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.
In the past, men were castrated—had their testicles removed or destroyed—in order to make them eunuchs so that they could play particular social roles. Many of these eunuchs also had their penises removed. Adult males are still castrated in contemporary North America, but for a variety of other reasons. Castration is part of sexual reassignment for transsexuals, and it also can be a court-approved procedure to reduce the risk of recidivism by sexual offenders. But by far the most common reason for either chemical or surgical castration is to treat advanced prostate cancer. By a low estimate, each year in North America 40,000 men begin androgen deprivation therapy by either surgical or chemical castration to slow the growth of cancer (Aucoin and Wassersug 2006). Given a median survival time of greater than six years (and climbing), there are thus more than a quarter of a million medically castrated men in the United States right now. Yet few people know of their existence.
Among the rarer reasons for castration is to fulfill a personal desire to be emasculated. Some men, for example, have sadomasochistic paraphilias and are sexually aroused by the idea of being castrated. These individuals actively seek out castration despite having no obvious medical need for it and, like the castrated prostate cancer patients, are similarly hidden from public view.
This paper explores motivations for, and consequences of, castration in contemporary Western culture. We focus on two disparate populations: prostate cancer patients, and males with castration paraphilias or other emasculating obsessions. Thus, we are concerned here only with males castrated after puberty. The physical and psychological effects of androgen deprivation differ depending on whether one is castrated before or after puberty (Zitzmann and Nieschlag 2000). Males who have their testicles removed before puberty retain prepubescent features, such as a high-pitched voice and the absence of facial hair. In contrast, males who are castrated after puberty retain facial hair and a deeper voice, but still experience physical changes such as loss of body hair, some gynecomastia, and penile shrinkage.
Medical Eunuchs: Advanced Prostate Cancer Patients
The main treatment for advanced prostate cancer (where the cancer has spread beyond the prostate gland) is androgen deprivation therapy (ADT). This can be achieved by either chemical or surgical castration. Various agents are used for chemical castration, ranging from LH-RH agonists to natural and synthetic estrogenic compounds (estradiol and diethylstilbestrol, respectively). In North America the most common hormonal treatments for prostate cancer are LH-RH agonists, such as leuprolide (Lupron) and goserelin (Zoladex). These drugs are often used short-term as adjuvant therapy to radiotherapy for the primary treatment of prostate cancer. Although in theory chemical castration need not be [End Page 545] permanent, even with short-term use, LH-RH agonists have persistent negative impact on testicular function (Murthy et al. 2007). In practice, patients who have failed primary treatment and have rising prostate-specific antigen levels stay on these drugs for the rest of their lives.
The side effects of an orchiectomy or extended use of an LH-RH agonist, in addition to those feminizing features already mentioned, include an average 10% gain in weight, mostly as fat in the abdominal and hip region, an average 3–4% loss of lean muscle mass, mild anemia, osteoporosis, hot flashes, and genital shrinkage (Higano 2003; Keating, O'Malley, and Smith 2006; Smith et al. 2006; Zitzmann and Nieschlag 2001). Greater than 85% of androgen-deprived males experience reduced libido, and erectile dysfunction is common. Depression is often reported in androgen-deprived prostate cancer patients, but it is hard to separate that from grief from having failed primary treatments for their cancer and, also, from aging (Shahinian et al. 2006). Cognitive effects of low testosterone have been noted in visual-spatial performance (Zitzmann and Nieschlag 2000, 2001). Most recently, Beer et al. (2006) reported "immediate and delayed verbal memory [was] significantly worse in patients on ADT." Other psychological changes are not so rigorously defined. However, changes in emotionality have been reported for these men, as well in male-to-female (MtF) transsexuals, most conspicuously as an increase in tearfulness (Gray et al. 2005; Wassersug et al. 2007). These changes, particularly those that impact upon the ability to function sexually as males, are not easy for the men to deal with.
