side effects of castration

Surgical CastrationArticle Contents Long-term consequences of castration in men: lessons of the Skoptzy and eunuchs of the Chinese and Ottoman courts CiteJean D. Wilson, Claus Roehrborn, Long-term Consequences of Castration in Men: Lessons from the Skoptzy and the eunuchs from the Chinese and Ottoman Courts, The Journal of Clinical Endocrinology & Metabolism, Volume 84, Edition 12, 1 December 1999, Pages 4324-4331, Castration of men and males of otherlogy was almost the first manuscript. In ancient times the procedure was performed for several reasons, including as punishment for prisoners of war (), and in the time of Aristotle in the fourth century BC the physiological consequences of male castration were understood with remarkable accuracy (). "Some animals change their form and character, not only at certain ages and at certain seasons, but as a result of being neutered; and all animals possessed of testicles may be subjected to this operation. Birds have their testicles inside, and the oviparous quadrupes near the loins; and of the vivipare animals that walk some have them inside, and most have them outside, but all have them at the lower end of the belly. The birds are castrated in the trumpet in the part where the two sexes join the copulation. If you burn this twice or three times with hot iron, then if the bird is full of growth, your crest grows sallow, it stops growing, and forgives sexual activity; but if you cast the bird when young, none of these male attributes or propensions will come to him as he grows. The case is the same with men; if you mute them in childhood, the hair that grows later never comes, and the voice never changes but remains high; if they are mutilated in the early age, the subsequent growth of the hair is left of them except growth in the groin, and it decreases, but does not depart completely. The congenital growth of the hair never falls, because an eunuch never gets heated. In the case of all castrated or mutilated men, the voice changes to the female voice... All animals, if they are operated when they are young, become bigger and better than their un mutilated companions; if they are mutilated when they are fully cultivated, they do not take any size increase. If the stalls are mutilated when, for their age, they still have no horns, they never grow horns at all; if they are mutilated when they have horns, the horns remain immutable in size, and the animal does not lose them... As a general rule, mutilated animals grow longer than immutilated animals ()." Unlike the speed and sophistication of the first advances, studies of the physiological effects of castration in more recent times have been relatively limited (presumably because there are fewer castrated men available for study), and most of the androgen deficiency studies focus on hypogonal states rather than castration (). However, in the 1940s, Hamilton and his colleagues made pioneering work in the United States on mentally deficient men who were castrated as a result of eugenic laws, quantifying the effects on skeletal development, hemoglobin production and metabolism (), and Bremer subsequently defined the relationship between testicular secretions and male sexual impulse and the role in men who were castrated in Norway. Most of the castration studies in men have involved relatively short-term experiences (usually men who had been castrated for less than a decade), but in the twentieth century the effects of long-term castration have been studied in three groups of men: the Skoptzy and the eunuchs of the court of the Chinese and Ottoman empires (). According to Penzer () three varieties of eunuchs were recognized in the antiquity: 1) castrati, clean cut, both the penis and the testicles were eliminated; 2) spiders, testicles were only eliminated; and 3) thlibiae, testicles were beaten and/or crushed. The three groups of eunuchs discussed in this review fall into the castrati category. Medical studies of men after long-term castration . Author(s) and Ref. . Date of publication . Number of items . Average age (yr) . Average duration of castration (yr) Skoptzy Tandler and Grosz (12) 1910 5 30 18 Koch (13) 1921 13 64 30 Chinese court eunuchs Wagenseil (19) 1933 31 57 38 Wu and Gu (25, 26) 1987, 1991 26 72 54 Ottoman court eunuchs Wagenseil (33) 1927 10 43 34 Group . Author(s) and Ref. . Date of publication . Number of items . Average age (yr) . Average duration of castration (yr) Skoptzy Tandler and Grosz (12) 1910 5 30 18 Koch (13) 