Thomas W. Johnson

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.

Background: Assigned males with genital ablation interests may be at higher risk of having erectile dysfunction (ED), especially those who have gone through androgen suppressing pharmacological therapies, orchiectomy and/or penectomy. Aim: To determine the prevalence and severity of ED in assigned males with castration interests, the types of management strategies they use and what factors are associated with using these strategies. Methods: We launched an online survey on the Eunuch Archive website to better understand how common ED is, as well as sexual frequencies, and the use of sexual management strategies among assigned males with genital ablation interests. Outcomes: ED and sexual activity frequencies, preferred role in sexual activities, and previous use of sexual management strategies. Results: Data from 363 assigned male individuals (50.7 ± 15.6 years old; 23.6% and 3.7% had been orchiectomized and penectomized respectively) showed that 11.2% reported having ED 25-50% of the time, 12.8% had ED 50-75% of the time, and 22.9% had ED 75-100% of the time. Yet a large proportion remained sexually active. For example, 63.5%, 56.2% and 8.8% reported watching porn, masturbating, and having partnered sex several times a week respectively. During partnered sex, 13% of the participants preferred to be in the insertive role, whereas nearly 40% preferred to be in the receptive role. A quarter preferred non-penetrative sex. To maintain sexual activities, commonly used strategies included oral medication (38.8%), vacuum erection devices (25.6%), and strap-on dildo (17.5%). Penile sleeve, penile injection and penile support device were rarely used (<10%). Clinical Implications: Data from our study can be used by clinicians to advise their clients, for example individuals with genital ablation interest who seek to maintain their sexual activities. Strengths & Limitations: Participants completed validated questionnaires. Data were collected online and could not be independently verified. Conclusions: A strong interest in genital ablation is often associated with a desire to be less sexual. Consistent with that is a high incidence of ED in this population. However, many men with exceptional interests in genital ablation nevertheless remain sexually active and use various strategies to maintain penetrative sex.

Introduction & Importance: Bilateral testicular torsion with testicular loss is a rare condition in prepubertal youth. This case represents one of the only documented cases of a modern, pre-pubertal youth raised as a eunuch through adolescence. Case Presentation: This is a case of a pre-pubertal boy (Z) who suffered bilateral testicular torsion and gonadal loss who was raised as a eunuch through adolescence. Clinical Discussion: Throughout his adolescence, Z demonstrated no deficits in psychosocial functioning, and displayed no intellectual or learning deficits. Compared to his peers and younger brother, Z was less interested in physical and competitive activities, preferring more supportive, pro-social behaviors, like caring for children. Conclusion: In this case, hormonal deprivation and delayed puberty did not appear to impact neurodevelopmental processes or psychosocial development. This case has potential issues for other areas of healthcare where concerns have arisen around long-term pubertal suppression.

Background: Although uncommon, some individuals assigned male at birth (AMAB) seek voluntary genital ablative procedures, and others fantasize about it. Aim: To learn more about the views of genital ablation and injuries in those who aspire to be castrated as compared with those who only fantasize about it. Methods: A survey was run on the Eunuch Archive internet community. Content analysis was conducted on the responses of 342 AMAB individuals with castration fantasy but no desire for actual surgery (fantasizers) vs 294 AMAB individuals who expressed a desire for genital ablation (aspiring). Outcomes: Study outcomes were responses to open-ended questions about genital ablations and injury. Results: Aspiring individuals were more likely to perceive a “physical appearance benefit” from orchiectomy, but fewer could recall how they first learned about the procedure. Some reasons that aspiring persons gave for desiring an orchiectomy included “achieving preferred self” and “health reasons.” Fantasizers, in contrast, worried about the potential side effects of orchiectomy, and more believed there to be no benefit to it. Clinical Implications: Psychiatrists and other clinicians need to understand their patients’ views on genital ablation to properly diagnose and provide the best personalized care. Strengths and Limitations: Strengths include a large sample of respondents. Limitations include the accuracy of the anonymous survey data. Conclusions: This study demonstrates divergent interests on genital ablation among AMAB individuals who have not had an any genital ablation yet have intense interest in the topic.

