Right now, about half a million men in North America are castrated. Strange how little you hear about them…I often lecture to academics on the psychology of emasculation. Typically, I begin by asking my audience a simple question: Who, if anyone, gets emasculated thesedays? Most of the time I am met with silence and awkward stares from the crowd. The mere question makes people uncomfortable. More often than not, the term ‘emasculated’ is interpreted metaphorically, as referring to those who have been denied or deprived of political power.

When I explain that I’m in fact asking about actual castrations, the answers I get are usually limited to testicular cancer patients, sexual predators and, occasionally, maleto- female transsexuals. While members of all of these groups may be castrated, the responses rarely include the largest population of contemporary emasculated males: advanced prostate cancer patients.

Castrating a male by destroying his testicles is a practice that most people now consider barbaric. Socially condoned castration of healthy males in order to make them into eunuchs ended in the early years of the 20th century with the collapse of the Chinese and Ottoman Empires, and with the death of Alessandro Moreschi, the last castrato of the Vatican choir. However, because of prostate cancer, there are currently more castrated men than ever before in history. As pointed out by Smith (2007), up to 600,000 prostate cancer patients are either chemically or surgically castrated in North America right now, making them about a hundred times more common than all other categories of castrated males in the Western world. The proportion of male citizens who are on castrating drugs is certainly comparable in other countries where screening for prostate cancer is common and the economy is strong enough for those citizens to be able to afford the medication. Given the detection rate for prostate cancer, some 4% of all men in Caucasian populations can expect to be chemically or surgically castrated before they die.

Testosterone is an androgen produced by the testicles that helps prostate cells grow, so chemically shutting down or surgically removing the testicles can slow the spread of cancer. The physical and psychological side effects of these treatments, however, can be severe. Androgen deprived adult men typically gain weight, mostly as fat, and lose muscle mass. They are at an increased risk of diabetes, osteoporosis and fatal heart attacks. Though they won’t become sopranos or lose their facial hair, they will lose much of the hair on their bodies. Their genitals will shrink in size. Most will suffer from hot flushes. Mentally, they can expect to experience reduced libido, difficulty in solving complex spatial problems, and increased emotionality. And, of course, they will be sterile. These effects are common for any castrated man.

Most advanced prostate cancer patients, nevertheless, accept medical emasculation in the hope that it will prolong their lives. The majority take castrating drugs and are typically on them for years, if not indefinitely. Given the number of prostate cancer patients who are chemically or surgically castrated in North America today and the severity of the side effects of such treatment, it may seem surprising how unrecognized this population of ‘modern-day eunuchs’ is – not only by my audiences, but by the public at large. Admittedly, the emasculating effects of chemical and surgical castrations are largely hidden from view when a person who no longer has functioning testicles is clothed. Thus if a castrated male doesn’t want anyone to know about his castration, he can hide it.

Another reason why advanced prostate cancer patients don’t come to mind more readily when people hear terms like ‘castrated’ or ‘emasculated’ is that their  treatment is rarely referred to so bluntly. Rather, it’s common to hear these patients say they are receiving ‘hormonal therapy’ or ‘androgen deprivation therapy’ – formal language that makes the actual status of their gonads sound more appealing (or less appalling). Similarly, most medically castrated men do not call themselves eunuchs. Most would be shocked and offended to be identified as such, despite the fact that it is the historically correct term for any male who lacks functioning testicles.

The invisibility of these men, I believe, is partly encouraged by the history of castration and our cultural attitudes toward a treatment that has been long considered shameful and more punitive than therapeutic. While it is increasingly acceptable in our society to be homosexual, it is less acceptable to be asexual. Admittedly, castration doesn’t guarantee asexuality, but it is a common outcome of the process, if not the very stereotype of the castrated male in our hypersexual society.