1921 13 64 30 Chinese court eunuchs Wagenseil (19) 1933 31 57 38 Wu and Gu (25, 26) 1987, 1991 26 72 54 Ottoman court eunuchs Wagenseil (33) 1927 10 43 34 Medical studies of men after long term castrationGroup . Author(s) and Ref. . Date of publication . Number of items . Average age (yr) . Average duration of castration (yr) Skoptzy Tandler and Grosz (12) 1910 5 30 18 Koch (13) 1921 13 64 30 Chinese court eunuchs Wagenseil (19) 1933 31 57 38 Wu and Gu (25, 26) 1987, 1991 26 72 54 Ottoman court eunuchs Wagenseil (33) 1927 10 43 34 Group . Author(s) and Ref. . Date of publication . Number of items . Average age (yr) . Average duration of castration (yr) Skoptzy Tandler and Grosz (12) 1910 5 30 18 Koch (13) 1921 13 64 30 eunuchs of the Chinese court Wagenseil (19) 1933 31 57 38 Wu and Gu (25, 26) 1987, 1991 26 72 54 eunuchs of the Ottoman court Wagenseil (33) 1927 10 43 34 The Skoptzy sect (or Skoptsy), which means the castro) Its origin in the eighteenth century, its propagation through a large part of Russia and in Romania and Besarabia, the attempts of the Russian government to suppress the movement, and the theological foundations of religion were described by Pelikan (), Grass (), and Pittard (). Because they believed that the second coming of Christ would occur only when the number of Skoptzys reached the apocalyptic number of 144,000, they became fiery proselytists. His critics claimed that they used coercion between children and prisoners, an accusation that seems justified by the fact that many were castrated below the age of 10, but others were religious enthusiasts who voluntarily submitted to the procedure as adults. The male members of the sect were encouraged to take the "great seal" (removal of the penis, scrotum and tests) or the "slower seal" (removal of the scrotum and tests, leaving the penis intact). Women are not castrate, but are subject to breast and external genital mutilation. In men the procedure was of great simplicity; that is, the operator seized the parts to be removed with one hand and struck them with the other. In the early years of the sect the surgical instrument was a red-hot or poker rod (therefore the expression fire baptism), but the castration instruments included pieces of glass, razors and knives. A cicatrix was formed, healing in 4-6 weeks (). In some cases the procedure was performed in stages (take the lesser seal before the large seal). When the penis was removed, nails were inserted into the urethra to avoid dung, and such men were said to urinate while sitting or chopping. Many Skoptzys were deported to Siberia, where they formed settlements, and the sect continued to perform castations until 1927 (). The persecution of the Skoptzys persisted in the Soviet era, and during the anti-religious fervor in 1929-1930 they were subjected to sensational public testing and publicity. It was estimated that there were between 1000 and 2000 Skoptzy in Soviet Russia in 1930, 500 of which lived in Moscow, but by 1962 none were thought to be alive (). Anatomical preparation of the external genitals of a Skoptzy man who had received the greatest seal. Koch reprint ( ).Anatomical preparation of the external genitals of a Skoptzy man who had received the greatest seal. Koch reprint ( ).Medical studies on the Skoptzy. Medical studies were conducted in the Skoptzy at least three different groups of researchers. At the end of the century Pittard made measurements in 30 Skoptzy men in 1 Romanian village and noted that they seemed to be higher than their peers (). In 1907 Tandler and Grosz examined 5 Skoptzy men in Bucharest whose average age was 30 years and who had been castrated between 5-21 years (). Later, during the German occupation of Romania in World War I, Walter Koch studied 13 Skoptzy men, all between 50 and 94 years (average 64 years), who had been castrated by an average of 46 yr (). Several anthropomorphic measurements were performed, and X-rays of the skull were obtained in some (). The eunuchs of the Chinese court The practice of employing eunuchs as judicial officials in China and in other Eastern countries dates back to prehistory (). The procedure by which the eunuchs of the Chinese court were castrated at the end of the nineteenth century during the Qing dynasty was described in some detail by Stent in 1878 (), and later descriptions of the practice, including those of Korasow (), Matignon (), and Wong and Wu (), appear to be paraphrases of Stent (). However, on the basis of published interviews of surviving