In the Absence of Testosterone: Hormonal Treatment, Masculinity, and Health among Prostate Cancer Patients Engaging in an Exercise Programme

Round 1

Reviewer 1 Report

Thank you very much for giving me the opportunity to review this paper. This is a very interesting paper focusing on ADT treatment and masculinity. Although it is very clear and very well written, there are some things that need to be clarified or to be expanded to further in this topic.

The paper describes emasculation processes, but it does not contemplate (or not explicitly enough) the opportunities that the new situation could give participants to actually perform (socially and physically) normative masculinity. In fact, to act stoically to face the cancer or to do physical activity with other men (especially for those who did not do it before participating in the programme) could be examples of the performance of normative masculinity, and not only ways of counter physical emasculation. Whether the participants feel this way or not should also be incorporated to the paper.

Especially important is to clarify (and analyse) how ADT treatment affects men in different ways according to their previous engagement with sport and age. Do older participants give the same explanation of ADT side effects than the younger?  Were the participants inactive before starting the program? If not, how did the different sport trajectories affect emasculation?

Other relevant question that researchers should contemplate is how participants conception of masculinity and femininity could influence the way they experience ADT side effects.

Author Response

General comment:

• Thanks for the constructive feedback and critique provided by both of the reviewers, which helped us bringing the piece forward. We have tried to meet the comments to the best of our ability and had few objections to the suggested revisions. Below we explain in detail how we have addressed each comment. Again, we thank the Reviewers.

Reviewer 1.

Thank you very much for giving me the opportunity to review this paper. This is a very interesting paper focusing on ADT treatment and masculinity.

Although it is very clear and very well written, there are some things that need to be clarified or to be expanded to further in this topic.

• Thanks for the encouragements.

The paper describes emasculation processes, but it does not contemplate (or not explicitly enough) the opportunities that the new situation could give participants to actually perform (socially and physically) normative masculinity. In fact, to act stoically to face the cancer or to do physical activity with other men (especially for those who did not do it before participating in the programme) could be examples of the performance of normative masculinity, and not only ways of counter physical emasculation. Whether the participants feel this way or not should also be incorporated to the paper.

• Good point. We have included a note on this in the result section (p. 10).

Especially important is to clarify (and analyse) how ADT treatment affects men in different ways according to their previous engagement with sport and age. Do older participants give the same explanation of ADT side effects than the younger? 

-this is an interesting point, but the sample is, sorry to say, too small here to make such an analysis possible. Therefore we have here focused on the more common understandings among the participants (highlighting variation when relevant). Thanks.   

Were the participants inactive before starting the program? If not, how did the different sport trajectories affect emasculation?

• We added some information on this in method section.

Other relevant question that researchers should contemplate is how participants conception of masculinity and femininity could influence the way they experience ADT side effects.

• This is addressed in the two first sections of the results.

Reviewer 2.

This was a nice read. Clearly framed and executed, well done. Good innovative application of theory with Merleau Ponty and stoicism. However, that part, it seems to me, could have been developed and been more brave.

• Thanks for the encouragements.

Only minor issues to deal with:

The Hoberman-section at the very beginning (line 259 of the results-chapter seems misplaced, better displayed in the discussion/conclusion perhaps? 

• We have moved this section to the conclusion section.

Thomas Johansson is referenced in a parenthesis. Remove first name, line 361)

- Revised

There is one blank space too many at line 430

• Revised

Lastly about being brave theoretically:

It was a good theoretical match to refer to M-P:s phantom limb in relation to experiences of erectile dysfunction. 

But, there is clearly another case here: Yes, function is gone, but body remains (and some time gains, as with breasts and buttocks).

So rather than a phantom we are here dealing with a more carnal form of the undead, such as zombies or ghouls. I would have tried to ask a question what would happen to embodiment theory and "phantomality", when the body parts aren't corporeally absent.

This is a minor remark and perhaps something that could be developed in an anthology chapter or more extended book discussion.

-Thanks, this is an interesting point. We added a short note on this in the analytical framework. We will surely develop more on this theoretically in upcoming writing. Thanks.

Good luck!

