Post-castration syndrome in women clinic. Manifestation of post-castration syndrome in women and methods of its correction
Hysterectomy with removal of the uterine appendages is one of the most frequently performed in gynecology and is associated with the development of post-total oophorectomy syndrome (PTOS, post-castration syndrome). Among abdominal operations hysterectomy in Russia is 38%, in the UK - 25%, in the USA - 36%, in Sweden - 35%. About 20% of women will have a hysterectomy during their lifetime. The average age of patients at the time of surgery is 43-45 years. Along with its therapeutic effectiveness in relation to the underlying disease, hysterectomy can negatively affect the health and quality of life of a woman.
Fast castration syndrome in women it develops after bilateral removal of the ovaries and includes vegetative-vascular, neuropsychic and metabolic-endocrine disorders caused by hypoestrogenism. Post-castration syndrome in women is also called surgical (induced) syndrome (based on the commonality pathogenetic mechanisms). The frequency varies from 55 to 100% depending on the age of the patient at the time of surgery, premorbid background, functional activity adrenal glands In general, the frequency is 70-80%.
Post-castration syndrome in women is more often detected in perimenopausal patients, as well as in patients with diabetes mellitus and thyrotoxic goiter (than in somatically healthy women).
Pathogenesis
The triggering and pathogenetically leading factor is hypoestrogenism with its inherent multiplicity of manifestations.
Disorders in the hypothalamic-pituitary region are accompanied by maladaptation of subcortical structures regulating cardiac, vascular and temperature reaction the body, since estrogen deficiency reduces the synthesis of neurotransmitters responsible for the functioning of subcortical structures.
The consequence of a decrease in the level of sex hormones with the cessation of the action of inhibin is a significant increase in the activity of LH and FSH until postmenopausal. Disorganization of adaptation processes can lead to increased TSH level and ACTH. Long-term estrogen deficiency affects the state of estrogen-receptive tissues, including the genitourinary system - atrophy of muscle and connective tissue increases with a decrease in the number of collagen fibers, vascularization of organs decreases, and the epithelium becomes thinner. Lack of sex hormones leads to gradual progression of osteoporosis.
Symptoms
The clinical picture of post-castration syndrome in women includes psycho-emotional, neurovegetative, and metabolic-endocrine disorders.
Psychoemotional disorders can occur from the first days of the postoperative period. The most pronounced are asthenic (37.5%) and depressive (40%) manifestations, phobic, paranoid and hysterical are less common. In formation psychoemotional disorders play a role as hormonal changes, and a psychologically traumatic situation due to the perception of hysterectomy as a mutilating operation.
Vegetoneurotic disorders develop from 3-4 days after ovariectomy and are characterized by mixed sympathicotonic and vagotomic manifestations with a predominance of the former. Thermoregulation is impaired in 88% of patients and is manifested by hot flashes, chills, a crawling sensation, and possible poor tolerance hot weather. 45% of patients have disturbed sleep, and fear of closed spaces is less common. Cardiovascular manifestations in the form of tachycardia, subjective complaints of palpitations, compressive pain in the heart and increased systolic pressure are detected in 40% of patients.
The clinical picture is similar to that of PGS, but, as a rule, it is more pronounced and prolonged. Reverse development of clinical manifestations without correction within a year occurs in 25% of patients; reproductive age more often (in 70% of cases), which is explained by the inversion of the main source of sex hormones, which becomes the adrenal glands.
Removal of the ovaries during hysterectomy causes metabolic-endocrine and urogenital disorders that occur after psycho-emotional and neurovegetative manifestations - 1 year or more after the operation and are most characteristic of premenopausal patients. The incidence of obesity, diabetes mellitus, ischemic heart disease, thrombophilia is gradually increasing, and the atherogenic index is increasing.
Hysterectomy is a risk factor for coronary heart disease, and the earlier the operation is performed, the higher the risk (1.5-2 times) of developing coronary heart disease at a young age. Already in the first months after surgery, atherogenic changes in the blood are observed: the content of total cholesterol(by 20%), low-density lipoproteins (by 35%). After removal of the ovaries, the risk of developing myocardial infarction increases 2-3 times, and mortality from cardiovascular diseases.
Removal of the uterus is associated with a higher risk of developing hypertension as a result of a decrease in the level of prostacyclins secreted by the uterus as vasodilating, hypotensive agents, and endogenous inhibitors of platelet aggregation.
Hysterectomy contributes to the occurrence of urogenital disorders (dyspareunia, dysuria, colpitis, prolapse) both due to hypoestrogenic metabolic and trophic changes in tissues and due to disturbances in the architectonics of the pelvic floor. 3-5 years after removal of the uterus, urogenital disorders of varying severity are observed in 20-50% of patients.
Hysterectomy with removal of the uterine appendages accelerates and intensifies the processes of osteoporosis; after it the average annual loss of mineral density bone tissue higher than in natural menopause. The incidence of osteoporosis in patients with post-castration syndrome is higher than in their non-operated peers.
Diagnosis of post-castration syndrome in women
The severity of psychoemotional and vegetoneurotic manifestations in patients who have undergone hysterectomy is assessed using the modified Kupperman menopausal index (MMI) as modified by E.V. Uvarova. There are mild, moderate and severe pathological post-castration syndrome in women. If necessary, additional methods for diagnosing psychoemotional, urogenital disorders and osteoporosis are used.
Treatment
The main treatment for post-castration syndrome in women is the use of hormone replacement therapy (HRT). It can be started on the 2-4th day after surgery. Parenteral forms of estrogens (gynodian depot) are preferable; it is possible to use
hormonal patches (estradiol), later - oral conjugated estrogens (Premarin). Prescribing HRT in the first days after surgery prevents post-castration syndrome in women.
Physiotherapeutic influence in early postoperative period may include the use of a galvanic collar according to Shcherbak, as well as decimeter wave exposure to the area of the adrenal glands and collar zone.
The choice of hormone therapy drug for long-term use depends on the volume surgical intervention, expected duration of HRT, condition of the mammary glands. The absence of a uterus allows the use of estrogen monotherapy, with fibrocystic mastopathy It is preferable to use estrogen-gestagens in a continuous mode.
For young patients (under 40 years old) who are expected to use HRT drugs for a long time, it is better to prescribe combination drugs(gynodian depot, divina, femoston, klimonorm cyclo-progynova, klimen); if necessary, a short course of estrogen monotherapy (estradiol, premarin) is possible. Parenteral administration medicines(in the form of gels, patches, intramuscular injections) excludes the primary metabolism of hormones in the liver and is therefore more acceptable for long-term HRT. It is also possible to replace one drug with another.