eunuchs, the surgical procedure seems to have been essentially the same in the days after the dynasty (). Possession and employment of eunuchs as servants in China were reserved for the imperial family and the 8 hereditary princes. The emperor held about 2000 in his service, the imperial princes and the princesses had about 30, and several family members were allowed 10 or so eunuchs each. At times, castration was punitive, as in the prisoners of war, but most were voluntarily performed in adults who, due to poverty or laziness, were castrated to obtain employment (usually as young adults, but sometimes in men after being born children) or in children under compulsion who were sold by their parents for the purpose of castration ().Specialists (defined knifes) performed the operation in an imperial city. The subject reclined in a large bank, and the genitals were anesthetized with a secret agent known only by the surgeon. Two assistants held their legs wide, and a third assistant secured their arms. The surgeon interposed between the legs armed with a curved knife (), grabbed the scrotum and the penis with the left hand, and asked the candidate or his parents to consent to the procedure. If the answer was yes, the genitals (scrotum, penis and testicles) were removed with a single cut. A plug made of a piter () was introduced into the urethra to prevent the formation of rigor. The wound was washed three times with a boiled pepper solution and covered with a piece of soft and moisturized paper. With the support of two attendees, the theme was made to walk around the room for 2-3 h. During the next 3 days, the subject was not allowed to drink liquids or urinate. The fourth day, the dressing and the plug were eliminated, and if the subject was able to urinate the operation it was considered a success. The healing took about 100 days, and finally all that was left was a contracted scar (). Urinary retention was treated with medications, and if the surgeon persisted he beat the patient on each visit. Complications included bleeding, infection, and urine extravagation, but death was rare (estimated about 2%). Until the convalescence was completed the cap of the pitalos was only eliminated to allow the urination. Over time the opening of the urethra could be reduced despite the use of dilators, resulting in urinary drip or retention, urinary tract infection and bladder stones. It was said that urinary incontinence was common and caused a characteristic odor in unfortunate victims. Stoma sometimes required dilation long after castration (–). [According to Wagenseil, other castration techniques were sometimes used, each involving the elimination of all external genitals ().]Some of the instruments used to create and treat eunuchs. a, Scalpel used by the knives for the elimination of the external genitals of the Chinese eunuchs (the leaf is described as 3.7 in length, and the mango as 2 in length). Redrawn de Matignon ( ). c, A urethral plug used to prevent incontinence in the eunuchs of the Ottoman Court (5 cm long). He put a rope in his eye to keep him from getting into the bladder. Redrawn of Millant ( ).Some of the instruments used to create and treat eunuchs. a, Scalpel used by knives for the elimination of the external genitals of the Chinese eunuchs (the leaf is described as 3.7 in length, and the handle as 2 in length.) Redrawn of Wong and Wu ( ). b, A uretral dilator for inserting in the Chinese urechuretral part). Redrawn de Matignon ( ). c, A urethral plug used to prevent incontinence in the eunuchs of the Ottoman Court (5 cm long). He put a rope in his eye to keep him from getting into the bladder. Redrawn de Millant ( ). External genitals of a young eunuch of the Chinese court. Matignon reprint ( ). external genitals of a young eunuch of the Chinese court. Matignon's reprint ( ).The amputated penis, testicles and scrotum, called "the precious" or "the treasures", were preserved in alcohol and either stored by the acuchillor or saved by the subject (, ). Genitalia retained by the staggers were kept in the labeled jars to indicate who they came from and when amputation was performed. The eunuchs were forced to show the genitals preserved to a special court official in each promotion ("inspection of the precious") to document the integrity of the operation, and eunuchs who, due to lack of care or malice, lost the items had to borrow or rent them to show them at the time of the promotion. Each eunuch was buried with the preserved genitals, due to the religious need