Long-Term Consequences of Castration in Men: Lessons from the Skoptzy and the Eunuchs of the Chinese and Ottoman Courts

Castration of men and males of other species was almost certainly the first experiment in endocrinology (if not in zoology), and the literature on the subject is vast. Indeed, the Cumming Manuscript Collection of the New York Academy of Medicine Library contains more than 1200 references, abstracts, and documents concerning the early history of human castration (1). In antiquity the procedure was performed for several reasons, including as punishment for prisoners of war (2), and by the time of Aristotle in the fourth century BC the physiological consequences of male castration were understood with remarkable exactitude (3). “Some animals change their form and character, not only at certain ages and at certain seasons, but in consequence of being castrated; and all animals possessed of testicles may be submitted to this operation. Birds have their testicles inside, and oviparous quadrupeds close to the loins; and of viviparous animals that walk some have them inside, and most have them outside, but all have them at the lower end of the belly. Birds are castrated at the rump at the part where the two sexes unite in copulation. If you burn this twice or thrice with hot irons, then, if the bird be full-grown, his crest grows sallow, he ceases to crow, and forgoes sexual activity; but if you castrate the bird when young, none of these male attributes or propensities will come to him as he grows up. The case is the same with men; if you mutilate them in boyhood, the latergrowing hair never comes, and the voice never changes but remains high-pitched; if they be mutilated in early manhood, the later growth of hair quit them except the growth on the groin, and that diminishes, but does not entirely depart. The congenital growth of hair never falls out, for a eunuch never goes bald. In the case of all castrated or mutilated male quadrupeds the voice changes to the feminine voice. . . All animals, if operated on when they are young, become bigger and better looking than their unmutilated fellows; if they be mutilated when full-grown, they do not take on any increase of size. If stags be mutilated when, by reason of their age, they have as yet no horns, they never grow horns at all; if they be mutilated when they have horns, the horns remain unchanged in size, and the animal does not lose them. . . As a general rule, mutilated animals grow to a greater length than the unmutilated (3).” In contrast to the rapidity and sophistication of the early advances, studies of the physiological effects of castration in more recent times have been relatively limited (presumably because fewer castrated men are available for study), and most studies of androgen deficiency focus on hypogonadal states rather than castration (4). However, in the 1940s, Hamilton and his colleagues did pioneering work in the United States on mentally deficient men who were castrated as a consequence of eugenics laws, quantifying the effects on skeletal development, hemoglobin production, and metabolism (5), and Bremer subsequently defined the relation between testicular secretions and male sexual drive and function in men who were castrated in Norway because of sexual offenses (6). Most studies of castration in men have involved relatively short term experiences (usually men who had been castrated for less than a decade), but in the 20th century the effects of long term castration have been studied in three groups of men: the Skoptzy and the court eunuchs of the Chinese and Ottoman empires (Table 1). According to Penzer (7) three varieties of eunuchs were recognized in antiquity: 1) castrati, clean-cut, both penis and testicles were removed; 2) spadones, testicles only were removed; and 3) thlibiae, testicles were bruised and/or crushed. The three groups of eunuchs under consideration in this review fall into the castrati category.