In trying to provide psychological support to these patients, the American Cancer Society published a widely distributed booklet, Sexuality and Cancer: For the Man Who Has Cancer and His Partner (Schover 2001). It states that "men who have lost their testicles or are on hormone therapy . . . fear becoming feminine in looks and personality. This is a myth. Manhood does not depend on hormones, but on a lifetime of being male" (p. 23). On first pass, this may sound reassuring. The quote, however, presumes that the male gender is socially constructed over a lifetime and is then invariant. There are no data showing that this is true or that this reassurance is effective. Instead, many studies show that the physical and psychological consequences of ADT are severe, leaving patients impotent, depressed, with cognitive deficits and a severely reduced quality of life (Beer et al. 2006; Chapple and Ziebland 2002; Fergus, Gray, and Fitch 2002; Gray et al. 2005; Navon and Morag 2004; Oliffe 2006), with some exceptions (Bloch et al. 2007).
Navon and Morag (2004) reported that a breakdown of spousal relationships is common with ADT. With reduced libidos, many castrated males withdraw affection and physical contact from their partners. They are often embarrassed by the changes they are experiencing and reluctant to discuss them. This can, in turn, lead to frustration and depression in the partners (Soloway et al. 2005). As one patient commented "I can't tell my wife that I've stopped enjoying sex with [End Page 546] her, and it really worries me" (Navon and Morag 2004, p. 2342). Navon and Morag (2003) suggest that collapse of spousal relations may occur in approximately half of these couples, but admittedly theirs was a single small study, and no long-term studies have been done to understand what the nature of the spousal relations was before the men were castrated.
In-depth interviews of prostate cancer patients on ADT have shown that many of these men find themselves in a situation where they no longer feel fully male but do not see themselves as so feminized as to be able to identify as female (Chapple and Ziebland 2002; Fergus, Gray, and Fitch 2002; Navon and Morag 2003; Oliffe 2005). For example, one patient stated: "I began to see myself as a man without masculinity. There's no other way of putting it. I mean, I'm not a woman, but I have a woman's breasts" (Navon and Morag 2004, p. 2341). Another commented: "You're basically turning into some[one of] hermaphrodite status which is, you know, not very happy" (Chapple and Ziebland 2002, p. 834), while a third said: "I'm no longer a viable man—I'm a eunuch. I'm a gelding" (Fergus, Gray, and Fitch 2002, p. 310). One patient summed up his feelings in the following way: "Whenever I saw my body, I wondered, 'Who am I? A woman? A man?' It's a very confusing situation. I believe I'm neither one thing nor another; that's the only way I can think about myself without becoming confused" (Navon and Morag 2003, p. 1383).
Androgen-deprived cancer patients often experience their "border bodies" (Zita 1998) and the iatrogenic complications of the loss of erectile function and of other physical signifiers of masculinity as profoundly shameful. A sample of quotes from a study conducted by Navon and Morag (2003) underscores this point. As one of the study participants stated: "Since the treatment, I find it hard to look at my body. It makes me hate myself" (p. 1382). Another commented that "every time I looked at myself, I became depressed" (p. 1383).
To escape this shame, androgen-deprived patients often go to great lengths to hide the effects of castration (Fergus, Gray, and Fitch 2002; Gray et al. 2005; Navon and Morag 2004). Navon and Morag (2003) reviewed the various ways that the men use disguising, diverting, and attempting to draw attention away from their emasculated attributes, such as loss of body hair or their loss of genuine sexual interest, by acting, as best they can, like normative males in public settings. For example, one ADT patient stated: "I only wear clothes that hide my chest and my hairless legs" (p. 1383). Another admitted: "I can't let anyone know what's happened to me, so I still flirt with women, although I no longer feel attracted to them" (p. 1384). Still another recalled "With my friends, I'm constantly forced to invent stories justifying why I'm hot [from hot flashes], and why it's better for me not to go to the beach. I often use some skin disease as a pretext" (p. 1383).