Patients with severe psycho-emotional manifestations are additionally prescribed tranquilizers and antidepressants in normal doses.
For prevention metabolic disorders Along with estrogen-containing HRT preparations, a course of vitamin therapy and taking microelements should be recommended. If osteoporosis is detected, in addition to HRT, pathogenetic therapy(calcium supplements, bisphosphonates, calcitonin). In the case of long-term use of HRT drugs in patients with SPTO, prevention of thrombotic complications and observation are necessary: mammography once every 2 years, mammary glands and palpation examination every 6 months.
If HRT is contraindicated, you can prescribe sedatives (valerian, motherwort, novo-passit), tranquilizers (phenazepam, diazepam, lorazepam), antidepressants - tianeptine (Coaxil), moclobemide (Aurorix), fluoxetine (Prozac), homeopathic medicines(klimaktoplan, klimadinon).
The article was prepared and edited by: surgeonPost-castration syndrome is a complex of disorders (vasomotor, neuropsychic, metabolic) that arise after removal of the ovaries in a mature woman.
The essence of post-castration syndrome
The most common and painful symptom of post-castration syndrome is tides, occurring as a result of a sharp expansion of the blood vessels of the skin of the face and upper body. In addition to hot flashes, neurovegetative disorders can manifest as sweating, dizziness, headaches, especially in the occipital region, and insomnia.
The incidence of post-castration syndrome varies , according to the authors, in the range of 50-80%. In some women, its symptoms disappear without therapeutic intervention within two years after removal of the ovaries, in others it lasts much longer. The initial state of the organs that regulate the most important factors plays a role in the occurrence of the syndrome. life processes nervous and endocrine systems, the age of the patient, as well as the ability of protective and adaptive mechanisms to quickly adapt to new conditions of existence of the body. Somatic diseases, as well as factors that adversely affect a woman’s psyche, complicate the course of post-castration syndrome.
The symptoms of the syndrome occur suddenly and in different time after removal of the ovaries. Most often this occurs 2-3 weeks after surgery.
The severity of its course depends to a certain extent on the cause of castration. So, with chronic inflammatory disease uterine appendages, including the ovaries, the symptoms of the disease are less pronounced. In cases of malignant neoplasms of the uterus or mammary glands, when the ovaries are not involved pathological process, their removal entails a more violent manifestation of the syndrome.
It is believed that young women have a harder time withstanding castration. After the age of 40, in some cases, the disorders inherent in post-castration syndrome do not occur at all (E. Teter, 1968; S. Milku, Danile-Muster, 1973). It is likely that castration performed in women of fertile age with a preserved menstrual cycle leads to more sharp fall the amount of estrogen in the body than in women during menopause and menopause. Research by O. N. Savchenko (1964, 1967) showed that in women operated on at the age of 23-35 years, the amount of estrogen excreted in the urine is only 4.6 mcg/day, and at the age of 39-51 years - 7.7 mcg/day. A significant difference was also found in the allocation of individual fractions of estrogens: in young women, estradiol and estrone predominated, and estriol accounted for only 21.8%, while in women of the older group, estriol accounted for 61% of the total amount of estrogens.
A milder course is also observed after castration caused by X-rays or radium rays. It is assumed that in such cases, estrogens can be formed in atretic and primordial follicles, which are less sensitive to radiation exposure than mature ones. This is partly confirmed by the results indicating the presence of estrogenic influence. In the urine of women who have undergone X-ray castration, an increase in the level of gonadotropins occurs no earlier than after 6-12 months.
In the first years after castration, neuro-vegetative disorders, mainly hot flashes, predominate. Subsequently, trophic changes in tissues and shifts in neuro-endocrine correlation develop. A sharp decrease in the amount of estrogen leads to atrophic processes in the reproductive system. With age-related decline in ovarian function, atrophic changes primarily occur in the external genital organs and gradually spread to the internal genital organs. After surgical castration, the uterus first atrophies, and the process of reverse development spreads simultaneously to the myometrium and endometrium. The cervix decreases in size, takes on a conical shape, the glands disappear, cervical canal closes. The cytological picture of the vaginal contents changes: the number of superficial cells, especially eosinophilic ones, decreases; after six months, intermediate and even basal cells are found. The pH of the vaginal environment increases, the vagina narrows, its mucous membrane becomes dry and easily vulnerable. Subsequently, the process of atrophy also affects the external genitalia. Glandular tissue The mammary glands are gradually replaced by fatty glands.
There is a tendency towards the occurrence of cardiovascular diseases (Novotny and Dvorak, 1973). Metabolic processes are disrupted. Body weight increases, mainly due to the deposition of fat in the abdomen and thighs. I. G. Grigorieva (1972), having examined 177 women castrated at childbearing age, with a duration of time elapsed after castration of 5-28 years, found hypercholesterolemia in 74% of cases, obesity in 55%, and hypertension in 61%. In the group of women aged 40-54 years, the frequency of hypertension was statistically significantly higher (57.2%) than in persons of the same age. age group with natural menopause (17.9%). One of the types of metabolic disorders due to castration is osteoporosis - the formation of bone tissue defects mainly in the area of the Div-Dvn vertebrae.
Pathogenesis
The pathogenesis of post-castration syndrome is complex and has not yet been fully studied. Removing the ovaries introduces dissonance into the glandular system internal secretion. This primarily concerns the hypothalamic-pituitary region. As a result of castration, the functional state of the hypothalamic nuclei, which take part in the formation of pituitary tropic hormones, is disrupted. Experimental studies have established an increase in the anterior lobe of the pituitary gland and the appearance of specific eosinophilic cells in it, which are called “castration cells.” Their formation is explained by an increase in the function of the anterior pituitary gland, but the cells appear provided that the connection between the adenohypophysis and the cerebral cortex is maintained, which indicates the presence of a certain relationship between the cerebral cortex and the gonads.
In response to a significant decrease in the amount of estrogen in the body, the release of FSH increases. According to V. M. Dilman (1968), after bilateral oophorectomy, the excretion of gonadotropins increases by more than 2 times. The effect of castration on serum levels in women was reported by Czygan and Maruhn (1972). On the 2-4th day after extirpation of the uterus and appendages and bilateral oophorectomy, both before and after the onset of FSH level, and on the 6-8th day the LH content increases. According to Aukin et al (1974), as time increases from the moment of castration, the release of gonadotropins in the urine progressively increases. However, it is not yet clear whether this is a consequence of overproduction of FSH or the excess is formed as a result of the fact that its use by the ovaries has ceased. There have been cases where, despite a high titer of gonadotropins in the urine, post-castration syndrome did not develop and, conversely, in patients with a severe form of the syndrome, a small amount of gonadotropins was detected in the urine. There is an assumption that hot flashes occur not so much due to an increase in the release of FSH, but as a result of a decrease in the amount of LH. Introduction human chorionic gonadotropin(LH) it is possible to achieve a reduction in neuro-vegetative changes.
