Eunuchs and eunuchism--an historical discourse.
Explore the source record for details and available documents.
SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Ancient Hebrew literature as well as the New Testament differentiate between castrated eunuchs and congenital eunuchs. Congenital eunuchism is very rare today, and assuming that this was also the case in classical times, we investigated possible reasons why congenital eunuchs feature prominently. We discuss the probability that the concept 'congenital eunuchism' might in ancient times have included effeminate men who, according to cultural views on 'maleness' and androgyny, were almost equated with eunuchs. The causes of congenital hypogonadism are reviewed in order to attempt clarification of the condition of Favorinus, a congenital eunuch in the second century AD. We suggest that although he might have been a true hermaphrodite, as suggested by some authors, it is more likely that he had one of the following conditions: functional prepubertal castrate syndrome, testicular gonadotrophin insensitivity, selective gonadotrophin deficiency or Reifenstein's syndrome.
Hypogonadism with spermatogenesis (fertile eunuch syndrome) occupies a special nosologic situation because of it's clinical and paraclinical features. These include: eunuchism of testosterone's target tissues, contrasting with clinically normal testes; normal embryonic male differentiation; low serum testosterone concentrations; moderately decreased or normal LH serum concentrations which are coincident with low testosterone levels therefore reflecting at least relative LH insufficiency; normal FSH levels; normal LHRH response; variable clomifen response; poor spermatogenesis improved by HCG and/or testosterone, and in some cases by HMG; atrophic leydig cells. Although in very rare instances it may include anosmia, the fertile eunuch syndrome should be clearly distinguished from complete FSH and LH deficiency with or without anosmia. It must also be distinguished from the very uncommon isolated FSH deficiencies. The fertile eunuch syndrome probably originates in insufficient hypothalamic production of LHRH. The mechanism by which spermatogenesis is at least partly spared remains unknown.
Fertile eunuch syndrome is caused by isolated LH deficiency, but its pathophysiology still remains controversial. We report a case of fertile eunuch syndrome with homozygous Trp8Arg and Ile15Thr mutations in the LH beta subunit gene. An 18-year-old man was admitted to our hospital for hypogonadism. Examination of genitalia revealed Tanner G1PH1, whereas both testes were elastically palpated and developed up to 18 ml. Endocrinological evaluations revealed normogonadotropic hypogonadism and there were normal responses after GnRH and hCG stimulation. Intratesticular testosterone concentration was almost normal (1.34 x 10(3) ng/g). By PCR direct sequencing, homozygous Trp (8) Arg and Ile (15) Thr mutations in exon 2 of LH beta were detected. Normal virilization and improved semen parameters were achieved after hCG supplementation. To our knowledge, this is the first case of fertile eunuch syndrome with homozygous Trp (8) Arg and Ile (15) Thr mutations in beta subunit of LH gene.
In 1960, there were 26 eunuchs from the palace of the Qing Dynasty still living in Beijing. The authors took that unique opportunity of carrying out a general physical examination, including palpation of the prostate, for every one of them. Their average age then was 72 years (59-83 years). They became eunuchs at the age of 10-26 years. The prostate was impalpable in 26 (81%) and 1-2 cm in width rectally in five, with a flat surface. At the time of the examination they had been eunuchs on the average for 54 years (41-65 years). This is probably the largest series of human beings followed for such a long period of time to confirm that testicular hormone is essential for the development and preservation of the prostate. The type of operation, the traditional way of carrying out the operation and the usual complications are presented.
A patient with isolated LH deficiency ("fertile eunuch" syndrome) was given synthetic gonadotropin releasing hormone (GnRH) by a single intravenous injection and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and dihydrotestosterone were measured. A significant rise in both gonadotropins was found after GnRH and the increase was similar to that reported for normal men. No significant change was noted in the serum androgen levels. The patient was re-tested with another single intravenous injection after a 6-h infusion of GnRH two days later. The rise in serum Fsh and LH levels during the infusion was greater than with the initial bolus. A further increase in LH but not FSH concentration was noted when a 150 mug bolus was given at the end of the infusion. Acute (4 day) treatment with human chorionic gonadotropin (hCG) resulted in an increase in the serum testosterone and dihydrotestosterone levels to those observed in normal adult males. The "fertile eunuch" syndrome thus appears to be a hypothalamic disorder. It is consistent with the concept of more than one hypothalamic factor controlling gonadotropin secretion. Other possibilities would be deficient or defective production of a releasing factor affecting one or both gonadotropins. The lack of a definite response of serum androgens to GnRH would appear to be secondary to a decreased number of differentiated Leyding cells.