As these quotes make clear, ADT patients experience their bodies and the difficulty they face in fulfilling heteronormative male gender role expectations as [End Page 547] deeply problematic and stigmatizing.1 There is a cost, though, in using denial and avoidance to deal with emasculation. If, for example, the men are reluctant to exercise for fear of revealing their hairless bodies, then they increase their risk of osteoporosis, weight gain, depression, and cardiovascular problems—all of which increase their risk of morbidity and mortality. In the long run, denial as a psychological defensive strategy is detrimental to the patients' physical and psychological health (Roesch et al. 2005). Accepting how much they have changed can be equally problematic. Fergus, Gray, and Fitch (2002) show that the patients feel "they are guarding a deep secret and fear they will be found out." One patient in those studies felt that disclosing one's castrated status was harder than coming out as gay. These patients' "border bodies" are problematic to both themselves and others. Not fitting the heteronormative male model in form and function is stigmatizing.
In summary, this research demonstrates that castration challenges the idea of what it means to be a male in our society and is deemed so shameful that, despite the tens of thousands of medical eunuchs among us, few people admit to this status. As a result, the public is largely unaware of how common medical castrations are in the Western world.
Whereas advanced prostate cancer patients do not desire castration and must unwillingly endure its side effects, there are other men who desire to be emasculated through castration. Some of these men even go to such extremes as self-castration in order to achieve eunuch status (Brett et al. 2007). This population has been superficially studied in terms of motivation for castration (Deshotels and Forsyth 2007; Wassersug, Zelenietz, and Squire 2004), and the responses of these men to being castrated is just now being explored (Brett et al. 2007). We have been studying both eunuchs and "wannabes" (men who express the wish to be castrated) with the help of the Eunuch Archive (www.eunuch.org), an Internet community of over 3,500 members fascinated by castration and in many instances having castration paraphilia (sexual interest in the idea of being castrated). We posted an on-line questionnaire asking about participants' demographics, sexual orientation, sexual history, knowledge of side effects, etc., to better understand what motivates these men and how those who are voluntarily castrated deal with the side effects (Brett et al. 2007; Johnson et al. 2007). In three months we received 996 responses. The survey results have been supplemented by ongoing interviews, approximately two dozen of which have been done to date. Steps taken to assure the validity of the data collected are discussed in Johnson et al. (2007). [End Page 548]
The mean reported age of the respondents was 42 years, and the majority had education beyond high school. Over 97% of respondents believed they have XY chromosomes; the others believed themselves to have XX or to have a sex-chromosome variant like Klinefelter syndrome (XXY). Seventy-six percent self-identified as males, and 9% identified as females, which suggests that there were a number of people who could be identified as transgendered (those who believe they have XY chromosomes but who identify as females). Fifteen percent responded either "other" or "neither" when asked to identify as male or female.
Not all individuals completed the survey form, and we restricted our analysis to those who gave sufficient and consistent information. Most (731) of the presumed-XY individuals were not castrated and accepted the label wannabe for the purposes of our survey. Of the 135 presumed-XY individuals who had been voluntarily castrated, 92 had had their testicles removed for some reason other than medical necessity, and 43 were chemical eunuchs. In addition, 18 individuals had been castrated for a medical reason, and 13 individuals claimed to have been involuntarily castrated. The mean age of this total of 166 eunuchs was 46 years old. Their mean age at castration was 40.
Despite voluntary castration, many of the surgical eunuchs took supplemental hormones: a full 37% went on testosterone and 23% took estrogen, while 40% took no gonadal hormones. Our questionnaire did not ask about motivation for the use of supplemental hormones. Those individuals taking a low dose of either testosterone or estrogen may have been doing so to try to counter some of the effects of androgen deprivation, such as hot flashes and osteoporosis. Those on full replacement testosterone may have had a purely body dysmorphic motivation for castration, where they disliked the look or feel of a scrotum with testicles in it, but did not want the other psychological and physical side effects of androgen deprivation. Those who were taking a transitional dose of estrogen may be understood as transsexuals who not only desired to not have testicles but who also wanted their bodies to be feminized. Overall, however, the numbers suggest that the majority of voluntarily castrated men who identify as eunuchs do not identify as male-to-female (MtF) transsexuals.