A 12-year-old boy lost both testes after testicular torsion. He is now 14, and his father wants to know if the boy should immediately start supplemental testosterone or if he might reasonably choose to live as a eunuch. The boy does not yet express any strong opinion except that he is embarrassed about his weight gain. We advised the father that there is no need to rush the decision as the boy could at least delay testosterone therapy until his teens or early 20s and still go through male puberty with little risk of adverse health effects. We seek to know if others endorse our endocrinological advice. The boy's father wants to be honest with his son about the social challenges the boy may face if he elects to delay or avoid puberty altogether and chooses to openly identify as a eunuch.

We report here on survey data from 11 genetic males, who had voluntary penectomies without any explicit medical need, yet did not desire testicular ablation. This group was compared to a control group of men who completed the same survey but had no genital ablation. The penectomy group was less likely to identify as male than the control group. They were also more likely to have attempted self-injury to their penis (at a median age of 41.5 years), been attracted to males without penises, and felt that they were more physically attractive without a penis than the controls. Motivations for voluntary penectomy were aesthetics (i.e., a feeling that the penile removal made them more physically attractive) or eroticism (i.e., at least two individuals thought that a penectomy would make them a better submissive sexual partner). In terms of sexual function, the penectomized and control groups reported comparable sexual function, with six penectomized individuals claiming to still be able to get and keep an erection, suggesting possible incomplete penile ablation. In their childhood, penectomized individuals were more likely than the controls to have pretended to be castrated and to have involved the absence of genitals of their toys in their childhood play. We discuss characteristics and sexual outcomes for individuals who have had a voluntary penectomy. A future study with a larger sample size on men who desire penectomies is warranted.

Introduction Some healthy males voluntarily seek castration without a recognized medical need. There are currently no standards of care for these individuals, which cause many of them to obtain surgery outside of a licensed medical setting. We seek to understand who performs these surgeries. Aim This study aims to characterize individuals who perform or assist in genital ablations outside of the healthcare system. Methods A cross‐sectional Internet survey posted on eunuch.org received 2,871 responses. We identified individuals who had performed or assisted in human castrations (“cutters”; n = 98) and compared this group with all other survey respondents (n = 2,773), who had not assisted in castrations. Next we compared the cutters with the voluntary eunuchs. Lastly, because many of the cutters have themselves been castrated, we also divided the physically castrated population (n = 278) into cutters (n = 44) and noncutters (n = 234) and compared them. Main Outcome Measures Self‐reported questionnaires were used to collect demographic information, gender identity and presentation, selected childhood experiences, and history of aggressive behaviors, self‐harming behaviors, and hospitalization. Results Distinguishing characteristics of cutters included: (i) presenting themselves as very masculine, (ii) having had their longest sexual relationship with a man, (iii) growing up on a farm, (iv) witnessing animal castrations, (v) having a history of sexually inappropriate behavior, (vi) having been threatened with genital mutilation as a child, (vii) having a history of self‐harm, (viii) being raised in a devoutly Christian household, (ix) having had an underground castration themselves, and (x) having body piercings and/or tattoos. Conclusions This study may help identify individuals who are at risk of performing illegal castrations. That information may help healthcare providers protect individuals with extreme castration ideations from injuring themselves or others. Jackowich RA, Vale R, Vale K, Wassersug RJ, and Johnson TW. Voluntary genital ablations: Contrasting the cutters and their clients. Sex Med 2014;2:121–132.

Johnson and Irwig discuss a community of biological males who desire emasculation and commonly resort to self-castration, castration by nonmedical professionals, or self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures. Eunuchs are biological males who have undergone voluntary castration for reasons other than male-to-female transsexualism. The term 'eunuch wannabe' refers to individuals who desire, or are planning, voluntary castration. Out of fear of embarrassment or rejection, many eunuch wannabes do not consult medical professionals regarding their desire for voluntary castration. Instead, they commonly resort to self-castration, castration by nonmedical professionals, or self-inflicted testicular damage via injections of toxic substances. Urologists should be aware of the growing popularity of these procedures. In particular, intratesticular injection of toxins is performed so that urologists will remove the damaged testicles.