Probably, after castration, the release of not only gonadotropic, but also other tropic hormones of the pituitary gland, including adrenocorticotropic and thyroid-stimulating, is disrupted.
Manifestations of post-castration syndrome such as arthrosis and diabetes are common. It has been suggested that there is a possibility of the formation of excess growth hormone and its role in the pathogenesis of these disorders (S. Milku, Danile-Muster, 1973). Some women experience thyrotoxicosis, which is explained by increased production of thyroid-stimulating hormone by basophilic cells of the adenohypophysis.
With the help of numerous studies and clinical observations, a close connection has been established between the ovaries and the adrenal cortex, so castration cannot but affect the condition of the adrenal glands. Their bark contains small amounts of steroids, similar in their action to sex hormones. The administration of female experimental animals causes an increase in the concentration of corticosteroids in the blood (A. V. Antonichev, 1968). Zondek and Burstein (1952) noted cyclicality in the excretion of corticoids in the urine in guinea pigs, which is closely related to the astral cycle; During estrus, corticoid excretion increases. After ovariectomy, low and acyclic secretion is observed. The administration of estrogen causes an increase in the amount of corticoids in the urine in both unspayed and castrated females. The authors believe that they stimulate the release of adrenocorticotropic hormone by the pituitary gland. After removal of the ovaries, hypertrophy of the adrenal cortex occurs. The relationship between its functional state and the severity of post-castration syndrome was shown by I. A. Manuilova (1972). The development of the syndrome is accompanied by a relative decrease in the function of the adrenal cortex and a weakening of the body’s compensatory reactions. In patients who do not have hot flashes, as well as with reverse development Post-castration syndrome, as a rule, reveals an increase in the function of the adrenal cortex, mainly glucocorticoid.
If, with age-related decline in ovarian function, the body gradually gets used to new hormonal conditions, then as a result surgical castration characteristic symptoms increase very quickly. Therefore, in establishing homeostasis after castration, it is especially great importance has a state of protective-adaptive mechanisms.
The sympathetic-adrenal system takes an active part in adaptation processes. Perhaps the occurrence of post-castration disorders is associated with irritation of the sympathetic nervous system as a result of hyperfunction medulla adrenal glands (M. G. Futorny, I. V. Komissarenko, 1969). This assumption is confirmed by the studies of I. A. Manuilova (1972), who studied the excretion of catecholamines (adrenaline and norepinephrine). The author found in almost all the examined patients an increase in the content of adrenaline in the urine and a decrease in the concentration of norepinephrine, which is an indicator of activation of the sympathetic-adrenal system. Particularly high numbers of adrenaline excretion were obtained in patients with a severe form of post-castration syndrome, which is probably due to stronger irritation of the hypothalamic nuclei.
Many authors consider the main cause of post-castration syndrome to be the disappearance or significant decrease in the amount of estrogens, based on the fact that their exogenous administration eliminates hot flashes. However, it is not. With the removal of the ovaries, the amount of estrogen hormones decreases sharply in all women, and post-castration disorders do not develop in all cases. In addition, I. A. Manuilova (1972) did not find a strict parallelism between the level of estrogen and the severity of post-castration syndrome. There was also no relationship between the level of estrogen excretion, the nature of the cytological picture of the vaginal smear and the duration of the operation.
Removal of the ovaries entails changes in the central nervous system, which was shown in an experiment by I.P. Pavlov. In the experiments of B. A. Vartapetov and co-authors (1955), the course of experimentally induced neurosis in dogs always worsened after castration. Removal of the ovaries in women entails changes in higher nervous activity, expressed in weakening inhibitory processes and slowing down differentiation processes.
Electroencephalographic studies in patients with a severe form of post-castration syndrome indicate a sharp excitation of the subcortex and an increase in the activating influence of the reticular formation on the cerebral cortex, as a result of which it is also involved in the pathological process (I. A. Manuilova, 1972).
Not only bilateral removal of the ovaries, but also unilateral oophorectomy in some cases leads to the development of vegetative neurosis, obesity, and impaired menstrual function(A. P. Galchuk, 1965; N. I. Egorova, 1966; F. E. Petersburgsky, 1968; A. E. Mandelstam, 1970, etc.). N.V. Kobozeva and M.V. Semendyaeva (1972) observed neuro-endocrine disorders that arose in the first 6 months after surgery in almost all women who underwent unilateral oophorectomy.
There are many reports of the occurrence of disorders similar to post-castration in patients after removal of the uterus with preservation of the ovaries. These disorders vary in nature, time of onset, intensity and duration. Their frequency, according to the literature, ranges from 47 to 82%. Hysterectomy causes more pronounced functional disorders than supravaginal amputation, which some authors explain by the exudative process in the stump area that often develops after surgery, which also involves the ovaries, resulting in their function being disrupted. According to M. L. Tsyrulnikov (1960), functional disorders after supravaginal amputation of the uterus occur in 40.9% of women, and after its complete removal - in 75%.
Perhaps among the causes neuro-vegetative syndrome After removal of the uterus, the disruption of the normally existing close relationship between the ovaries and the uterus, which is the point of application of the action of sex hormones, is of a certain importance. Probably, the limitation of the sphere of influence of ovarian hormones due to the removal of the organ that consumes them, as well as the switching off of a larger or smaller number of interoreceptors causes certain shifts in neuro-endocrine relationships. The importance of the uterus in the regulation of the gonadotropic function of the pituitary gland and the reproductive cycle is shown by experimental studies by O. P. Lisogor (1955). Mechanical irritation of the uterine mucosa leads to an increase in the content of gonadotropic hormones in the pituitary gland, an increase in frequency and prolongation of estrus. In many women, after diathermocoagulation of the cervix in the first half of the menstrual cycle, the content of pregnanediol in the urine significantly increases, which can be explained reflex action on the adenohypophysis and ovaries (M. A. Pugovishnikova, 1954).
The influence of ovarian hormones extends to all parts of the reproductive system, providing their inherent functions. Violation of the integrity of the reproductive apparatus and interoceptive connections at any link can lead to functional changes not only in the genital organs, but also in other organs and systems of the body. In this regard, the observations of S. N. Davydov and S. M. Lipis (1972) are interesting. They showed that with unilateral tubectomy, 42.3% of women developed hot flashes, sweating, increased excitability, sudden palpitations, and insomnia, and with bilateral tubectomy, similar phenomena, that is, symptoms of post-castration syndrome, were observed in 60% of women. In addition, these patients experienced an increase in body weight, diffuse enlargement of the thyroid gland, and painful engorgement of the mammary glands in the premenstrual period.