to be as complete as possible by leaving another world. The eunuchs of the palace were divided into 48 departments (to take care of gardens, patios, kitchens, armory, furniture, etc.). Each department had a superintendent, usually sixth grade, and a chief eunuch served mainly the complement of eunuchs. At least in the last phase of Qing dynasty, eunuchs were subject to the Imperial Household Department, which was not headed by an eunuch (). Most of the Chinese eunuchs were castrated as adults, but the castrated eunuchs before the age of 10 were considered 'approximately pure' and were rewarded as personal servants. All eunuchs received a regular allowance, as well as the room and board. The majority lived in the palaces until they were released from service in old age. Some spent their last days in monasteries. Those who had families and children before castration met with their families, and other married and adopted. The most frequent marriage partners were house-breeding; such wives were called "companions sitting in meals" to indicate a platonic relationship (). [George Kates, an American, rented a house in the Imperial City in Beijing of such a couple in the 1930s, the wife having been a maid to the empress of the wrist (). This couple survived until the Cultural Revolution of 1966–76, the wife who died of malnutrition, and the husband who disappeared after being deported to the camp.]After the revolution of 1911 Emperor Pu Yi retained the state of head of figure and continued to reside in the Forbidden City. According to the articles according to the new government, the existing eunuchs continued to be employed in the Department of Imperial Households (). However, on 15 July 1923, all eunuchs staff (with the exception of about 50 domestic employees of the elderly of the imperial family) were expelled from the Forbidden City because they were suspected of stealing and selling furniture and artworks and were believed to have burned a part of the building as a protest against a planned inventory of the palace treasures (). Although there is disagreement as to whether eunuchs were responsible (, ), corruption in the Imperial House Department was widespread. Medical studies on the eunuchs of the Chinese court. The expulsion of the Eunuchs from the Forbidden City left the majority of the unemployed and many indigent. Ferdinand Wagenseil, Freiburg Institute of Anatomy, but after Shanghai Tungchi University, conducted anthropometric studies on normal men in northern China (), and in 1930 examined 31 eunuchs at Beijing German Hospital (). The study technique included measurements of height, weight and a variety of skeletal dimensions, radiographic studies of the skull and descriptions of the skin and body hair. The average age in this group was 57 years, and the average duration of the castration was 38 years. In 1960 Wu and Gu (, ) performed careful physical examinations, including the palpation of the prostate in 26 eunuchs (5 of which had been castrated after the 1911) revolution they lived in Beijing. The average age in this last study was 72 years and the average duration of the castration was 54 years. The eunuchs of the Ottoman Court The practice of employing eunuchs as palace officials in Constantinople (Istanbul) apparently began during the reign of the emperor Justinian in the last days of the Roman Empire and persisted through the Byzantine () and Ottoman era (). In contrast to China, eunuch ownership in Turkey is not limited to royal palaces; any citizen who can pay the purchase price is entitled. Some eunuchs of the Ottoman Empire were from Russia or the Balkans, but from the 16th century the black eunuchs were in charge of the harem in the Ottoman court, most of the individuals of Ethiopia or Sudan who had been castrated as children (). The slave traders kidnapped some, and some were sold into slavery by their parents. According to Penzer, slave exporters used stop points, and it was during the stops in those places where the castration of children took place (). According to other reports, many of the children were castrated in a monastery in Upper Egypt where the Coptic priests performed the operation (, ). The child was held in a chair; the phallus and the scrotum were tied with a cord that was thrown taught, and the phallus, scrotum and testicles were removed as close as possible with a single stroke of a razor. The bleeding stopped with boiling oil, and the wound was clothed with a wax and thigh extract. In some cases, we achieved the