masculinity at all or temporarily?

I think it does to a degree. Initially, especially early on. As I said I had a prosthesis and I think that had, that had something to do with why I decided I would have it. Part of it I think was automatic, I'm losing a testicle, I want one back. And as I said early one with the surgery it was so rushed between diagnosis and surgery that I'm not sure I was making a 100% rational decisions all the time. So thinking back I'm really not sure why I decided to have the prosthesis. I think part of it is vanity, part of it is the self-image, part of it is sort of masculinity and sexuality. There is a severe worry you know as I said you know the idea of someone close to my genitals with a sharp knife makes me still very nervous. Probably even more nervous now I've only got one testicle than I did when I had two. But yes it is worrying.
 

In rare situations, men may lose both testicles or they may be born with one testicle, and then lose the other testicle due to cancer. However, men in this situation can have testosterone replacement (see 'Hormone treatment'), and thus can continue to have a full sexual relationship, with penetrative sex. One man, who initially said that losing one testicle had been a tremendous blow (see above, Interview 37), and who felt emasculated when he lost the other testicle, started on hormone replacement therapy and then felt more positive, asserting that 'there is no reason whatsoever for a man to feel any less of a man because a small part of the body has been removed.

 

Describes how he felt when he lost both testicles.

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Age at interview: 50
Sex: Male
Age at diagnosis: 39
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So how did the idea that you were now losing two affect you?

Through no fault of anybody else's, and I think it's because of how I felt myself, I felt almost as if I'd been emasculated, mutated. I didn't blame anybody because it wasn't as if it was a mistake by somebody, this was something that had happened to me and I found that I was in the position where I didn't know whether I could ever have sex again, I didn't know what the future held for me, would it spread, and a whole manner of things. And there wasn't much in the way of help for people that had both testicles removed. I then after about a week or so they then started giving me injections of a hormone that they explained to me that I needed to keep my body going.

They've removed a part of my body, but the rest of my body is whole, the rest of my body works very well, and there is no reason whatsoever for man to feel any less of a man. And that is very, very, important; don't ever feel any less of yourself because a small part of your body has been removed.

One man recalled that when he heard he was about to lose his only testicle he was glad to be offered two false ones. He worried about his masculinity and feared that others might think he was a homosexual because of his lack of interest in women. Only later did he realise that he could have an excellent sex life with the help of hormone replacement therapy and that the false testicles weren't in the end so important.

 
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Explains why he decided to have two false testicles.

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Age at interview: 26
Sex: Male
Age at diagnosis: 24
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Yeah I did feel threatened for my masculinity because I actually had, I had a chip on my shoulder at school about people finding out that I had one ball and it was quite a strong chip on my shoulder. I think that's why I found it so hard, the idea when I got cancer, I mean may be it would've been different for me if I'd had two, and they were just taking away one you know.

Mm of course.

Because you know you can, I know for a fact you can live a normal life on one, you get the right amount of testosterone, you can, things are very normal. But I remember at school when it came to like taking showers and stuff I was really quite paranoid about that. So when it came to someone offering you know to have two [false testicles] I thought, I think I was bringing in that sort of insecurity of like my childhood, I thought about it, oh wow, I can make it alright now by having two. So I think yeah my masculinity was definitely threatened. Because I know as a child just the idea of people finding out I had one and may be questioning my masculinity that "Oh you've only got one testicle, you know you're not a real man," you know the whole playground tactics, I was always worried about that. And so yeah when he [the doctor] said that, [that he could have two false testicles], I was like yeah give me two, anything to make you know strong like man, two testicles. Now it's quite, I just don't know where it all came from, because now like I said, I wouldn't even mind if the prosthesis that I have wasn't there because at the end of the day it's purely, you know it's just, it's not part of me anyway you know.

One man, however, born with only one testicle, who was treated for cancer many years ago, was not offered hormone replacement therapy when he had his testicle removed, and describes a deep sense of stigma, loss of masculinity and lack of self-esteem. He feels that he will never get over the pain, the humiliation, the disappointment and shock of being castrated.

Last reviewed December 2017.

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