Just over half of the voluntary eunuchs were single (including both divorced and separated). One third were married, and an additional 5% were unmarried but partnered with females. One in ten were partnered with males. Over a half of the individuals considered themselves either homosexual (27%) or bisexual (29%). Just over 35% identified as heterosexual. Surprisingly, just 4% considered themselves asexual (whereas about 1% of the general population considers themselves asexual; Bogaert 2004). Twenty percent claim to have changed their sexual orientation since being castrated, but our questions were not probing enough to discern the direction of that change (e.g., heterosexual to homosexual). In contrast to the castrated prostate cancer patients, the voluntary eunuchs reported higher levels of sexual activity and interest. Not surprisingly, there were significantly more individuals on high doses of supplemental testosterone who rated [End Page 549] themselves as sexually interested and active than individuals on no gonadal hormones. What was surprising was that the individuals who were on high-dose estrogen also reported a significant increase in sexual desire and activity above the agonadal level (t-tests, both p < .001). The voluntary eunuchs were on average more than two decades younger than the cancer patients. In terms of both their self-rated physical health and the fact that they were not burdened with a diagnosis of advanced cancer, they were clearly healthier than the prostate cancer patients. Nevertheless, these data suggest that both biological factors—age, health, and hormones—and psychological expectations, too, influence sexuality in the androgen-deprived male. In this regard, it is worth noting that eunuchs in history have been sexually active, and even at times lascivious, depending on the cultural norms of the time and place (Aucoin and Wassersug 2006).
In our survey, approximately one in five voluntary eunuchs and wannabes reported sexual, physical, and/or emotional abuse in their childhood. Yet overall the voluntary eunuchs had high levels of self-reported mental health, physical health, and social interactions (Johnson et al. 2007). Nevertheless, 49% reported having depression of either a major or minor sort before castration, and 38% reported depression after castration. The direction of change is opposite that of prostate cancer patients, which is consistent with the belief that the effect of androgen levels on depressive illness is "probably closely related to general stress reactions" (Zitzmann and Nieschlag 2001). Stress is theoretically increased for cancer patients facing castration, but reduced by castration for the eunuch wannabes (Brett et al. 2007). Indeed, the incidence of one stressor for many voluntary eunuchs, obsessive-compulsive behavior, was self-reported as being reduced by half upon castration—a significant decline (C2 test, p < .01). For those with intense castration ideations, being androgen-deprived may not necessarily increase the risk of depression and may (for some) actually be therapeutic. Where obsessive-compulsive ideations are focused on castration, the castration itself can resolve that problem.
The motivation for voluntary castration was explored by Wassersug, Zelenietz, and Squire (2004) and more extensively by Johnson et al. (2007) and Brett et al. (2007). An individual voluntary eunuch or wannabe may have more than one reason for desiring castration, and his motivations may change over the years. For example, some of the eunuchs in an online survey who first thought that they were MtF transsexuals later decided that they were not and settled into a eunuch identity.
In our study, the top self-reported reason for the eunuchs having desired castration was libido reduction (37%), and this was similarly true for wannabes. However, approximately a third of the voluntary eunuchs claimed to have a dysmorphic view of their genitals, and a similar percentage acknowledged that they were stimulated by ideas of castration in a way that suggests castration paraphilia. Some subtle differences can be found between those individuals who were [End Page 550] chemically versus surgically castrated. Although they did not differ significantly on any demographic parameters (age, education, or religious background), chemical eunuchs were more likely to seek castration for libido control or to advance transition as MtF transsexuals (C2 test, p < .05). There was also a slight tendency for more surgical eunuchs than chemical eunuchs to report masochistic ideations involving genital mutilation in advance of their actual castration (C2 test, p < .10). Seventeen percent of the surgical eunuchs gave "a desire to be female" as a reason for getting castrated. Almost as many (15%) said that they were castrated "to please a partner."
Personal narratives from 372 men with castration paraphilia revealed five common themes among the self-reported life histories of those with extreme castration ideations: (1) having witnessed farm animals being castrated while growing up; (2) having been threatened by a parent with castration for behavior deemed inappropriate; (3) having been sexually abused as a child; (4) having been raised in a strict religious household; and (5) being homosexual (Johnson et al. 2007). Several narratives seemed to feature castration as a punishment for having sexual desire. For example, one respondent claimed: "My mother caught me in the living room . . . . I was having a good time playing with that thing down there that felt good when I touched it. As I recall she . . . became unglued. She took me into the kitchen, pulled my shorts down around my ankles. She picked up a knife and gripped my little boy thing in the other hand. She asked me if I wanted her to 'cut it off' because I was playing with that thing." Another said, "I've always thought that I penectomized myself as penance for past sexual sin. . . . I was taught that sexual fun was sinful and degrading," and a third person claimed that "Jesus's words ('If your right hand causes you to sin, cut it off') played a major role in my decision."
