What is male castration?
The testes (testicles) are two almond-shaped male sex organs contained in a sac called the scrotum, which sits directly behind the penis. Testes produce sperm for reproduction and testosterone to maintain male secondary sexual characteristics, such as a deep voice, male pattern hair growth and muscle strength, and wide shoulders. Castration is removal or inhibition of both testes. Castration by surgical removal of the male testes is called orchiectomy or orchidectomy. Chemical castration is achieved by administering hormones.
Why is castration performed? Castration is most commonly performed to treat cancer or reduce the almost certain risk of cancer. The testes produce the male hormone testosterone, which stimulates growth of some cancerous tumors. For example, a man with testicular cancer requires orchiectomy or chemical castration to prolong life. A boy with undescended testicles (retained in his abdomen instead of moving down into his scrotum) is at risk of developing cancer if they are left in place.
Other reasons castration is performed include to:
- Stanch bleeding or remove dead tissue when the testicles have been traumatized by force, sports, radiation, workplace chemical exposure, or cancer chemotherapy
- Remove a serious infection, such as gangrene or flesh-eating disease (necrotizing fasciitis)
- Treat testicular torsion
- Correct orchitis or infarct, complications that can occur 2 or 3 days after an inguinal hernia repair
- Treat a rare form of tuberculosis
- Treat infarction of the testicles from a rare vascular condition, polyarteritis nodosa (PAN)
- Make a hermaphrodite child, who has ambiguous sex organs, distinctly female
- Allow the female hormones given to a male-to-female transsexual to work more quickly, or as a cheaper alternative to expensive, difï¬Âcult vaginoplasty
- Offer a voluntary, rehabilitative alternative to long-term incarceration for repeat sex offenders who want help to control their urges
- Follow religious, social and wartime practices
What are the statistics? Cancer of the prostate gland is the second most frequent cancer affecting men, after skin cancer. One in every 9 Australian men will develop prostate cancer. There are 18,700 new cases of prostate cancer every year in Australia, and 3,000 of those men will die of it. There are 230,110 cases of prostate cancer every year in the U.S.A. and 29,900 will die of it. Your chances of developing prostate cancer increase as you age, from 1 in every 1,000 men in their forties, to 80 in every 1,000 men in their seventies.
Testicular torsion (twisting testes from bell clapper deformity) occurs in 4.5 cases per 100,000 American males per year aged 1 to 25, so it is more prevalent than testicular cancer. An orchiectomy is required in 34% of cases, usually because young boys are too shy to seek treatment for an acutely painful groin. It usually affects the left testicle, and occurs most frequently in one-year-olds and 12 to 18-year-olds, with the peak at 14 years of age.
Testicular cancer occurs in 4.2 males out of every 100,000. Testicular cancer is the most common cancer affecting men aged 15 to 35. Less than 5% of males develop cancer in both testes. You are most likely to require removal of both testes (bilateral orchiectomy) if you are Caucasian (white), have undescended testicles, a family history of genital cancer, and have already had one testicle removed because of cancer. Boys with untreated undescended testicles are 3 to 14 times more likely to develop testicular cancer than the general population.
In Australia, 1 in 650 males is born with Klinefelter syndrome. In the USA, 1 in 500 to 1,000 males has an extra sex chromosome. Boys with genetic disorders affecting their sex chromosomes and testicles, like Klinefelter syndrome, are more likely to develop cancer. Sometimes, doctors recommend orchiectomy to prevent the development of testicular cancer in affected boys. Sports trauma rarely results in orchiectomy, probably because of jock strap protection and the testicles’ mobility. For example, there are 100,000 Australian rugby players, and over a 16-year reporting period, only 14 players required complete or partial orchiectomy.
What are the signs and symptoms of genital cancer? Most men discover cancer in their testicles through self-examination, but doctors also find many early cases as part of a routine physical examination. It usually first appears as a hard, painless, irregularly shaped lump. It may produce a heavy feeling in the groin.
Testicular cancer does not produce pain until it is well advanced. The male may have nausea, vomiting, swollen legs and breasts, and a nodule around the neck. When testicular cancer has spread to other body parts (metastasized), it produces back pain, coughing, and shortness of breath (SOB).
Early prostate cancer does not cause symptoms. It is usually detected by a PSA blood test result greater than 4.0 ng/ml (nanograms per milliliter of blood) or a digital rectal exam (DRE) by a doctor. Signs and symptoms of advanced prostate cancer include: Difï¬Âcult or painful urination (dysuria); desperate need to urinate (urgency); frequent urination, especially at night (nocturia); a weak or uncontrollable flow of urine; retained urine in the bladder; bloody urine or semen; painful ejaculation.
What are my treatment options? Your treatment options depend on why you need castration, the skill of your doctor, and how much viable tissue you have remaining for reconstruction. Every case is different, but in general, here are your options: PROBLEMS & SOLUTIONS
- Gender reassignment – Solutions include nti-androgen hormones, orchiectomy, vaginoplasty, or a combination of all three can be used
- Prostate cancer – Solutions include anti-androgen hormones, radiation, chemotherapy short-term and orchiectomy long-term
- Testicular cancer – An orchiectomy is required
- Testicular torsion – Detorsion is successful in 100% of boys who report pain within 6 hours of onset. An orchiectomy is required in all boys who are left in pain more than 24 hours.
- Serial sex offenders – Solutions include incarceration, or a combination of psychotherapy with anti-androgen hormones
- Straddle injury – An orchiectomy is required
Why use testosterone after castration?
What to expect when visiting the doctor?
The information in this article has been taken with permission from the official Lawley booklet on Understanding Castration.