hemostasis with hot sand, and the wound was dressed with an acacia bark extract. It was said that mortality was high, only one in three survivors. As in the case of the Skoptzy and the Chinese eunuchs court, a nail was introduced into the urethra to avoid the formation of rigor. The eunuchs who sit to urinate, and both the strict uretral and incontinence must have been common, because some eunuchs carried silver quills for self-cateterization, presumably due to the rigorous (), and others used a removable plug () to prevent incontinence (). Due to the high mortality rate, survivors were sold at high prices either to Turkey or Persia (). The doctors of the harem inspected the eunuchs upon arrival to be sure that both the penis and the testicles had been removed and re-examined every few years to be sure that nothing was amiss (). The eunuchs entered the judicial service in the lowest rank and passed successively through the grades of novice, middle grade and higher rank. Strict rules of behavior were applied for eunuch guild. Some took learning and literature and served as tutors to real children; others ascended to high administrative ranks (). It was said that some 200 eunuchs had lived in the Topkapi Palace in Istanbul after the royal family had moved to other palaces (), and after the Turkish revolution the eunuchs continued to be devoted servants until the royal family was sent to exile in March 1924 (). Medical studies on the eunuchs of the Ottoman court. Hikmet and Regnault seem to have made the first medical observations on eunuchs in Istanbul in 1901 (). During the first world war, Ferdinand Wagenseil had been assigned as a doctor to the German Red Cross Hospital in Istanbul, where he took care of a 40-year-old harem eunuch who died after a feverish disease (presumably typhus) and subsequently examined 10 additional eunuchs, most of which had annulled difficulties (). An autopsy was performed in the man who died; the others (average age, 43 years; mean duration of castration, 34 years) were subjected to detailed anthropological measurements and physical examinations, and X-rays of skull were obtained in four of them. The Medical Consequences of Long-term CastrationBecause the results of the various studies overlap and are complementary, they will be discussed together. Extension of the pituitary. Tandler and Grosz obtained an X-ray of the skull in a 20-year-old Skoptzy man, who had been castrated at 10 years of age and observed that the Turkish seal was enlarged (). Koch obtained X-rays from the skull in 10 Skoptzy men and reported that the pituitary glands were normal in size in 3, enlarged in 4, and "especially" enlarged in 3 (). In the latter group, there was also erosion of the sella of the dorsum of the pituitary ("sattellehne"). The average length of the castration was the same in the 3 groups studied by Koch (46 yr), but the average age at which the castration (11 yr) was performed was younger in the group with the highest pituitary. In his Istanbul Wagenseil study, he reported that 2 out of 4 skull X-rays obtained revealed the expansion of the pituitary with the thinning of the dorsum seal; the average age of castration was 11 years, and the average duration of the castration was 44 years in these 2 men (). In the same study the pituitary was normal in the autopsy in the 40-year-old man who had been castrated for an uncertain duration (). In his Beijing Wagenseil study he obtained X-rays of skull in 27 eunuchs and checked them at the University of Bonn where "the expansion of the Turkish seal could not be found in general" (). The reason for the apparent discrepancy between findings in the Chinese eunuchs and those of the Ottoman eunuchs is unclear, but it is of interest that the average age at which the castration was performed was greater in the Chinese group (average age at castration, 18 yr; less than a quarter had been castrated before the age of 14. Subsequently, the reactive hyperplasia of the pituitary was described in hypogonadal men (–), including men with Klinefelter syndrome (). There is also at least one case in which a large secret hypophysical adenoma of gonadotropin developed 35 yr after a man was castrated for cryptorchidism (). Skeletal changes. Tandler and Grosz described the failure of the closure of the epiphytes in the skeleton of an eunuch () and later in a 35-year-old Ottoman eunuch that had been castrated at 8 years () Koch reported that the thinning of the skull bones was evident by X-rays in all Scottish men examined