Castration is the process by which a man loses the use of his testicles. It is carried out either by the permanent removal or by the in situ degeneration of the testes. Castration can be achieved by surgical, chemical, endocrine, and immunological approaches. It leads to the loss of production of spermatozoa and the male sex hormone, testosterone. 

What is Chemical Castration?

Chemical castration is the process of administering anaphrodisiac drugs to dwindle the sexual desire in men by lowering the production of sex hormones or androgens. The drugs include cyproterone acetate (CPA), medroxyprogesterone acetate (MPA), and Luteinizing hormone-releasing hormone (LHRH) agonists. 

Chemical castration is also known as:

• Androgen Suppression Therapy
• Androgen Depressive Therapy
• Hormone Therapy

Chemical castration assists in the treatment of hormone-related cancer, such as prostate cancer. It is also a punishment for rapists and sex offenders.

The prime androgens in human males are testosterone and dihydrotestosterone. About 90-95% of these androgens are produced by the male gonad, the testes. The adrenal glands also secrete fewer amounts of androgens. Luteinizing hormone-releasing hormone (LHRH), which is also known as Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus of the brain. This LHRH triggers the pituitary gland to release Luteinizing Hormone (LH), which further stimulates the Leydig cells of the testes to secrete Testosterone. 

LHRH agonists: In chemical castration, LHRH agonists are used to suppressing the hormones. LHRH agonists are drugs that dwindle the amount of testosterone produced by the testes. They are either injected or placed as implants under the scrotum, the skin that covers the testes. These drugs cause the testes to shrink by the passage of time. Some of the LHRH agonists include Leuprolide, Goserelin, Triptorelin, and Histrelin. 

Treatment to decrease adrenal gland production: Sometimes, trace amounts of androgens released by the adrenal glands can also cause sexual arousal and sexual fantasies. Hence, drugs that control the production of androgens from the adrenal glands are used. These include Abiraterone and Ketoconazole. 

Other treatment: Injection of the female sex hormone, estrogen into a man also results in suppression of androgens. This method of chemical castration is least practiced due to certain side effects such as breast enlargement and blood clot formation.

Chemical Castration is continuous: Chemical castration is not a one-time treatment but it continues over a long period of time. The injection or oral medication is continued until the desired effects are achieved. It lasts until you terminate the intake of drugs. Once you discontinue the medications, hormone production bounces back to normal. 

Medical Benefits of Chemical Castration

Chemical Castration helps to prevent the spread of Prostate cancer in men.

In a man affected by prostate cancer, the production of androgens stimulates the cancer cells to multiply. Chemical Castration, also known as Androgen Suppression Therapy, lowers the production of these androgens (testosterone and dihydrotestosterone), and hence the prostate cancer cells shrink and do not multiply rapidly. This therapy is done either as an initial treatment of cancer cells along with radiation or as a final treatment when cancer has spread too much to be cured by chemotherapy or surgery.

When the LHRH agonists are first given, the testosterone levels may rise rapidly. This effect is known as a flare. It might result in the spread of prostate cancer cells to the nearby bones and spinal cord. Hence, anti-androgens are administered along with LHRH agonists during the first few weeks of the treatment to prevent a flare. Anti-androgen pills include Flutamide, Bicalutamide, Nilutamide, Enzalutamide, and Apalutamide.

In an advanced stage of Prostate Cancer, LHRH antagonists are used. These drugs lower the androgen levels rapidly than the LHRH agonists, and they do not cause a flare. Examples of LHRH antagonists are Degarelix (an injection) and Reluglix (a pill).  

Chemical Castration for Rapists

With every passing year, the number of rape cases has been escalating. In some countries, chemical castration is being practiced to punish men, who are put behind the bars for sexual violence. This process reduces their sexual desire, and they lose their fertility eventually. Chemical castration has become an alternative to life imprisonment and the death penalty. 

In an experiment conducted in 1981, forty-eight men who had sexually deviant behavior were given medroxyprogesterone acetate (MPA) for a continuous period of twelve months. The research recorded a diminish in distorted sexual behavior and greater control over sexual desires. However, chemical castration for rapists is a debate in India since the Delhi Gang Rape in 2012. 

Chemical Castration VS Surgical Castration

Chemical castration is distinct from surgical castration in several ways. Chemical castration is done by administering the anaphrodisiac drug as an injection, oral medication, or implants under the skin. The effect of the drugs on the hormone levels is a slow process and is not immediate. The testes shrink only after some time. When you stop the intake of the drugs, the effects are reversible. Surgery is not performed, and it is also not a form of sterilization.

Surgical castration or orchiectomy is the permanent removal of one or both of the testes through an incision in the scrotum. The effect of this surgery is instant, and it reduces the testosterone levels by 90%. Unlike chemical castration, this process is not reversible and is permanent.

Side Effects of Chemical Castration

In a chemically castrated man, the testosterone levels subside eventually. It causes some possible side effects that are listed below:

• Loss of Libido or Sexual Desire: Chemically castrated men usually lose their sexual pleasure due to a lack of male sex hormones.
• Erectile Dysfunction or impotence: Chemical castration causes erectile dysfunction, which is the inability to achieve and maintain an erection during sexual intercourse. It further leads to complete infertility.
• Gynecomastia: This is a condition in which the breast becomes large and pendulous due to decreased levels of testosterone. The chemically castrated man loses his manliness, and the female sex hormone dominates.
• The slow disappearance of the prostate gland: Androgens are required for the development of the prostate gland. It loses its viability in the complete absence of the gonadal hormones. Chemical castration for several years leads to the disappearance of the prostate gland.
• Osteoporosis: Chemical castration increases the risk of osteoporosis in prostate cancer patients. It leads to thinning of the body bones, limbs, and skull.

Other Side Effects Include

• Shrinkage of the testes and the external genitalia (penis)
• A decrease in red blood cell counts, causing anemia
• An increase in cholesterol levels
• Loss of muscles
• Fatigue
• Depression
• Infertility

According to reports, side effects and negative consequences increase with the increase in the time of medication.