Treatment
Treatment methods for post-castration syndrome are varied and include various methods of influence, both individual organs, and on the entire body as a whole in order to slow down the development of changes that inevitably occur after surgery to remove the ovaries, and to enable compensatory mechanisms to equalize the disturbed balance.
Based on modern ideas about the pathogenesis of post-castration syndrome, treatment should be comprehensive: restorative and sedatives, vitamin therapy, hormone therapy. One of the elements of treatment is the impact on the patient’s psyche. In some cases beneficial influence a change of environment, introduction to regular work or its resumption have a positive effect. Special attention should be given a hygienic regime, including gymnastics and water procedures.
Vitamins are widely used in the treatment of patients with post-castration syndrome. There are reports that vitamin B1 reduces the secretion of FSH (M. Yules, I. Hollo, 1963). Vitamin Be has the same effect. A good therapeutic effect was obtained as a result of a course of treatment with vitamins and PP with a 2% solution of novocaine (K.N. Zhmakin, I.A. Manuilova, 1966). Vitamins and novocaine are administered intramuscularly in one syringe; Duration of treatment - 25 days. In combination with other methods, multivitamin preparations in the form of pills can be prescribed.
I. A. Manuilova (1972) noted a much longer course of post-castration syndrome in patients treated with sex hormones. With long-term administration of both estrogens and androgens, the production of glucocorticoids and estrogens decreases, which may be associated with the development of functional inertia of the adrenal cortex.
When prescribing hormonal therapy, it is necessary to take into account the age of the patient and the nature of the disease that required the use of such extreme radical method treatments such as castration. If it was made due to malignant neoplasm genitals or mammary glands, then hormone therapy contraindicated regardless of age. If the operation was performed for other indications, then in women young(up to approximately 38-39 years) combinations of estrogens and progestins are used as replacement therapy, introducing them cyclically until the endometrium loses the ability to respond in the form of menstrual-like bleeding.
Replacement therapy involves reproducing the endometrial cycle by administering estrogens and progestins. To do this, estrogens are first used to produce changes in the endometrium similar to the proliferative phase. Subsequent administration of progestins should ensure secretory transformations of the endometrium. Exist various options sex hormone therapy regimens. Prescribe 1 ml of 0.1% estradiol dipropionate once every 3 days (5-6 injections in total) or 0.1% sinestrol solution or 10,000 units of folliculin daily. After this, 10 mg of progesterone is administered daily for 7 days. Long-acting preparations are more convenient - 1 ml of 0.5% diethylstilbestrol propionate once every 7 days (2-3 injections in total), then 2 ml of 12.5% oxyprogesterone capronate. When removing the ovaries while preserving the uterus, it is recommended to administer 100,000 units of estrogen and 30-40 mg of progesterone monthly (S. Milku, Danile-Muster, 1973). Currently, combinations of estrogens and progestins are used, including long-acting ones. In some cases, this makes it possible to restore not only the menstrual cycle, but also its rhythm (Schneider, 1973), but long-term results in terms of the duration of the therapeutic effect, which largely depends on the ability of the endometrium to respond to exogenous hormonal stimulation, are still unknown.
After bilateral oophorectomy with removal of the uterus, the goal of treatment is to relieve vasomotor disorders and prevent the atrophic process in tissues and osteoporosis. For this purpose it is used as estrogen hormones, as well as their combinations with progestins or androgens. Doses are selected individually.
Long-acting estrogen preparations are recommended for young women to prevent vasomotor complications. The administration of 2 ml of 0.6% dimestrol solution has a therapeutic effect for several months. The most convenient use of estrogen drugs orally in the form of tablets. Treatment begins with small doses: ethinyl estradiol is prescribed at 0.01-0.02 mg; synestrol - 0.5-1 mg/day; octestrol - 1 mg; the dose of diethylstilbestrol is two times less; sigetin has a weak estrogenic effect, inhibits the gonadotropic function of the pituitary gland, it is used orally at 0.01-0.05 g 2 times a day, the course of treatment is 30-40 days.
Ohlenroth et al (1972), determining the content of estrogen in the urine of women with ovaries and uterus removed after administration of estriol, came to the conclusion that the hormone should be administered 2 times a day orally in an amount of 1-2 mg or 1 time a day intramuscularly.
Ta-Jung Lin et al (1973) studied colpocytological changes in castrated women with an atrophic type of vaginal smear under the influence of an estrogenic drug (Premarin), which was administered at a dose of 1.25 mg daily for 21 days, followed by a 7-day break. Every 2 months there was a one-month break. The hot flashes disappeared on the second day, but resumed immediately after stopping treatment. In vaginal smear Basal cells disappeared, the number of intermediate cells increased, and cells of the superficial layer were found in very small numbers.
The authors did not establish a connection between the nature of vaginal contents and the clinical manifestations of post-castration syndrome.
Estrogenic hormones are widely used to treat post-castration metabolic disorders. Rauramo (1973) reports their beneficial effect on skin trophism in castrated women. Using autoradiography, thinning of the epidermis and a decrease in its mitotic activity that developed as a result of castration were detected. The use of estriol succinate and estradiol valerate led to the restoration of the thickness of the epidermis and the activation of mitotic processes in it. For atrophic disorders in the tissues of the vulva and vagina, globulin containing 2000 units of folliculin is prescribed after 2-3 days, and folliculin ointment (S. Milku, Danile-Muster, 1973).
The administration of estrogens (agofollindepo Spof) has a pronounced therapeutic effect in the treatment of patients with developed after castration coronary atherosclerosis and dyslipoproteinemia. The content of serum lipids such as cholesterol and 6-lipoproteins is normalized (Novotny Dvorak, 1973).
Apply combination treatment estrogens and androgens in a ratio of 1: 20 and 1: 10 - 1 ml of 0.1% estradiol dipropionate or 10,000 units of folliculin along with 2 ml of 1% testosterone propionate. Injections are given once every 3 days (3-5 injections), and then the intervals are increased to 10-12 days. In this case, after 2-3 months, the phenomena of post-castration syndrome completely disappear (G. A. Kusepgalieva, 1972) and proliferation of the vaginal epithelium is observed according to the type of the middle follicular phase with the initial atrophic type of smear.
