What is Chemical Castration?
Using anaphrodisiac drugs to lower sexual desire or libido is known as chemical castration. The treatment lowers the levels of male hormones or androgens.
Luteinizing hormone-releasing hormone (LHRH) comes from the pituitary glands signals the testicles to make testosterone. The LHRH agonist stimulates the production of luteinizing hormone. This causes the testosterone levels to rise.
The effect lasts for a few weeks. Taking anti-androgen for a few weeks can relieve the concern.
If the LH levels are raised, their production from the pituitary gland stops. It no longer signals the testicles to make androgens. This reduces the testosterone levels to very low, just like surgical castration.
What are LHRH Agonists?
LHRH agonists are also known as gonadotropin-releasing hormone (GnRH) agonist. They do not affect the production of androgens in the adrenal glands directly, as anti-androgens do.
Some of the LHRH agonists are:
- Goserelin (Zoladex)
- Histrelin (Vantas)
Leuprolide (Lupron, Eligard)
- Triptorelin (Trelstar)
Chemical Castration Procedure
Chemical castration is a one-time treatment in which the doctor injects the drug or implants them under the skin.
Depending on the drug and the dose, it would be repeated once a month or once a year.
In the case of advanced prostate cancer, LHRH antagonists are recommended by the doctor as they work faster than LHRH agonists. They do not cause an increase in testosterone levels. LHRH antagonists include the following medicines:
- Degarelix (Firmagon) in monthly injection dosage
- Relugolix (Orgovyx) as a daily pill
As long as a person is under drugs the effect of chemical castration stays. The hormone production returns to normal once the drugs are stopped. The effects are also reversible, but in some cases where the medicines are continued for long, the side effect may stay.
Side Effects of Chemical Castration
There are a few side effects related to chemical castration, which include:
- Reduced or absent sexual desire
- Erectile dysfunction
- Shrinkage of testicles and penis
- Hot flashes
- Tenderness in the breasts
Long term side effects include:
The longer you are under treatment, side effects and complications increase(2). Therapies are recommended by the doctor to prevent or ease the side effects.
There are also a few concerns that the men treated with chemical castration are at the risk of:
Difference Between Chemical Castration and Surgical Castration
Chemical castration is done using oral medications, injections, or implants to lower the hormone levels. There is no immediate change in the appearance of the testicles.
They might shrink over time and in some cases, they become so small that you cannot even feel them. The effect of chemical castration lasts as long as someone is under the treatment. As the treatment stops the change is reversible.
Surgical castration, also known as orchiectomy, involves the removal of both the testicles. This procedure reduces the levels of testosterone in the blood(3).
It is an outpatient procedure and once done cannot be reversed.
A procedure that involves the removal of the tissue that produces androgen instead of the entire testicle is called subcapsular orchiectomy. This keeps the scrotum intact. In some cases, artificial testicles are inserted into the scrotum.
Uses of Chemical Castration
Chemical castration is used in the treatment of hormone-dependant cancers such as prostate cancer. It slows down the cancer growth and metastasis.
The treatment can be beneficial in the prostate cancers that have spread or recurred after first-line treatment.
Chemical castration can also be used to slow the progression of male breast cancer.
The patient needs to inform the doctor of any medicine they are taking, including the over-the-counter herbal medicines, while undergoing the treatment. Some herbal medicines interact with a drug-metabolizing enzyme in the body and can lead to adverse effects(4).