Psychological wellbeing of eunuchs and other individuals with interests in genital altering procedures

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Abstract
Introduction: The Eunuch Archive (EA) is an online community where individuals with interests in genital ablation share information, personal experiences, and social support. This study compared psychological wellbeing among individuals with different genital ablation interests and examined patterns and motivations for engaging with the EA. Methods: An anonymous online survey was posted on the EA website. Participants were categorized into 4 groups: individuals with genital ablation fantasies without a desire for surgery (Fantasy), individuals desiring orchiectomy but not having undergone the procedure (Aspiring), individuals who had undergone orchiectomy and were receiving androgen replacement therapy (Androgen Eunuchs), and individuals who had undergone orchiectomy without androgen replacement therapy (Eunuchs). Psychological wellbeing was assessed using validated measures of anxiety and depression (Hospital Anxiety and Depression Scale), insomnia (Insomnia Severity Index), and loneliness (Three-Item Loneliness Scale). Group differences were analyzed using ANOVA and chi-square tests, and regression analyses examined associations between reasons for visiting the EA and psychological outcomes. Results: The final sample included 338 participants (mean age 51.1 ± 15.7 years). Significant group differences were observed for loneliness and anxiety, but not for depression or insomnia. Individuals in the Eunuchs group reported lower loneliness and anxiety than participants in the Fantasy and Aspiring groups. Frequency of EA use was similar across groups, although motivations differed. Participants in the Fantasy group more frequently reported reading stories, whereas Aspiring individuals and Eunuchs more often sought medical information and social connection. Posting stories was associated with depressive symptoms (OR = 2.3, P = .007), while seeking connection with others was associated with anxiety (OR = 2.0, P = .007), depressive symptoms (OR = 2.0, P = .010), and insomnia symptoms (OR = 2.0, P = .004). Discussion: Psychological wellbeing and motivations for engaging with the EA differed according to embodiment goals and surgical status. Individuals who had undergone orchiectomy without androgen replacement reported lower loneliness and anxiety than other groups. These findings highlight the importance of understanding online community engagement and psychosocial factors among individuals with genital ablation interests and may help clinicians provide more informed and non-stigmatizing care. Limitations include reliance on self-reported data from a single online community and the inability to verify participant responses.

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