Shame, more than anything else, seems to keep the castrated cloistered and collectively out of view. This is not surprising, considering the profoundly negative language of emasculation in modern society. Nowadays to be labelled as ‘neutered’, ‘emasculated’ or a ‘eunuch’ implies a level of impotence that goes well beyond the gonads. The popular metaphorical meaning of castration, as used by feminists in the last century and epitomized in the title of Germaine Greer’s famous book The female eunuch, certainly exacerbates the problem. If women fear being emasculated in a political sense, most men fear emasculation on both political and biological levels. The modern male is expected to be sexually active and virile for as long as he lives – or at least that is what can be inferred from the endless ads for Viagra and similar drugs, which imply that a male who can have erections has a higher all-round status in society. (Coincidentally, those drugs are largely ineffective for castrated men, who suffer a reduction in, if not complete loss of, libido.)

So who then might fit, and possibly even accept, the label of ‘modern-day eunuch’? While the most common answer that I get to my question of who is physically emasculated in modern society is ‘the testicular cancer patient’, few of these men fully meet the criteria of ‘eunuch’. Testicular cancer does not usually lead to the loss of both testicles, and even when both are removed, these men can safely take supplemental testosterone, which prostate cancer patients cannot. In a narrow sense, the rare testicular cancer patient who has lost both testicles could be described as a eunuch.  But if he is on supplemental testosterone, his sexual desire will not be particularly compromised and he will still be able to have erections. He will not experience the suite of physical and mental changes that the truly castrated man experiences, thus, he will not feel emasculated in the same way. Accordingly, to say that he is emasculated, either literally or metaphorically, is not really a valid description.

Although male-to-female transsexuals have their testicles removed as part of sexual reassignment surgery, they too typically do not identify as eunuchs since they undergo castration as a step toward becoming female. While in transition, transsexuals may technically be defined as ‘eunuchs’. However, sexual reassignment for them usually involves not just castration but also the construction of a neo-vagina and taking female  hormones to develop feminine characteristics such as breasts. Transsexual women thus identify as females and certainly not as eunuchs.

There are individuals, though, who truly want to be eunuchs, and they too remain out of public view. These males wish to be castrated for a wide variety of reasons. Some have castration fetishes (paraphilias) and are turned on by thoughts of the removal of their own genitals. As with other extreme ideations that link sexuality with pain, an act that might suppress sexual interest for most people becomes erotic for them. Others suffer from a gender identity disorder (GID) akin to that of male-to-female transsexuals. However whereas male-to-eunuch transsexuals know that they do not like being male, neither do they desire to be female. Still others appear to have a body dysmorphia, where although they are happy to think and feel like males, they are convinced that they shouldn’t have ‘extra parts’ (external genitalia) hanging from their torso. They find their own male morphology offensive, but have no desire to have a female morphology. These men are not unlike those rare individuals with a Body Integrity Identity Disorder (BIID), who  obsessively desire the amputation of a hand or foot. BIIDs directed at the genitals seem to be more common than ones focused on the limbs, but are far less studied. Also among those who wish to be emasculated are some deeply devout individuals, who fear that their sexual thoughts are so immoral that these urges will exclude them from heaven. They are motivated by an extreme religious desire for purity.

Recently, my colleagues and I have started to explore possible motivating factors for voluntary castration in the Western world. In reviewing the personal histories of nearly 200 voluntary eunuchs, we have found a high  incidence of them (1) having been sexually abused as children, (2) having  witnessed the castration of animals in their youth, (3) having been threatened with castration in their youth, frequently by their parents, and/or (4) having a strict religious background that condemned sexuality. Indeed, some of the  voluntary eunuchs who were sexually abused as young boys sought castration out of fear that they might do to a child what was done to them. In the same vein, there is a substantial proportion of individuals who have been charged with sexual impropriety who are not opposed to chemical or surgical castration to diminish their libido, and thus their risk of harming others.

