Hormone Therapy: Beyond the Euphemism

Hormone therapy, also called “androgen deprivation therapy” (ADT) is a widely prescribed treatment for prostate cancer. Androgens are the male hormones—the most well known of which is testosterone—that cause boys to develop secondary sexual characteristics during puberty and control men’s sexual functioning once they mature. However, for men with prostate cancer, testosterone is the food supply for cancer cells, encouraging these cells to grow and multiply.  Thus, substantially lowering testosterone levels in a man’s body can help shrink prostate tumors.  Hormone therapy is used in cases of advanced (Stage III) and metastatic (Stage IV) cancers, or sometimes as a treatment for cancer that has returned after first being treated by surgery or radiation.  At any given time, approximately 600,000 men in the United States are undergoing hormone therapy as a treatment for prostate cancer.

The earliest form of hormone therapy was orchiectomy (surgical castration), or the permanent removal of the testicles, where about 95% of a man’s androgens are produced.  Orchiectomies are still performed in less affluent countries such as India.  In the US and Europe, ADT drugs called “Testosterone Inhibiting Pharmaceuticals” (TIP) are the norm. Depending on the drug used, a dose can be injected every 30 to 90 days, and implants that last up to a year are also available.  Depending on the aggressiveness of the cancer, these drugs may be administered over a period of six months to two or three years, or even for the remainder of a patient’s life.

Chemical Castration
But what is TIP-based ADT, really?  ADT shuts down androgen production in the testicles to “castrate levels” just as effectively as orchiectomy.  ADT is “chemical castration.”  And the side effects of chemical castration are no less severe than surgical castration: hot flashes, loss of body hair, decreased muscle mass, breast growth, and most significantly, loss of libido, and impotence, which can be permanent, even after ADT is discontinued.

But no urologist or oncologist is likely to say to his or her patient, “In order to stop the growth of your prostate cancer we need to chemically castrate you.”  Instead he or she is likely to say, “We need to put you on hormone therapy,” often even avoiding the more complicated terminology “androgen deprivation therapy.”

“Hormone therapy” is a polite euphemism, pure and simple.  (And since the idea is to eliminate male hormones—including testosterone—it would be more accurate to call it “anti-hormone therapy” or “hormone elimination therapy.”)  While urologists and oncologists all understand what “hormone therapy” really is, not all prostate cancer patients do.

A recent study published in the European Journal of Cancer Care found that many of the men it surveyed had no idea that the hormone therapy they were prescribed was intended virtually to eliminate male hormones from their body—in the strictest sense, to castrate them.

Euphemism or Facing the Facts?
The reasons for the euphemism “hormone therapy” are obvious. The word “castration” carries with it enormously negative personal and societal connotations, all of which are emasculating and dehumanizing.  No man wants to think of himself as a “eunuch.”  This psychological issue is precisely why orchiectomy’s permanency has caused the practice to fall out of favor.  Chemical castration at least holds the promise of restoring one’s manhood when it is discontinued (although this is certainly not guaranteed).

So, therein lies the conundrum: if by informing patients that they are to be chemically castrated as part of their treatment leads to dreadful psychological side effects, does that justify using the euphemism “hormone therapy”?  Does the euphemism deny patients the information they need about what to expect from their treatment, especially when the urologist or oncologist is squeamish about describing exactly what the very benign-sounding “hormone therapy” actually entails?

Source: Richard Wassersug, PhD, “Beyond the Abstract: The Language of Prostate Cancer Treatments and Implications for Informed Decision Making by Patients and Their Partners,” UroToday, http://bit.ly/MDDSU9 Accessed August 10, 2012.

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