Most women, after stopping hormones, very quickly experience hot flashes and other post-castration disorders again. Therefore, hormonal therapy must be carried out over a long period of time. Implantation of crystalline estrogens into the subcutaneous fatty tissue, the resorption of which occurs in approximately 4-6 months, carries the risk of hyperplastic processes in the endometrium and. In this case, it is impossible to stop further absorption of the hormone.
Ovarian transplants also function for a limited time (6-12 months), and the results of their use are not always satisfactory. The possibility of ovarian tissue transplantation is currently being studied. To reduce intensity immunological reactions in the recipient's body, Yu. M. Lopukhin and I. M. Gryaznova (1973) used amniotic membranes as a semi-permeable membrane. The graft took root in all patients and was actively functioning for 6-10 months.
For the treatment of neuro-autonomic disorders, thyroid preparations that have a sedative and antigonadotropic effect can be used (S. Milku, Danile-Muster, 1973).
Long-term hormonal treatment in addition to control hormonal balance of the body (using mainly colpocytological studies) also requires periodic determination of liver function, body weight, state of the blood coagulation system, and blood pressure.
POST CASTRATION SYNDROME(lat. post after + castratio castration; syndrome; syn. castration syndrome) - a symptom complex that develops after the cessation of endocrine function testes in men and ovaries in women reproductive period and characterized by specific metabolic-endocrine, neuropsychic and other disorders. The syndrome caused by the cessation of the endocrine function of the gonads (or their hypofunction) in the pre-pubertal period is called eunuchoidism (see).
Post-castration syndrome in men
Post-castration syndrome in men is the result of traumatic, surgical or radiation castration (see), as well as destruction of testicular tissue due to acute and chronic infectious diseases.
Pathogenesis of P. s. in men it is caused by dysfunction of the hypothalamic, endocrine and neurovegetative regulatory systems(see Autonomic nervous system, Hypothalamic-pituitary system) in response to sudden loss of endocrine testicular function.
Pathophysiol, disorders with P. s. are characterized by a sharp tension in the hypothalamic systems (see), activating the gonadotropic function of the pituitary gland (see), the main result of this is increased secretion gonadotropic hormones (see). Other systems of hypothalamic regulation are involved in the process, and primarily the sympathoadrenal system (see). A sharp decrease in the concentration of androgens (see) in the blood is manifested by a number of specific endocrine and metabolic disorders. Sexual desire in many men remains for a long time after castration. Sometimes there is even the ability to have sexual intercourse due to the preservation of the corresponding mechanisms in the c. n. With.
Pathological changes caused by castration include the phenomena of demasculinization of the phenotype: changes in the nature of hair growth, reduction in muscle volume, redistribution of fat deposits in the subcutaneous tissue according to the eunuchoid type, progression of obesity due to loss of the anabolic and fat-mobilizing effects of androgens. The development of osteoporosis of various localizations is observed. The thyroid gland decreases in size in the post-castration period, tissue pancreatic islets(islets of Langerhans) increases, an acceleration of regressive processes in the pineal body (epiphysis of the brain) is noted.
To the earliest wedge, manifestations of P. s. include vegetative-vascular disorders. Patients complain of “hot flashes” (a sudden feeling of heat, often accompanied by redness of the face), increased sweating, a feeling of lack of air, shortness of breath, sometimes chills, paresthesia, dizziness, a feeling of palpitations with a normal pulse. Transient hypertension is often detected.
Later wedge, manifestations of P. s. associated with the development of a number of metabolic disorders. Patients complain about physical weakness, decreased ability to work, weakening muscle tone. Obesity develops with typical deposition of fat in the subcutaneous tissue on the thighs and in the hypogastric region (hypogastrium). The skin becomes thin, dry and wrinkled due to decreased secretion of the sebaceous glands and inhibition of anabolic processes in connective tissue. Osteoporosis causes pain in the bones, especially in the tubular bones. Note specific to P. s. neurotic manifestations (irritability, sleep disturbances, phobias). In cases where castration was carried out in late age, P. s. does not manifest itself so clearly; metabolic and vegetative-vascular disorders are less pronounced.
Diagnosis P. s. in men it is diagnosed based on medical history, taking into account the appearance of characteristic symptoms.
The main method of treating P. s. in men, androgen replacement therapy is used. The most common treatment is with long-acting sex hormones - sustanon, testenate, etc.; short-acting drugs and oral drugs (methyltestosterone, testobromlecite) are less effective. The duration and intensity of androgen replacement therapy depend on the severity of androgen deficiency and the age of the patient. The main contraindication for androgen therapy is cancer prostate gland. There is a method of surgical allotransplantation of testicles on a vascular pedicle, which has not yet received widespread use. In the treatment complex P. s. Depending on the wedge, the symptoms include treatment with sedatives, cardiovascular, antihypertensive and other drugs, etc.
Forecast P. s. in men depends on the individual characteristics of the patient. In most cases, it is possible to gradually reduce vegetative-vascular and neurotic manifestations. Endocrine metabolic disorders in P. s. require long-term androgen replacement therapy.
Prevention of P. s. consists in the prevention and treatment of inf. lesions of the testicles (see Orchitis), as well as in providing radiation protection in production, in X-ray rooms, etc.
Post-castration syndrome in women
Post-castration syndrome in women is characterized by the development of a certain wedge, a symptom complex with vegetative-vascular, neuropsychic and metabolic-endocrine disorders against the background of cessation of the endocrine function of the ovaries (see) in the reproductive period. According to the literature, the development of P. s. observed in 60-80% of cases after surgery to remove the ovaries. Every 4th woman after removal of the ovaries experiences a severe course of P. s. with vegetative-vascular disorders for 2-5, sometimes 5-10 years.
Pathogenetic mechanism of P. s. in women it is usually explained by a decrease in the content of estrogen (see) in the body due to the removal of the ovaries or an increase in the secretion of gonadotropic hormones. At the same time, there is evidence indicating that not all women with such hormonal disorders develop P. s. This gives reason to believe that in the formation of P. s. In women, the reaction of the endocrine glands to castration-induced hypoestrogenemia plays an important role. It has been established that the glucocorticoid function of the adrenal cortex in patients with a severe form of P. s. decreases and increases as the condition improves. A study of the excretion of catecholamines (see) showed a relative increase in the excretion of adrenaline (see) in all women after castration, which indicates a moderate activation of their sympathoadrenal system. The development of post-castration syndrome is accompanied by an increase in thyroid function and expansion peripheral vessels, especially in the distal limbs.