and that the kyphosis was common () (). Also, Wagenseil observed that 20 of the 31 Chinese eunuchs had kyphosis of the column () (). These observations appear to have been made before kyphosis is recognized as a manifestation of severe osteoporosis in women (). In Wagenseil's study, men with kyphosis averaged 59 years and had an average castration duration of 42 yr, while men who did not have kyphosis were slightly younger (average age, 54 years) and had a slightly shorter average duration of castration (33 yr) (). The involvement of the spine is common in men with osteoporosis of various etiologies (), and in view of the fact that bone mineral density gradually decreases over time after castration, especially in the early years (), it is surprising that kyphosis was not even more common in Chinese eunuchs and Skoptzy. In addition, it does not appear that there has been a greater incidence of fractures in eunuchs, and Wagenseil had not observed kyphosis in his previous study of eunuchs in Istanbul (). The reason for the discrepancy between the Turkish study and the other studies is unclear. Turkish eunuchs were somewhat younger (average age, 44 years), and were Ethiopians or native Sudanese and could have had higher initial bone densities (). Alternatively, vitamin D deficiency osteomalacia was common in northern China in the early years of this century (), and vitamin D deficiency could have contributed to osteopenia in Chinese eunuchs (and possibly in Skoptzy). Photograph showing kyphosis in a 54-year-old Skoptzy man who had been castrated at 15 years old. Koch reprint ( ).Photograph showing kyphosis in a 54-year-old Skoptzy man who had been castrated at age 15. Koch reprint ( ).Photograph showing kyphosis and gynecomastia in eight Chinese eunuchs. The average age of these men was 56 years, and the average time since the castration was 38 years. Wagenseil Reprint ( ).Photograph showing kyphosis and gynecomastia in eight Chinese eunuchs. The average age of these men was 56 years, and the average time since the castration was 38 years. Wagenseil reprint ( ).Gynecomastia. Hikmet and Regnault reported that the breasts of the Ottoman court eunuchs were made large and pendulums () Although not commented by either of the two authors, gynecomastia is also evident in 5 of 9 pictures of Skoptzy men published by Koch () and in 7 of 14 photographs of Chinese eunuchs published by Wagenseil () (). In addition, Wu and Gu reported that 9 of the 26 subjects of their study had breast enhancement (, ). These gynecomastia observations in castrated men are in accordance with the subsequent report of Heller, Nelson and Roth that approximately half of the men with prepuberal functional hypogonadism develop gynecomastia (). In hypogonadal men, gynecomastia develops when estrogen formed by extraglandular aromatization of adrenal androgens is sufficient to cause breast enlargement to deeply low testosterone values (). The reason gynecomastia develops in some but not all men with primary hypogonadism are not known. Apparent disappearance of the prostate. Androgen action is necessary for the development of the prostate gland during embryogenesis (), and prostate is not developed in men with mutations that profoundly affect the function of the androgen receptor () or steroid 5α-reductase-2 (). In addition, since the nineteenth century it has been known that prostatic hyperplasia does not develop in the prepuberal castros and that castration causes regression of the hyperplastic prostate (). Hikmet and Regnault reported that the prostate became atrophy in the eunuchs of the Ottoman court (). Also, in the Wagonseil autopsy description of a 40-year-old eunuch, the prostate gland was prepuberal in size (16 × 24 × 13 mm, corresponding to a weight of approximately 4 g) (), a finding that is hardly surprising. However, Wu and Gu's report that the prostate was completely impalpable in 21 of 26 Chinese eunuchs (and very small in the other 5) (, ) was unexpected and implies that the viability of the gland throughout life requires the continued presence of gonadal hormones, presumably androgens. Very small prostates may be lost in physical examination by Wu and Gu (, ).Alternatively, the disappearance of the prostate may be a function of time after castration, as the duration of castration in their study was much longer than in any other report, recognizing that the duration of castration in the subset of men with hardly palpable prostates (55) (54). Comments Hopefully, it will never again be