From Terror to Treatment: a History of Human Castration

Abstract

Objectives Castration is any action, surgical or chemical, by which an individual loses use of the gonads, most commonly referring to loss of the testicles. Reference to elective castration has been, according to Diodorus, as old as the human record itself, first being practiced in pharaonic Egypt. Castration has been practiced as a means to produce eunuchs, a punitive measure in military and secular courts, and a source of trophy-taking in warfare. The role of castration in the control of advanced and metastatic prostate cancer became a well recognized standard of care in the mid-20th century earning Nobel Prizes for its pioneers. Our aim was to better understand the history of human castration and its transformation from an instrument of terror to a standard and sometimes life-saving urological treatment. Methods A literature review on human castration was performed through Medline, PubMed, the Gutenburg Project, and Google Scholar searching words “castration”, “eunuch”, “orchiectomy” and “androgen deprivation”. We accessed the public archives of the British Museum (London) and digital classical libraries as cited. Reports were collected to create a timeline. Results First reports of human castration date back to the 21st century (BCE) in the ancient city of Lagash, Sumeria when used for the creation of court eunuchs. Castration figured prominently in most ancient cultures from myth to jurisprudence. The god Uranus was castrated by his son, Cronus (Saturn), with an adamantine sickle, throwing the severed gonads into the sea. There is at least conjectural evidence of castration on medical, criminal, and even volitional grounds from pharaonic and classical history through medieval and modern times. Primitive medical observations recognized the different phenotypes of pre-pubertal and post-pubertal eunuchs especially on the voice which may account for the popularity of some castrati in the history of choral music. Castration was a well-established procedure in the domestication of animals for millennia but it was only in 1941 that Charles Huggins and others first demonstrated the effects of bilateral orchiectomy in the control of prostate cancer. Medical castration, now with special androgen receptor inhibitors, continues to be a mainstay in the management of metastatic and hormone refractory prostate cancer. Conclusions Medical or surgical castration plays an important role in the modern management of advanced prostate cancer. Castration has existed in human cultures for thousands of years, although its true prevalence is unknown, accounted for in the folklore and sparse records typical of ancient times.