Not surprisingly, these ideations often betrayed a masochistic element. For example, one man wrote: "The thoughts that I began to have at 12 were of harm (in general), which became more and more specifically focused on the testes." Another said "I never felt as though I had an actual 'disorder,' however, I could not control my desire to be castrated. I fantasized about it for years and started to cut my scrotum open repeatedly, and attempted castration for sometime. Eventually I enlisted the help of a friend, but I did the cutting."
A number of the narratives recorded included a sense of wanting castration to correct a mismatch between anatomy and sense of self. Among our sample of voluntary eunuchs are many classic MtF transsexuals. A third of the wannabes, for instance, expressed interest in sex reassignment to female. More than twice as many respondents, however, were not interested in being female. For example, one respondent wrote: "I am not transsexual, as far as I know. I am transgender, and only want to lose them. Happily, that is possible now. . . . I feel mostly gender-neutral. I do not wish to become a woman. But I have my gender-issues, I definitely do not feel 'male.' I think that there is a whole broad range between [End Page 551] 'male' and 'female.'" Another said similarly: "the desire [was] to lose my testicles and leave behind some of the effects of being male. . . . I should say that I have absolutely no desire to be female." A third reported: "I was castrated on 12/06/97 in a cheap hotel room. . . . Castration was the right thing for me so I did not have severe depression or problems adjusting. I never wanted to be a girl but I did not enjoy being male either." Some reported that this sense of being "not male" went far back into early childhood. For example, one respondent wrote: "I knew at age 4 that I wasn't suppose[d] to have male parts. I never acted on it until my 30's for many different reasons. . . . Mostly because I knew I was suppose[d] to act . . . male. I do not regret being castrated and would do it over in a heartbeat, I only wish I could have gone to a doctor to have it done correctly because of the complications I'm having now from the specific method used by a cutter."
For every voluntary eunuch who answered our questionnaire, we received responses from approximately seven non-castrated wannabes. In terms of demographics and motivation, the wannabe population differs little from the eunuchs. Both voluntary eunuchs and wannabes typically reported that their castration ideation began around puberty and seemed to grow with age. On average, the wannabes were two years younger than the mean age at which the eunuchs were castrated. This suggests that given enough time, a certain percentage of them will go ahead and get themselves castrated.
A concern we have is where those castrations will be performed. Fewer than one in ten of the wannabes had discussed the procedure with a medical doctor. Twenty-one percent of the wannabes said that they had attempted to contact underground cutters, and 19% had attempted self-castration. Amongst the voluntary surgical eunuchs, less than half (47%) were castrated by licensed physicians.
Despite their openness with us through the Eunuch Archive, voluntary, self-identified eunuchs and wannabes share one prominent feature with prostate cancer patients: they are hiding from public view. Few are open about their emasculated status in everyday life. Only 8% of the surgical eunuchs report being "out" beyond immediate friends and family.
The historical association of castration with humiliation, we believe, encourages most castrated individuals to conceal the morphological and emotional changes they experience. The brutality of involuntary castrations in the past may help explain why castrated individuals—whether castrated voluntarily or out of medically necessary—now tend to be private about their emasculation. This reticence to reveal their gender variance is reinforced by the common language of emasculation. One hears almost daily of someone referred to as neutered, impotent, castrated, or having "no balls." Although this language is largely metaphorical, [End Page 552] it implies global powerlessness—socially, politically, and sexually—and its use in movies and newsprint is overwhelmingly pejorative.
