Each year hundreds of thousands of males begin long-term androgen deprivation therapy (ADT), i.e. chemical or surgical castration, to slow the progress of prostate cancer. ADT causes loss of muscle mass and body hair; genital shrinkage and erectile dysfunction; variable amounts of breast growth and the development of a characteristically postmenopausal female pattern of fat distribution. ADT also changes mood and affect, most conspicuously seen as increased emotionality and depressed libido. Given these changes, it is not surprising that many patients on ADT no longer feel 'manly', yet do not experience themselves as women. For many, this gender liminality is psychologically and socially traumatic. Faced with these difficulties, how can castrated males understand themselves in a positive way?We explore the idea that some men may benefit from embracing the alternative gender identity of 'eunuch'. Unfortunately, due in part to the historic practice of forced castration, the word 'eunuch' is now largely pejorative, although it is the correct biological term for a castrated male. We examine the benefits and risks of contemporary castrated males accepting this identity to help them adapt to the changes they experience.
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