Introduction: Castration is any action, surgical or chemical, by which an individual loses the use of the gonads, particularly testicles. Surgical castration consists in bilateral orchiectomy and chemical castration uses pharmaceutical drugs to deactivate the testes. Human castration is a practice known from Sumerian time as cruel torture. In history, it has been a religious practice or instrument to obtain eunuch slaves or white voices. Aim of our study was to explore the history of human castration.
Methods: A literature review on human castration was performed through Medline, PubMed and Google Scholar, searching words “castration”, “orchiectomy” and “androgen deprivation”.
Results: The earliest records for intentional human castration to produce eunuchs are from the Sumerian city of Lagash in the 21st century BC. Ancient Greeks and ancient Romans used it to produce eunuch slaves. During Byzantine Empire, it was considered such as a punishment. In Arabian countries castration started to be used to obtain faithful harem guardians since 750 AD and then, during the Ottoman Empire, the Imperial Harem was a powerful institution of the Sultan. From the late 16th century castration was carried out in Italy to preserve the unbroken male voice into adult life. In 1941 Huggins and Hodges demonstrated control of prostate cancer growth rate by androgens and showed that there is no better way to achieve temporary control of prostate cancer growth than androgen deprivation (AD). The earliest method of AD is represented by the bilateral orchiectomy, which means a definitive therapy for the patient. In 1944 treatment with Diethylstilbestrol was described as to the first method of reversible castration. In 1979 Schally et al showed that advanced prostate cancer patients treated with daily doses of LHRH agonists experienced a 75% decrease in serum testosterone levels and a marked reduction in cancer-associated bone pain. Medical castration by means of medrossiprogesterone acetate or cyproterone acetate is also used for convicted rapist or sex offenders in some countries. Although more expensive, medical castration is nowadays the standard considering its hypothetical reversible effect and the psychological trauma related to surgery.
Conclusions: The possibility to change male habitus through surgical castration has been evident since the 11th century BC and used to punish or to create specific workers such as eunuchs or singers. Just only in the last century the role of surgical castration has been associated with prostate cancer treatment and LHRH agonist and antagonist have become the new standard to induce castration.
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