 -Thanks again for the support provided to bring the piece forward.

Reviewer 2 Report

Dear authors,

This was a nice read. Clearly framed and executed, well done. Good innovative application of theory with Merleau Ponty and stoicism. However, that part, it seems to me, could have been developed and been more brave.

Only minor issues to deal with:

- The Hoberman-section at the very beginning (line 259 of the results-chapter seems misplaced, better displayed in the discussion/conclusion perhaps? 

- Thomas Johansson is referenced in a parenthesis. Remove first name, line 361)

- There is one blank space too many at line 430

Lastly about being brave theoretically:

It was a good theoretical match to refer to M-P:s phantom limb in relation to experiences of erectile dysfunction. 

But, there is clearly another case here: Yes, function is gone, but body remains (and some time gains, as with breasts and buttocks).

So rather than a phantom we are here dealing with a more carnal form of the undead, such as zombies or ghouls. I would have tried to ask a question what would happen to embodiment theory and "phantomality", when the body parts aren't corporeally absent.

This is a minor remark and perhaps something that could be developed in an anthology chapter or more extended book discussion.

Good luck!

Author Response

General comment:

• Thanks for the constructive feedback and critique provided by both of the reviewers, which helped us bringing the piece forward. We have tried to meet the comments to the best of our ability and had few objections to the suggested revisions. Below we explain in detail how we have addressed each comment. Again, we thank the Reviewers.

Reviewer 1.

Thank you very much for giving me the opportunity to review this paper. This is a very interesting paper focusing on ADT treatment and masculinity.

Although it is very clear and very well written, there are some things that need to be clarified or to be expanded to further in this topic.

• Thanks for the encouragements.

The paper describes emasculation processes, but it does not contemplate (or not explicitly enough) the opportunities that the new situation could give participants to actually perform (socially and physically) normative masculinity. In fact, to act stoically to face the cancer or to do physical activity with other men (especially for those who did not do it before participating in the programme) could be examples of the performance of normative masculinity, and not only ways of counter physical emasculation. Whether the participants feel this way or not should also be incorporated to the paper.

• Good point. We have included a note on this in the result section (p. 10).

Especially important is to clarify (and analyse) how ADT treatment affects men in different ways according to their previous engagement with sport and age. Do older participants give the same explanation of ADT side effects than the younger? 

-this is an interesting point, but the sample is, sorry to say, too small here to make such an analysis possible. Therefore we have here focused on the more common understandings among the participants (highlighting variation when relevant). Thanks.   

Were the participants inactive before starting the program? If not, how did the different sport trajectories affect emasculation?

• We added some information on this in method section.

Other relevant question that researchers should contemplate is how participants conception of masculinity and femininity could influence the way they experience ADT side effects.

• This is addressed in the two first sections of the results.

Reviewer 2.

This was a nice read. Clearly framed and executed, well done. Good innovative application of theory with Merleau Ponty and stoicism. However, that part, it seems to me, could have been developed and been more brave.

• Thanks for the encouragements.

Only minor issues to deal with:

The Hoberman-section at the very beginning (line 259 of the results-chapter seems misplaced, better displayed in the discussion/conclusion perhaps? 

• We have moved this section to the conclusion section.

Thomas Johansson is referenced in a parenthesis. Remove first name, line 361)

- Revised

There is one blank space too many at line 430

• Revised

Lastly about being brave theoretically:

It was a good theoretical match to refer to M-P:s phantom limb in relation to experiences of erectile dysfunction. 

But, there is clearly another case here: Yes, function is gone, but body remains (and some time gains, as with breasts and buttocks).

So rather than a phantom we are here dealing with a more carnal form of the undead, such as zombies or ghouls. I would have tried to ask a question what would happen to embodiment theory and "phantomality", when the body parts aren't corporeally absent.

This is a minor remark and perhaps something that could be developed in an anthology chapter or more extended book discussion.

-Thanks, this is an interesting point. We added a short note on this in the analytical framework. We will surely develop more on this theoretically in upcoming writing. Thanks.

Good luck!

 -Thanks again for the support provided to bring the piece forward.