Pathophysiol, features of P. s. in women after surgical castration they are characterized by a certain relationship between the wedge and the course of P. s. and the nature of changes recorded on electroencephalograms (EEG). In patients with mild course of P. s. Usually there is a slight decrease in the amplitude of the dominant alpha waves and the appearance of slow waves such as theta. In patients with long-term and severe course P.S. (more than 20 “hot flashes” per day) there is a sharp decrease in the number of alpha waves and an increase in beta activity, as a result of which the EEG curve takes flat view, which indicates a sharp excitation of the subcortical structures of the brain and an increase in the activating influence of the reticular formation of the midbrain on the cortex big brain; Thus, in patol, the process involves not only subcortical formations, but also the cerebral cortex. Varying degrees of involvement in patol, the process of subcortical structures of the brain, according to EEG, are due to the premorbid characteristics of women subjected to surgical castration.
During the adaptation process in women after castration, the glucocorticoid function of the adrenal cortex (cortex) increases, the function of the thyroid gland decreases, the tone of peripheral vessels increases, and slight hypoglycemia develops with moderate activation of the sympathoadrenal system.
On radiographs of the skull of women with P. s. it is possible to detect changes in the bones of the skull in the area of the dorsum of the sella turcica and the posterior sphenoid processes (posterior inclined processes, T.). The extent of these changes depends on the severity and duration of post-castration syndrome.
In patients with mild course of P. s. and after a relatively recently performed castration operation, thinning of the posterior wall of the sella turcica and slight hyperostosis of the posterior wedge-shaped processes are observed. In patients with severe form of P. s. Along with hyperostosis of the posterior wedge-shaped processes, pronounced decalcification of the sella turcica is detected.
On radiographs of the bones of the cranial vault, every two women out of three after castration reveal hyperostosis of the occipital bone. Significant hyperostosis (the thickness of the occipital bone is 14 mm and higher, with a norm of 8.2 ± 1.22 mm) is usually observed in patients in whom P. s. occurs with severe diencephalic pathology, significant obesity and hypercholesterolemia.
Often P. s. in women it is characterized by atrophy of the epithelium of the mucous membrane of the vagina and uterus, a decrease in the size of the uterus, labia minora and clitoris. Due to atrophy of the glandular parenchyma, the mammary glands become smaller (they often visually appear enlarged, but this is the result of obesity).
Klin, painting by P. s. may vary depending on the patient’s age, premorbid personality characteristics and the nature of the body’s compensatory reactions. Severe postcastration syndrome is observed in patients with weakened hypothalamic-pituitary and sympathoadrenal systems that are unable to activate certain compensatory mechanisms necessary to normalize homeostasis.
Symptom complex P. s. consists in the appearance of vegetative-vascular disorders (“hot flashes” - a feeling of heat, redness of the face, sweating; palpitations, headaches, pain in the heart, dizziness), paresthesia, neuropsychiatric disorders, metabolic and endocrine disorders (obesity, atherosclerosis, hypercholesterolemia, osteoporosis), pain in the joints and limbs. These symptoms with P. s. can occur in various combinations and be of varying intensity.
Very often, hypertension develops in the post-castration period, and in women operated on after 45 years, it develops 3 times more often than in women whose castration operation was performed before 45 years.
The most constant and typical complaint with P. s. are "tides". Therefore, the frequency and intensity of “hot flashes” are conventionally considered as an indicator of the severity of P. s. Hot flashes usually appear after 3-4 weeks. after surgery to remove the ovaries and usually reach maximum severity after 2-3 months. after operation. They may be accompanied by sweating, palpitations, a feeling of shortness of breath, a feeling of fear, and sometimes fainting with convulsions and dizziness. "Tides" intensify at night, in the hot season, when nervous excitement and after hot tea or coffee.
Diagnosis P. s. usually does not present any difficulties; it is diagnosed based on the history of the operation to remove the ovaries and the appearance after approximately 1 month. after surgery "hot flashes".
Treatment of patients with severe form of P. s. It is advisable to start from the first months after surgery. It should be aimed at activating compensatory reactions of the body, normalizing functional state higher parts of the brain that control the body's adaptation reactions.
Patients with P. s. (both women and men) should be recommended physiotherapeutic treatment (see below), as well as calcium and glutamic acid preparations, drugs with a tranquilizing effect (frenolone, meprobamate, seduxen, elenium, valium, tazepam 0.5-1 tablet 2-4 times a day for 1-2 months, injections of vitamins B1, B6, C, PP and intramuscular injection 2% novocaine solution for 20-25 days.
In the absence of effect from the therapy, women with P. s. should be prescribed 1/4-1/2 tablets of infecundin or bisecurin for 1 week, then 1/4 tablets over the next 2 weeks. with a break of 2 weeks. In the future, breaks should be increased to 3-4 weeks. and more. A repeated course of treatment is recommended only if frequent hot flashes recur. The use of synthetic progestins (see) in combination with tranquilizers and restorative therapy enhances the therapeutic effect. Good effect can be obtained by prescribing Premarin 0.3-0.625 mg per day for 20 days, followed by the use of any progestins (5-10 mg) or pregnin (30 mg) daily for 6-8 days. In some patients, electroanalgesia gives good results.
Forecast P. s. in women depends on the premorbid characteristics of the patients, the state of the hypothalamic-pituitary and sympathoadrenal systems, the age at which castration was performed. With adequate therapy for the patient's condition, health improvement occurs quite quickly.
Mental changes in post-castration syndrome
Castration performed in adulthood in persons who are psychologically prepared for the need for surgical intervention, especially in men, may not cause mental changes that would affect the ability to work or require special assistance, but more often castration reproduces the picture of menopause (see Menopausal syndrome).
With P. s. men have nervous mental disorders- tearfulness, irritability, sleep disturbances, depression, general weakness etc. - are associated not only with hypothalamic pathology and metabolic disorders, but also with the manifestation of demasculinization. A decrease or disappearance of erections and sexual potency, a decrease in hair growth, etc. provoke the development of neuropsychic manifestations. In women with P. s. neuropsychic disorders (tearfulness, irritability, general weakness, fatigue, insomnia, memory impairment) are observed in more than half of the patients. Characteristic feature neuropsychiatric disorders in women after removal of the ovaries is the development of varying degrees asthenic syndrome.
In women undergoing ovarian removal surgery under the age of 45, neuropsychiatric disorders are observed more often and are more severe.
In a wedge, a picture of mental changes at P. s. psychogenic reactions - reactive states - may come to the fore various depths, due to the fact and circumstances of castration. These conditions are depressive disorders that sometimes occur intermittently; less often, such disorders are mixed anxiety-depressive or depressive-hypochondriacal and depressive-senestopathic.
The picture of mental changes in P. s. may also reflect the individual’s reaction to castration, to the medical and social consequences of castration (decreased libido, inability to have children, signs of hirsutism in women, etc.), because the intellectual sphere of patients remains quite intact in many cases.