Chemical castration with the same or similar drugs used to treat prostate cancer patients and  transsexuals is currently offered to some recidivist sexual convicts in the USA. This treatment, although known to be largely effective when voluntarily, is currently offered in only eight states through their criminal justice system. Even in Texas, the one state that allows surgical castration as an option for recidivist sexual convicts, Byzantine bureaucratic procedures (ironic considering that eunuchs were particularly abundant in the Byzantine court) often mean that individuals who seek castration to control their sexual urges have difficulty obtaining the treatment. In Texas, several times as many men have requested the surgery as have received it. Whereas the United States media reports (and promotes)  anxiety about sexual predators, the legal system seems to shy away from providing a pharmacological or surgical solution for these men, even when they seek it themselves. This is despite European studies that show a recidivism rate approaching zero for convicted sex offenders who obtain voluntary castration.

There are two somewhat contradictory explanations for why this treatment remains largely unavailable despite its effectiveness. For many upstanding but  sensitive citizens castration, be it chemical or surgical, is seen as too harsh and too inhumane for the state to sanction. On the other hand, some lawmakers consider the option ‘too easy’. For them, a simple medical solution to a moral challenge is too benign to be considered adequate justice. This line of thinking has a long history. In the early years of Christianity, Christians debated whether or not voluntary castration could be used to ensure chastity. Eunuchs were common in society, and some competing faiths of the day had castrated priests. Indeed, the idea of becoming a eunuch ‘for the Kingdom of Heaven’ is stated explicitly in Matthew 19:12. The importance of this debate can be seen in the first canon of the Council of Nicaea (318 AD), which prohibited the self-castrated from becoming Christian clergymen. About a century later, St Augustine argued that priests must will their way to celibacy, rather than take a surgical shortcut to asceticism. Augustinian ethics have lingered in the Western world for nearly 2000 years. Today many judicial officials evidently still believe that one must first and foremost will one’s way to righteous restraint.

Here we have an ironic contrast. A huge number of men are castrated in North America today, but refuse to acknowledge this fact publicly and hide their castrated status from society. On the other hand, a small group of men willingly seek castration in an attempt to fit in better in that same society, yet are unable to receive the treatment. While it is difficult, but not impossible, for maleto- female transsexuals to obtain medical castrations, it is far more difficult for males who want to be castrated for any other reason to get the surgery. As a result, most either go underground to ‘cutters’ or do their own castrations. Fewer than half of those in our study had their surgeries performed by a qualified physician.

Are there any similarities to be found between these seemingly disparate groups of modern-day eunuchs? And if so, is there anything to be gained by asking, for example, if the experience of advanced prostate cancer patients on ADT is in any way similar to that of voluntary eunuchs seeking freedom from libidinous thoughts? Might such an examination help explain how so many men can be androgen-deprived while the public remains unaware of their condition? These  questions are worth asking if we want to understand fully the effects of testosterone – and of its removal.

Shame and concealment seem to be common features. If castration is considered shameful – and many people believe that it is a punitive procedure primarily applied to paedophilic perverts – then those who are castrated out of medical necessity are not likely to be out and open about their gonads once they’re gone. Indeed, if only the depraved are supposed to get deprived (of testosterone, that is), then one can expect the castrated to stay in the closet. This invisibility is disturbing on several accounts. The lack of public knowledge about castration is tragic for those who voluntarily desire to be androgen-deprived for reasons other than cancer control. If the public was more aware of the effectiveness of chemical and surgical castration in reducing libido, or of the relief it can bring to people with a ‘male-to-eunuch’ GID or a genital-directed BIID, they might be willing to make such treatments more available to those who seek them as an elective procedure..

For prostate cancer patients, invisibility often causes them to suffer their side effects in isolation. It also diminishes the attention focused on their disease. If the frequency of contemporary castrations were better appreciated and the effects of androgen deprivation better known to the public, society might also be more motivated to fund research for newer, better prostate cancer treatments.

Richard Wasserug teaches at the Faculty of Medicine at Dalhousie University in Halifax, Nova Scotia, Canada, where he runs a course entitled ‘Embodying the body: The human body for anatomists and humanists’. He is currently a Visiting Professor at the Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.