possible to repeat the studies reviewed in this document, since in more recent times we have used different means of expressing the inhumanity of man to man. It is for the credit of the pioneering medical scientists involved that useful medical information was obtained on the long-term effects of castration, under circumstances that must have been difficult, of the study of these groups of now extinct castrated men, and it is impressive that all their findings (osteoporosis, lack of closure of the epiphises, reactive pituitary hyperplasia, reduction of the prostate, and development of the forms of the later confirmed gineas A matter of interest concerning castration in men cannot be resolved from the available data, namely, whether the life of men is shorter than that of women due to the presence of testicles or the absence of ovaries (and menstruation) (). In fact, there is no valid data indicating that castration has some effect on the useful lives of men. It is of some interest that no mention seems to have been made of the relationship between castration and chanting in any of the literatures concerning the Chinese, Ottoman, or Skoptzy eunuchs, while there was a long tradition in Italy that associated the castrated state with a phenomenal song of men in both choirs and opera (). The probable reasons for this apparent discrepancy are several. First, the so-called castrati singers were, in fact, a heterogeneous group formed by women who stood up as castrated men, men with hypogonadism and/or cryptorchidism, men with intact tests that probably sang like tenors or falseta, and some singers who had their testicles removed or crushed (). It is therefore difficult to interpret literature on the subject in medical terms. Secondly, in cases where castration was performed, only children with extraordinary singing capacity were chosen for such a procedure, and the singing capacity is likely to be no different in men selected for castration using other criteria than in the general population. Recognition Cindy Karolikowski, Reference Library of the Shiffman Medical Library in Detroit, provided valuable assistance in the initiation of these studies, and the assistance of Caroline Duroselle-Melish, Reference Library in the historical collections of the Library of Medicine of the New York Academy, made it possible to expand its scope. We are also grateful to the reference librarians at the New York Public Library and the Southwest Medical Center at the University of Texas. The German translations were made by one of the authors (C.R.), and we are in debt with Philippe E. Zimmern to help with French translations. Cumming ED. 1931-1937 Eunuch: a collection of manuscripts on the history of human castration with notes on the personalities of eunuchs. Scarsdale: Library of the New York Academy of Medicine (59 volumes). Melicow MM. Nowakowski H. Hamilton JB. Pelikan E. 1876 Gerichtich-medizinische Untersuchungen uber das Skopzentum in Russland (A summary of this book is available as theme 12 in the Cumming collection of the Library of Medicine of the New York Academy). Grass KK. Die Russischen Sekten, Zweiter Band, Die weissen Tauben oder Skopzen, Leipzig, 1914 [Taked by Kolarz (10)]. Pittard E. Koch W. Stent, CG. 1877 Chinese eunuchs. J North China Branch R Asiatic Soc (New Ser. 11); reimpresed in: Humana C, The Bed Guard. London: Arlington Books, pp. 125 to 153, 1973. Korsakow W. Matignon J-J. Wagenseil F. Jay JW. Wagenseil F. Andrews E. Hikmet (without initial given), Regnault F. Millant R. 1908 Les eunuques: a travers les age. In: Bibliotheques des Perversions Sexuelles. Paris: Vigot Freres; vol 13, p 226. Wagenseil F. Bower BF. Kleinberg DL. Message A. Huggins C. Email alerts Related articles inCiting articles via ConnectResources ExploreOxford University Press is a department at Oxford University. In addition, the University's goal of excellence in research, scholarship and education by publishing around the world or This PDF is available for Subscribers OnlyFor full access to this pdf, enter an existing account or purchase an annual subscription.