Treatment mental disorders caused by castration, symptomatic. In these cases, antidepressants, minor tranquilizers, and sleeping pills are used. Psychotherapy plays an important role in combination with appropriate hormone replacement therapy.
Physiotherapy for post-castration syndrome
Treatment with physiotherapeutic methods is recommended to begin as early as possible, i.e. in the first months after castration. For patients with mild course of P. s. In order to stimulate the body's protective adaptive reactions, microwave therapy in the centimeter or decimeter range can be applied to the area of the adrenal glands. It is advisable to combine physiotherapy with general hardening and toning procedures: walks on fresh air, treat gymnastics, hydrotherapy (rubbing, washing or dousing with cool water, rain shower or sulfur, pine, sage, sea, sodium chloride baths).
For patients with severe P. s. treatment is carried out in two stages. At the first stage, all of the above procedures are recommended. At the second stage, galvanization is prescribed (see) - endonasal, cervicofacial, on the collar area; novocaine or magnesium electrophoresis on the collar area (see Electrophoresis, medicinal) can be combined with massage of this area, alternating between days or on the same day after 30-90 minutes. after electrophoresis or 2-3 hours before it.
For frequent, debilitating “hot flashes”, it is recommended to use electrosleep (see), 10-12 procedures per course (repeating the course after 4-6 months), central electro-analgesia according to Persianinov - Kaetrubin, the pronounced therapeutic effect of the cut allows you to reduce drug use load on the patient's body. When repeating a course of treatment, balneotherapy is desirable - oxygen, nitrogen, carbon dioxide, pearl baths. Women with P. s. over 45 years of age, radon or iodine-bromine baths are useful.
San.-kur. treatment should be carried out in conditions climate zone, familiar to the patient.
Treatment physical factors does not exclude the simultaneous or sequential (independent course) use of hormonal drugs, as well as psychotropic drugs.
Bibliography: Vartapetov B. A. Postcastration disease and the neurohormonal mechanism of its occurrence” in the book: Physiology and Pathology endocrine system, ed. V. P. Komissarenko et al., p. 85, Kharkov, 1965; Gynecological endocrinology, ed. K. N. Zhmakina, p. 436, M., 1980; Grollman A. Clinical endocrinology and its physiological foundations, trans. from English, M., 1969; Dilman V. M. Aging, menopause and cancer, L., 1968; Kvater E.I. Hormonal diagnostics and therapy in obstetrics and gynecology, M., 1967; Manuilova I. A. Neuro-endocrine changes when ovarian function is turned off, M., 1972; Milku S. Therapy endocrine diseases, trans. from Romanians, Bucharest, 1969; Rosen V. B. Fundamentals of endocrinology, M., 1980; Guide to Clinical Endocrinology, ed. V. G. Baranova, JI., 1977; Savchenko O. N. Ovarian hormones and gonadotropic hormones, JI., 1967; Starkova H. T. Fundamentals of clinical andrology, M., 1973; Teter E. Hormonal disorders in men and women, trans. from Polish, Warsaw, 1978; In 1 e u 1 e g M. Endokrino-logische Psychiatrie, Stuttgart, 1954; Endocrine causes of menstrual disorders, Symposium on gynecologic endocrinology, ed. by T. R. Givens, Chicago, 1978; The menopause, a guide to current research and practice, ed. by R. J. Beard, p. 86, a. o., Lancaster, 1976; Textbook of endocrinology, ed. by R. H. Williams, Philadelphia, 1974.
I. V. Golubeva, I. A. Manuilova (gin.); D. D. Orlovskaya (psychiatrist), I. F. Perfilyeva (cur.).
Post-castration syndrome– a condition that develops in a woman after surgery to remove the ovaries - the so-called surgical menopause. It should be noted that post-castration syndrome develops in menstruating women. In women undergoing menopause, clinical manifestations There are no post-castration syndromes as such, since the symptoms of menopausal syndrome and post-castration syndrome are very similar.
Post-castration syndrome is characterized by the following disorders in the body:
All these symptoms individually and especially in combination with each other lead to a significant decrease in quality of life, decreased performance, and decreased self-esteem.
The first symptoms of the disease may appear a few days after surgery. This is explained by a sharp cessation of the release of female sex hormones, estrogens, into the body, which are produced in the ovaries. A woman begins to experience seizures bad mood, irritability, aggression, tearfulness, obsessive thoughts, hot flashes, chills, sleep disturbances, irregular heartbeat or palpitations. Declining ovarian function healthy person occurs gradually, so the deficiency of necessary hormones is not felt so strongly. 1-5 years after surgery may appear late symptoms post-castration syndrome.
These include:
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Is it possible to cure post-castration syndrome?
After examining and collecting the patient’s medical history, the doctor prescribes lab tests to determine the level of sex hormones, thyroid hormones, cholesterol and blood lipids. The parameters of the blood coagulation system (coagulogram) are determined. Examination of the mammary glands (ultrasound of the mammary glands, mammography) and ultrasound of the thyroid gland are mandatory. To identify disturbances in the functioning of the cardiovascular system, an ECG is recorded. It would be a good idea to visit an endocrinologist, mammologist and neurologist. The treatment regimen for post-castration syndrome includes hormone replacement therapy to normalize the disturbed hormonal levels taking into account identified health problems. This therapy eliminates hot flashes, stabilizes blood pressure, improves memory and attention, eliminates dryness of the genital mucosa, and restores sexual desire, eliminates urinary incontinence. Additionally, sedatives, restorative therapy, vitamin therapy, correction of mineral and trace element deficiency are prescribed. Successful in the fight against unpleasant symptoms diseases and some homeopathic medicines, remedies traditional medicine based on herbs and calcium preparations. Tangible benefits come from sports, relaxing massage, and vitamin and mineral complexes. It is important to remember that you should not self-medicate!
How to prevent exacerbation of post-castration symptoms?
To reduce the severity of the manifestations of post-castration syndrome, each woman is recommended to take a number of preventive measures:
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Currently, castration of men is carried out in most cases according to medical indications. In some countries, chemical castration and sometimes surgical removal of the testicles are used as punishment for sex offenders. Serious changes occur in the bodies of castrated men and a number of complications may develop, so any method of castration can be used only if there are good reasons for this and there are no other options for solving the problem.
How and why is castration performed?
Before studying the procedure for chemical or surgical castration of men, it is necessary to understand what it is and what castration can be. Thus, a distinction is made between partial and complete castration. After partial castration in men, either endocrine or generative function disappears. Complete leads to the cessation of both functions.