Mutations in the GnRH receptor (GnRH-R) gene have been reported to cause idiopathic hypogonadotropic hypogonadism (IHH). Herein, we describe a 26-yr-old male with a mild phenotypic form of IHH, the fertile eunuch syndrome (IHH in the presence of normal testicular size and some degree of spermatogenesis), associated with a homozygous mutation (Gln106Arg) in the GnRH-R. This mutation, located in the first extracellular loop of the GnRH-R, has been previously shown to decrease but not eliminate GnRH binding. The proband had hypogonadal testosterone levels, detectable but apulsatile gonadotropin secretion, and a normal adult male testicular size of 17 mL at baseline. After only 4 months of treatment with hCG alone, he developed sperm in his ejaculate and his wife conceived. Following cessation of hCG therapy, the patient demonstrated reversal of his hypogonadotropism as evidenced by normal adult male testosterone levels and the appearance of pulsatile luteinizing hormone secretion. This case thus expands the emerging clinical spectrum of GnRH-R mutations, provides the first genetic basis for the fertile eunuch variant of IHH and documents the occurrence of reversible IHH in a patient with a GnRH-R mutation.
A semi-structured interview has been used to evaluate sexual functioning in transvestite-eunuchs known as Hijaras of India. Hijaras can be castrated males or male children with ambiguous external genitalia. Attitudes, experiences, behavior and frequency of sexual practices of the Hijara are described.
The olfactory and gonadal dysfunction in Kallmann syndrome share a common embryologic pathophysiology. To characterize further the linkage between the hypogonadotropic hypogonadism and anosmia, the authors performed a detailed evaluation of olfactory function in a patient with Kallman Syndrome having the rare variant of partial gonadotropin deficiency (fertile eunuch). The subject was seen initially at age 16 years because of delayed puberty. He received testosterone replacement therapy and subsequently completed pubertal development. As an adult, while untreated, he had subnormal levels of serum testosterone, low gonadotropins, and normal response to luteinizing hormone- releasing hormone. He also had impotence that was reversible with testosterone therapy, and a normal sperm count. Despite the mild degree of hypogonadism, olfactory function was completely absent, and the response to nasal trigeminal stimulants was markedly attenuated. Complete anosmia may therefore be associated with gonadotropin deficiency that is only partial; the presence of anosmia does not predict the need for gonadotropin therapy to attain fertility.
The functioning of the hypothalamo-pituitary-target organs axis was assessed in 3 patients with 'fertile eunuch' syndrome (FE) and 6 patients with 'classic' hypogonadotrophic hypogonadism (HH) with or without hyposmia. Both groups of patients did not differ from each other with regard to basal serum prolactin levels, pituitary growth hormone and thyrotrophin reserve and the thyroid or adrenal gland function. Both groups differed, however, with respect to the hypothalamo-pituitary-gonadal function: 1. the pituitary LH response to exogenous LH-RH was (low)-normal in FE and blunted in HH; 2. the basal FSH levels were normal in FE and undetectable in HH; 3. the basal LH levels were normal in FE and 3/6 patients with HH and low in the remaining three; 4. the basal and HCG stimulated plasma testosterone concentrations were significantly higher in FE than HH. The data suggest that FE represents a less severe form of LH-RH deficiency, rather than a distinct disorder.
The purpose of this article is to present the various types of eunuchs, the castration techniques and the modification observed on males due to castration.
We used a survey posted on the Internet to explore the motivation of men who are interested in being castrated. Out of 134 respondents, 23 (17%) reported already having been castrated. The 104 (78%) individuals who said they had not been castrated were asked why they wanted to be castrated and why they had not actualized that desire. They were given multiple-choice answers to select from. The major reason (selected by 40% of respondents) for desiring castration was to achieve a "eunuch calm" and freedom from sexual urges; however, a large proportion (approximately 30%) of respondents found fantasies about being castrated sexually exciting and a similar percentage desired castration for the "cosmetic" appearance it achieved (which we interpret to mean scrotal removal along with an orchiectomy). This high interest in castration as either a sexual stimulus (a fetish) or a cosmetic enhancement was unexpected and contrasted with the more classically stated motivation for voluntary castration in the psychiatric literature, i.e., libido control and transsexualism. Internet discussion groups that serve these men may encourage them to act out their castration fantasies. Alternately, Internet discussions may give them a displacement outlet for their fantasies and decrease the risk of castration by nonmedically qualified "street-cutters" or by self-mutilation. Forty percent of our respondents claimed that they would have an orchiectomy, if it were cheap, safe, and simple. A quarter wanted to try chemical castration first, but 40% were embarrassed to talk to their doctors about their interest in castration. Information now available on the Internet provides these men with increasingly easy access to street-cutters and directions on how to perform surgical castrations, putting them at risk of permanent injury and disability. Physicians need to be aware of these risks.
Two men are described who fulfill the criteria for both the Kallmann and the fertile eunuch syndrome, and we report the erythrocyte and HLA phenotypes of these men and their children. There were no paternal exclusions noted in red blood cell phenotypes encompassing seven separate red cell systems. The HLA phenotypes indicate that the probability that these men were the fathers of the children was greater than 99.99%.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.