Self-esteem among eunuchs of Hazara Division, Pakistan.

Self-esteem among eunuchs is highly influenced by a variety of factors. The aim of the current study was to investigate the differences in self-esteem of eunuchs on the basis of education, income, age and marital status. The study was conducted at the University of Haripur, Pakistan, from December 2015 to November 2016. A sample of 140 eunuchs was collected from different areas of Hazara division, through purposive and snowball sampling technique. A self-esteem scale with four sub-scales was used to measure the self-esteem of eunuchs. One-way analysis of variance was used to determine education level differences. The t-test was applied to find out the impact of demographics differences such as marital status, income level, and age on self-esteem of eunuchs. The scale used was found to be quite reliable with alpha coefficient of 0.85. The outcomes are significant and showed that educated, higher income, younger and unmarried eunuchs had higher self-esteem (p<0.05).

Could gonadal and adrenal androgen deficiencies contribute to the depressive symptoms in men with systolic heart failure?

BACKGROUND: Testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) are neurosteroids and their deficiencies constitute the hormone risk factors promoting the development of depression in elderly otherwise healthy men. We investigated the link between hypogonadism and depression in accordance with age and concomitant diseases in men with systolic HF using the novel scale previously dedicated for elderly population. METHODS: We analysed the prevalence of depression and severity of depressive symptoms in population of 226 men with systolic HF (40-80 years) compared to 379 healthy peers. The severity of depression was assessed using the Polish long version of Geriatric Depression Scale (GDS). RESULTS: In men aged 40-59 years the severity of depressive symptoms was greater in NYHA classes III-IV compared to NYHA classes I-II and reference group. In men aged 60-80 years depressive symptoms were more severe in NYHA class III-IV compared to controls (all p ≤ 0.001). In multivariate logistic regression model in men aged 40-59 years advanced NYHA class was associated with higher prevalence of mild depression (OR = 2.14, 95%CI: 1.07-4.29) and chronic obstructive pulmonary disease (COPD) with higher prevalence of severe depression (OR = 69.1, 95%CI: 2.11-2264.3). In men aged 60-80 years advanced NYHA class and TT deficiency were related to higher prevalence of mild depression (respectively: OR = 2.9, 95%CI: 1.3-6.4; OR = 3.6, 95%CI: 1.2-10.63). CONCLUSION: TT deficiency, COPD and advanced NYHA class were associated with higher prevalence of depression in men with systolic HF.

The hidden world of self-castration and testicular self-injury.

Eunuchs are biological males who have undergone voluntary castration for reasons other than male-to-female transsexualism. The term 'eunuch wannabe' refers to individuals who desire, or are planning, voluntary castration. Out of fear of embarrassment or rejection, many eunuch wannabes do not consult medical professionals regarding their desire for voluntary castration. Instead, they commonly resort to self-castration, castration by nonmedical professionals, or self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures. In particular, intratesticular injection of toxins is performed so that urologists will remove the damaged testicles.

Experiences and treatment patterns of hypogonadal men in a U.S. health system.

OBJECTIVE: To examine self-reported experiences with hypogonadism (HG) and patterns of testosterone replacement therapy (TRT) in men seeking care in a U.S. healthcare system. METHODS: Men ≥ 18 years old with HG were identified from the 2008-2010 Reliant electronic medical records database. Surveys, including validated instruments for measuring symptoms of HG, were collected and evaluated for demographic and behavioural data. RESULTS: Surveys were mailed to 133 men with HG in 2012. Of the 107 surveys returned, 95 were included in the final analysis. Most respondents were Caucasian (90.5%). Men reported developing symptoms of HG, as well as being diagnosed, at a median age of 50 years. The most common symptoms reported as reasons for seeking treatment were erectile dysfunction (66.3%), fatigue (59.0%) and decreased sex drive (57.9%). These continued to be the most bothersome symptoms at the time of the survey regardless of whether the patient received treatment, although men who were currently taking TRT reported less severe symptoms. Approximately 88% of men reported taking TRT at some point, with 61.9% on therapy at the time of the survey. CONCLUSIONS: This study examined men's experiences with HG, including symptoms, quality of life, and treatments. Some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy. In light of this lack of adherence, patients may benefit from appropriate expectation setting regarding reasonable timelines for symptom improvement, the strengths and challenges of various TRT formulations, the importance of adherence and the benefits and risks of TRT.