No resultsNo resultsProcessing results.... What are the adverse effects of surgical and medical castration on the treatment of prostate cancer? Surgical and medical castration leads to a series of side effects, including the following, which can have a significant impact on a man's quality of life: Related questions:Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer Statistics 2018: GLOBOCAN estimates the incidence and mortality worldwide by 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov. 68 (6):394-424. . American Cancer Society. Cancer data " Figures 2021. Available in . Access: February 2, 2021. Shah, Rajal B., and Ming Zhou. Isthological variables of Adenocarcinoma Acinar, Ductal Adenocarcinoma, neuroendocrine tumors and other carcinomas. Interpretation of prostate biopsy. 2019. 69-95. Humphrey PA, Moch H, AL, Ulbright TM, Reuter VE. WHO 2016 Classification of Urinary System Tumors and Male Genital Organs Part B: Prostate and bladder Tumors. 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Virchows Arch. 2013 Dec. 463 (6):803-9. . Olsen JR, Azeem W, Hellem MR, et al. Context regulatory patterns dependent on androgen receptor and androgen receptor genes. BMC cancer. 2016 Jul 4. 16:377. . .Chad R Tracy, Assistant Professor of MD, Department of Urology, University of Iowa, Roy J and Lucille A Carver College of Medicine Chad R Tracy, MD is a member of the following medical societies: , , Disclosure: Nothing to reveal. Nathan A Brooks, MD Resident Physician, Department of Urology, University of Iowa Hospitals and Clinics Nathan A Brooks, MD is a member of the following medical societies: Disclosure: Nothing to reveal. Mohammed Said, MD Fellow in Minimally Invasive Surgery and Endourology, Department of Urology, University of Iowa, Roy J and Lucille A Carver College of Medicine Disclosure: Nothing to reveal. Edward David Kim, MD, FACS Surgery Professor, Urology Division, University of Tennessee Medical Faculty; Consulting Cabinet, University of Tennessee Medical Center Edward David Kim, MD, FACS is a member of the following medical societies: , , , , , , Disclosure: Serve(d) as speaker or member of a speaker's office for: Endo. Tracey L Krupski, MD, Assistant Professor of MPH, Department of Urology, University of Virginia Medical School Tracey L Krupski, MD, MPH is a member of the following medical societies: , , , Disclosure: Nothing to reveal. Bagi RP Jana, MD, MBA, MHA, FACP Cancer Medicine Professor, MD Anderson Cancer Center; Medical Professor, Texas University Medical Branch at Galveston Bagi RP Jana, MD, MBA, MHA, FACP is a member of the following medical societies: , , , Disclosure: Nothing to reveal. Gerald W Chodak, MD , Editor, www.ProstateVideos.com; Medscape Urology, Experts and Viewpoints--Controversies in Urology; Director of Medical Content, Answers Media, LLC; Author, Winning the Battle Against Prostate Cancer Gerald W Chodak, MD is a member of the following medical societies: Disclosure: Nothing to reveal. Isamettin Andrew Aral, MD, MSc Attending Physician, Nassau Radiologic Group (Long Island Radiation Therapy); Assistant Professor of Radiational Oncology, New York State University Downstate College of MedicineIsamettin Andrew Aral, MD, MSc, is a member of the following medical societies: , , and Divulgation: Nothing to reveal. Hassan Aziz, MD Clinical Professor, Department of Radiation Oncology, Downstate Medical Center and Long Island College Hospital, State University of New York at DownstateHassan Aziz, MD is a member of the following medical societies: and Disclosure: Nothing to disclose. Michael Giasullo, MD Clinical Assistant Professor, Department of Urology, State University of New York Downstate Medical Center; Chief, Department of Surgery, Division of Urology, Lutheran Medical Center; Consulting Staff, Bay Ridge Urology Associates; Assistant Attending Physician, Department of Surgery, Urology Section, Methodist Hospital Michael Giasullo, MD is a member of the following medical societies: and Disclosure: Nothing to reveal. Leonard Gabriel Gomella, MD, FACS Professor Bernard W Godwin de Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson UniversityLeonard Gabriel Gomella, MD,CS is a member of the following medical societies: , , , , , , , , Society of University Urologists, and MD Nicholas Karanikolas, MD Associate Professor, Department of Urology, SUNY Downstate College of Medicine; Director, Urologic Oncology, Staten Island University Hospital; Attending Physician, Department of Urology, Brooklyn Veterans Administration HospitalNicholas Karanikolas, MD is a member of the following medical societies: Disclosure: Nothing to reveal. Francisco Talavera, PharmD, PhD Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-chief, Medscape Drug ReferenceDisclosure: Medscape Salary Employment Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center Dan Theodorescu, MDromaDunder Stock

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