Adult men are castrated if bilateral testicular tumors and prostate cancer are detected. If the patient is indicated for surgical removal of eggs, such an operation is called orchidectomy. Patients with prostate cancer do not have their entire testicles removed, but instead undergo an enucleation procedure, which removes the testicles. How complete removal eggs, and removal of testicular parenchyma alone can be performed only after confirming the presence of prostate cancer using a biopsy.
Castration leads to a number of changes in male body:
- A man’s subcutaneous fat tissue begins to actively and quite quickly develop, and he gains weight.
- Hair growth and its distribution according to the female type are noted.
- Sexual desire decreases sharply.
- The prostate gland atrophies.
If castration was performed before the onset of puberty, the boy experiences a noticeable change in bone structure, namely: 
- His tubular bones lengthen.
- The size of the skull remains relatively small.
- There is a pronounced development of the brow ridges and jaws.
Both as a result of chemical castration and after a surgical procedure, the functioning of the endocrine system in the male body is disrupted.
Castration for medical reasons
As noted, one of the indications for castration is prostate cancer. The tumor in most cases begins to develop under the influence of testosterone and dihydrotestosterone. These hormones promote the growth of normal and pathogenic cells. And it is lowering testosterone levels that is one of the main treatment options for prostate cancer.
Surgical removal of eggs can reduce testosterone concentrations by 85-95%. The operation can be performed under general, local or epidural (when an anesthetic is injected into the area spinal cord through the spine) with anesthesia. The specific option is selected together by the doctor, anesthesiologist and the patient.
However, in the case of prostate cancer treatment, complete surgical removal of eggs is in most cases replaced by an enucleation procedure, during which only their parenchyma is removed.
Preparation and performance of surgical castration
Before performing surgical castration, the doctor must verify the presence of cancer using a biopsy. In addition, the patient undergoes a number of additional tests and undergoes special examinations, namely: 
- General urine and blood tests.
- Biochemical blood test, which allows you to determine the concentration of bilirubin, urea, creatinine, total protein, etc.
- Blood test for hepatitis different shapes, syphilis, HIV/AIDS.
- Fluorography and electrocardiogram.
- If there is such a need, the man is referred to a consultation with a therapist and other doctors.
Some time before the operation (usually 1-2 weeks, the doctor will tell you the specific period), the patient should stop taking medications that affect blood clotting processes. The doctor will tell you about the specifics of taking other medications and life in general during the preparatory period during a personal consultation, taking into account the individual characteristics and needs of the patient.
Surgical castration is a relatively simple procedure. After anesthesia and other preparatory measures, the doctor makes an incision in the skin and subcutaneous tissue in the scrotum area, after which he dislocates the testicle and spermatic cord into the incision. The stitching, ligation and dissection of the ligament descending the testicle are performed. The vas deferens after preliminary removal from spermatic cord bandaged and cut. After this, surgeons perform stitching, ligation and dissection of the remaining elements of the spermatic cord. Finally, stitches are applied.
There is also a more complex variety surgical operation, which allows you to preserve the protein membrane of the testicles and provides a more acceptable cosmetic result. The operation takes a little time. Complications during the operation practically do not appear. In most cases, patients are sent home on the day of surgery.
Features of chemical castration
Chemical castration is a kind of alternative to surgical procedure. The main advantage of chemical castration is that it does not cause such serious damage to a person’s physical and mental health as surgery. This technique is most often used to punish sex offenders or when there are suspicions that a man's sexual behavior may be dangerous to other people.
The main purpose of chemical castration is to suppress sexual function. After some time, sexual function is restored. The procedure is carried out by introducing into the man's body a drug containing a modified form of testosterone. This drug almost completely reduces sperm production. Testosterone production stops. As a result, chemical castration leads to a decrease in sexual function, but is temporary and less radical than surgical intervention.
Complications after castration
Many men develop the so-called after castration. post-castration syndrome. It is expressed by a whole list of complexes. Endocrine, vascular-vegetative and neuropsychic disorders are noted.
It manifests itself in the form of various symptoms, the nature and severity of which largely depends on the age of the patient, his state of health and the compensatory reactions of the body.
Thus, the most common vegetative-vascular disorders include the so-called. tides, palpitations, excessive and frequent sweating for no particular reason. After castration, these symptoms begin to appear on average after 1 month and reach their peak within 2-3 months after surgery. In addition, one of the most common symptoms post-castration period are periodic headaches that occur mainly in the temples and back of the head. In addition to headaches, there is high blood pressure and pain in the heart.
It is necessary to take into account the fact that there is a whole complex of symptoms that sometimes even doctors mistakenly mistake for the manifestation of other diseases. In the case of post-castration syndrome, such manifestations are pain in the heart, rapid growth excess weight, pain in the joints, lower back and head, fainting, dizziness, etc.
Adult men who have undergone surgical castration often develop nervous and mental disorders, and almost always develop hypertension.
Many men constantly feel weak and tired, and they may experience physical and mental stress for no reason. Another characteristic symptom of post-castration syndrome is memory impairment. It becomes more difficult for a man to remember current events, to the point that he will not be able to remember the events of a book he has just read or a feature film he has watched. Many patients periodically experience depression, they become indifferent to what was interesting to them before castration. For some, the state of indifference reaches such an extent that thoughts of suicide begin to appear.
Among metabolic and endocrine disorders, atherosclerosis and obesity develop most often. In addition, hair loss or the beginning of its growth according to the female type, the appearance of fat deposits according to the female type, and sexual desire decreases.
In most cases, in men with post-castration syndrome, one type of disorder characteristic of this condition is more pronounced.
Treatment of post-castration syndrome
First of all, the doctor must make sure that the cause of the existing manifestations is post-castration syndrome and not other diseases. To do this, the patient’s medical history is studied, he may be referred for tests and additional examinations. It all depends on the individual characteristics of the man in each specific case.
Treatment of post-castration syndrome is necessarily comprehensive. It should include taking medications that help normalize the function of certain parts of the brain. The order of treatment may vary. As a rule, it all starts with the course sedatives and general strengthening agents. The patient must undergo physical therapy, undergo sessions of water procedures, ultraviolet radiation, etc. In addition, complex therapy necessarily includes vitamins, tranquilizers and antipsychotics. The duration of treatment depends on the severity of the patient's condition. Long-term hormonal therapy may be prescribed. You can start taking any medications only as prescribed by your doctor.
Many experts strongly recommend appropriate psychotherapeutic preparation of a man for the changes awaiting him even before castration. The patient should know what he needs to be prepared for after such a procedure. It is important to consult a doctor in a timely manner, because... Some men in this state have thoughts of suicide.