Rather than fight this stereotype, it is easier for most emasculated individuals to strive to present and perform as "normal" (intact) males in everyday life. This is not difficult when clothing covers their non-normative bodies. Their invisibility in contemporary society is ironic, in that eunuchs have probably been the most conspicuous alternatively gendered individuals throughout history. Yet modern-day eunuchs are so invisible that they are not even mentioned in one of the most extensive lists published of those "who are in the fringes of the hetero-sexual world" (Zita 1998). Eunuchs are not currently recognized in the GLBTIQ (gay/lesbian/bi/trans/intersex/queer) collective (but see Wassersug 2003).
The eunuch.org Internet community is starting to bring the modern-day eunuchs out of the closet. The Eunuch Archive, for instance, has sponsored some small social gatherings of eunuchs in Maryland, Minnesota, Oregon, and Wisconsin in 2006, with additional gatherings planned in the United States, Canada, and England in 2007. In 2005, some castrated males appeared as eunuchs and topless (revealing their gynecomastia) in the Pride Parade in Halifax, Nova Scotia. We have attended some of these events and have been consistently impressed by the high level of functionality and community spirit amongst the approximately two dozen eunuchs that we have personally met and interviewed. Like many marginalized groups, they may profit from open acceptance of their variance from the heteronormative gender binary.
We cautiously favor activities that educate the pubic about the prevalence and diversity of androgen-deprived individuals in the modern world. First, prostate cancer patients on ADT may benefit from realizing how common their treatment is. They may find solace in knowing of others who are functioning well—maintaining a good quality of life, despite being chemically or surgically castrated. Eunuch wannabes may similarly appreciate knowing of others like them. Most importantly, though, educating the medical community about the existence of men with extreme castration ideations may open the way for these men to bring their concerns to the attention of physicians. A willingness for these men and physicians to communicate is a necessary prelude to having them seek medical treatment rather than relying on unqualified underground cutters to provide surgical treatment for the obsessive ideations.
As noted above, many studies show that prostate cancer patients are humiliated by the idea of castration and are distressed by the physical and psychological changes they experience on ADT (Chapple and Ziebland 2002; Fergus, Gray, and Fitch 2002; Gray et el. 2005; Oliffe 2006; Navon and Morag 2003, 2004). Denial is a common, but questionably effective, coping strategy used by these [End Page 553] patients (Roesch et al. 2005). This raises the issue of whether these patients might benefit more from an alternative strategy of accepting rather than avoiding and denying the reality of their emasculation (Wassersug 2007).
Although their physical status formally fits the eunuch label, chances are that few androgen-deprived cancer patients would accept that identifier, given the stigma associated with the brutal production of eunuchs in the past and the pejorative connotation of contemporary terms associated with castration. The secretive nature of both the advanced prostate cancer patient and voluntary modern-day eunuch suggests that most people still consider the emasculated condition stigmatizing. Ironically, eunuchs throughout history were more often politically powerful than impotent in the broad sense (Aucoin and Wassersug 2006). Yet this history is largely unknown to the public. It thus remains to be seen whether medically emasculated individuals could regain some self-esteem by being more informed and open about the biological realities of androgen deprivation.
Our comparison of castrated cancer patients with voluntary eunuchs suggests that the biological impact of castration can vary greatly depending on one's desire and expectation. Whereas the major psychological side effect of reduced libido occurs in both populations, this is viewed as loss by most of the men in one group and a gain by many of the men in the other. The information provided by the voluntary eunuchs similarly suggests that neither depression nor complete asexuality is an obligatory outcome of castration.
In a rather strange way, the self-identified voluntary eunuchs may have better agreement between their physical status and their gender identity than either the prostate cancer patients or MtF transsexuals. Castrated MtF transsexuals strive to be female. The majority of the castrated cancer patients, in contrast, strive to recoup their masculinity. Both are trying to fit into a strict gender binary. To the extent that both are agonadal and non-reproductive, from a strictly biological perspective any goals they may have to be heternormative females and males cannot be fully realized. In contrast, the self-identified voluntary eunuchs provide a good example of the capacity for individuals to live in a gender space outside the social norm of the male/female binary.
1. Heteronormativity, insightfully discussed in Jackson (2006), is the social norm in the heterosexual world, where gender, gender identifiers, and penetrative sexual performance are all perceived of as falling into two distinct natural categories, male and female.