As I continue this series leading up to International Eunuch Day on March 24th, I turn my focus to those who become eunuchs due to medical necessity or personal choice. In my previous articles, I explored the ancient traditions of Dies Sanguinis and the ritual castration of Cybele’s followers, then examined the diverse historical roles of eunuchs in different cultures. I also looked at the evolving identity of modern eunuchs, including members of traditional communities like the hijra and those who (like me) find connection through online spaces.

Today, I want to explore two key groups within the contemporary eunuch community: those who undergo castration for medical reasons and those who do so voluntarily as a form of self-expression or identity affirmation.

Medical Eunuchs: Necessity and Survival

Medical castration is a procedure often performed for critical health reasons, with prostate cancer treatment being one of the most common causes. Many men undergoing androgen deprivation therapy (ADT) to slow the progression of cancer experience a significant reduction in testosterone levels, leading to effects similar to surgical castration.

In other cases, testicular removal (orchiectomy) may be necessary due to cancer, severe injury, or other medical conditions. While these individuals may not have sought castration for personal reasons, they often find themselves navigating the same physical and emotional changes that voluntary eunuchs experience.

For some, medical castration leads to identity shifts – whether by necessity or personal reflection. Some men simply adjust to their new hormonal state, while others embrace the term eunuch as part of their identity. However, unlike voluntary eunuchs, medical eunuchs may struggle with societal expectations, often facing a lack of understanding regarding the profound impact of losing testosterone.

At the same time, many medically castrated individuals reject the eunuch identity altogether, seeing their medical treatment or surgery as unrelated to gender or personal identity. For them, castration is a medical event, not a defining characteristic. This highlights an important truth: adopting or rejecting the eunuch identity is a deeply personal choice, and no one should feel pressured to align with a particular label based on their medical history.

The medical profession continues to find it difficult to come to terms with men who need surgical intervention for non-life-threatening issues, such as testicular torsions, which can be excruciating. Long-term unbearable pain is itself life-threatening, and its not unheard of for men who suffer from testicular pain to seek to resolve the issue themselves through self-harm and suicide.

Voluntary Eunuchs: Choice and Self-Understanding

In contrast to those who undergo castration due to medical necessity, voluntary eunuchs actively choose this path for a variety of deeply personal reasons. These motivations can include:

• Gender identity – Some individuals feel that a eunuch identity best represents who they are, particularly those who see themselves as non-binary, gender nonconforming, or outside the traditional male-female binary. This includes me – my decision for surgery was rooted in my gender identity. I needed to realise the physical aspect of who I am.
• Bodily autonomy and comfort – Some find that living without testosterone leads to a greater sense of well-being, reducing dysphoria, aggression, or unwanted sexual urges. Some simply find testicles unbearably uncomfortable, as they get caught in tight places, sat on and squashed.
• Spiritual or philosophical beliefs – In rare cases, people choose castration for religious or personal philosophical reasons, much like the devotees of Cybele in ancient times.

Unlike medical eunuchs, voluntary eunuchs often face significant legal and ethical challenges when seeking castration. Many doctors refuse to perform the procedure without a medical justification, leading some individuals to seek underground or dangerous alternatives. The recent case of Marius Gustavson, who performed illegal and non-consensual castrations, highlights the risks involved when legitimate medical pathways are unavailable.

Hormonal and Psychological Effects

Whether medical or voluntary, eunuchs experience profound hormonal changes due to the loss of testosterone. These changes can include:

• Physical effects – Reduced muscle mass, increased body fat, changes in skin texture, and a shift in body odour.
• Emotional and psychological effects – Some experience a calming effect, reduced anxiety, or diminished sexual drive, while others may struggle with depression or loss of energy.
• Health considerations – Lower testosterone can lead to osteoporosis, reduced red blood cell production, and metabolic changes, requiring ongoing medical monitoring.

Despite these challenges, many eunuchs report feeling at peace with their decision, particularly those who voluntarily embrace the identity.

You can read more about the physical and emotional considerations of castration in our community wiki.

Bridging the Gap Between Medical and Voluntary Eunuchs

One of the key issues facing modern eunuchs is visibility. Medical eunuchs often do not realise they share common experiences with voluntary eunuchs, and vice versa. Raising awareness about the broader eunuch identity helps both groups feel less isolated and encourages more open discussions about bodily autonomy, medical ethics, and quality of life.

As International Eunuch Day approaches, I believe it is essential to acknowledge and respect the diverse reasons why individuals become eunuchs, whether by choice or circumstance. By fostering greater understanding and dialogue, we can create a more inclusive and supportive space for all eunuchs, past and present.