Socio-sexual behaviour of hijras of Lahore.

OBJECTIVE: To assess risk behaviours including number and type of sex partners, condom use, knowledge of STIs and HIV/AIDS among hijras (eunuch) of Lahore. METHODS: Two hundred hijras were recruited through Respondent Driven Sampling and interviewed by a team of experienced interviewers. RESULTS: The mean age of the respondents was 29.2 +/- 6.3 years (Range 18-55). More than two third (68.5%) were illiterate; 23% were married. Among married, 89% were married to women and had 1 to 7 children. Sixty percent had taken some hard drug (Cocaine, Heroin, Morphine and Amphetamine) during the last 12 months and 3% had injected drugs. Eight percent had sex with a woman during the last year. During the last one week, 82% respondents had 1-21 new clients and 69.5% never used condom; 21.5% had oral sex with new clients. During the same period, 72% respondents had 1-12 regular clients and 71.5% of them never used condom while 7% respondents had 1-5 non-paying partners. During the last one month, five hijras had paid women to have vaginal sex. Nineteen hijras paid another man to have sex with them. Only 27.1% were not aware of any symptom of sexually transmitted Infections. Majority of the hijras (81.5%) were familiar with HIV/AIDS. However knowledge about its mode of transmission was faulty. CONCLUSION: Due to low level of accurate knowledge regarding STI/HIV and pernicious risk behaviours, hijras may become a potent source of HIV transmission, if necessary remedial measures are not taken.

Modern-day eunuchs: motivations for and consequences of contemporary castration.

This article compares the motivations for, and responses to, castration between two groups of males: prostate cancer patients and voluntary modern-day eunuchs with castration paraphilias or other emasculating obsessions. Prostate cancer patients are distressed by the side effects of androgen deprivation and typically strive to hide or deny the effects of castration. In contrast, most voluntary eunuchs are pleased with the results of their emasculations. Despite a suggested association of androgen deprivation with depression, voluntary eunuchs appear to function well, both psychologically and socially. Motivation, rather than physiology, appears to account for these different responses to androgen deprivation.

Follicular unit transplantation: the option of beard construction in eunuchoid men.

BACKGROUND: Psychosocial problems are very common in eunuchoids and may be related to the impact of underlying disorders on the physical appearance which makes them unable to overcome the sense of inferiority of childhood. A beardless patient treated with follicular unit transplantation (FUT) is reported here. OBJECTIVE: Such patients desire to get rid of a boyish appearance and want to achieve a masculine appearance. One of the easiest methods to achieve this goal is FUT. METHODS: By using an 18-gauge needle, the recipient bed was prepared under local anesthesia after premedication, and 1200 one- or two-hair micrografts were transplanted to the perioral (goatee) and its extensions to the sideburns. RESULTS: After completion of the procedure to the planned area, we achieved restoration of a masculine appearance which made the patient seem quite satisfied. CONCLUSION: The process of beard reconstruction is time consuming and tedious, but highly effective.

Systematic evaluation of sexual functioning in eunuch-transvestites: a study of 12 cases.

A semi-structured interview has been used to evaluate sexual functioning in transvestite-eunuchs known as Hijaras of India. Hijaras can be castrated males or male children with ambiguous external genitalia. Attitudes, experiences, behavior and frequency of sexual practices of the Hijara are described.

The hijras of India: cultural and individual dimensions of an institutionalized third gender role.

The hijra (eunuch/transvestite) is an institutionalized third gender role in India. Hijra are neither male nor female, but contain elements of both. As devotees of the Mother Goddess Bahuchara Mata, their sacred powers are contingent upon their sexuality. In reality, however, many hijras are prostitutes. This sexual activity undermines their culturally valued sacred role. This paper discusses religious meanings of the hijra role, as well as the ways in which individuals and the community deal with the conflicts engendered by their sexual activity.