Chemical Castration

What is chemical castration?

Chemical castration (kas-TRAY-shun) is the use of chemicals or drugs to stop sex hormone production. Different glands in your body release hormones into your blood. The hormones give instructions to your organs, like how to manage your energy, growth and moods. Sex hormones specifically start puberty and help manage your reproductive health.

But sometimes, different types of cancer “feed” on your sex hormones. Chemical castration helps treat these cancers by reducing the amount of sex hormones your body makes, which prevents the hormones from fueling cancer growth.

Other names for chemical castration include:

• Medical castration
• Hormone therapy
• Androgen depressive therapy
• Androgen deprivation therapy
• Androgen suppression therapy

“Depressive,” “deprivation” and “suppression” are different ways of saying you’re reducing or cutting off sex hormones in your body.

What does chemical castration treat?

Healthcare providers use chemical castration to treat tumors that feed on sex hormones. Providers may use it to treat breast cancer, male breast cancer and prostate cancer.

Another name for some sex hormones is androgens. Everyone makes androgens. But you make more of them if you’re male. Androgens include testosterone and dihydrotestosterone (DHT). One of their jobs is to make your prostate gland grow and function.

What happens before chemical castration?

Before a healthcare provider suggests chemical castration, they must know if the type of cancer you have might respond well to chemical castration. They’ll recommend tests to determine what kind of cancer you have and its stage. Tests may include:

• CT scan
• PET scan
• Endoscopy
• Biopsy
• Blood tests for cancer

If the goal is to permanently reduce your testosterone, providers may discuss an orchiectomy (or-kee-EK-tuh-mee) with you. An orchiectomy is a procedure that removes one or both of your testicles to permanently reduce your testosterone levels. They may also suggest a subcapsular (suhb-KAP-suh-ler) orchiectomy. A subcapsular orchiectomy only removes the testicular tissue that makes testosterone.

What happens during chemical castration?

Chemical castration is an ongoing treatment. A healthcare provider will usually administer the drugs as injections or implants under your skin. But you may take some drugs as a pill. Depending on the specific drug and dosage amount, you may need repeated treatments anywhere from monthly to only once a year.

Chemical castration to treat prostate cancer can work in one of the following ways:

• Decreasing the production of androgens in your testicles
• Preventing androgens from being able to work in your body
• Stopping any other parts of your body from producing androgens

What drugs are used in chemical castration for prostate cancer?

The categories of chemical castration medications that healthcare providers use to treat prostate cancer include:

• Gonadotropin-releasing hormone (GnRH) agonists or GnRH analogs
• GnRH antagonists
• Antiandrogen treatments
• Androgen synthesis inhibitors

GnRH agonists or GnRH analogs

These medications stop your pituitary gland from releasing luteinizing hormone. Luteinizing (LOO-tee-in-ny-zing) hormone tells your testicles to make testosterone.

First, GnRH agonists or analogs cause a high level of hormone that your body eventually ignores. At that point, your testosterone levels may increase (testosterone flare). You may need antiandrogen therapy at the same time to help with side effects.

In the U.S., drugs in this category include:

• Goserelin (Zoladex®)
• Histrelin (Supprelin® or Vantas®)
• Leuprolide (Camcevi®, Eligard® or Lupron®)
• Triptorelin (Trelstar® or Triptodur®)

Another name for GnRH agonists and analogs is luteinizing-hormone releasing hormone (LHRH) agonists and analogs.

GnRH antagonists

These medications prevent testosterone production without causing a testosterone flare. In the U.S., drugs in this category include:

• Degarelix (Firmagon®)
• Relugolix (Orgovyx®)

Antiandrogen treatments

These drugs stop your body from using androgens. Healthcare providers commonly use antiandrogen treatments when chemical castration is no longer working well. They may use this in combination with chemical castration. In the U.S., antiandrogen drugs may include:

• Flutamide (Eulexin®)
• Bicalutamide (Casodex®)
• Apalutamide (Erleada®)
• Nilutamide (Nilandron®)
• Enzalutamide (Xtandi®)
• Darolutamide (Nubeqa®)

Another name for this therapy is complete androgen blockage.

Androgen synthesis inhibitors

Androgen synthesis inhibitors prevent the production of androgens anywhere in your body. They stop the production of the enzyme CYP17. CYP17 is necessary for any tissue to make testosterone, including prostate cancer tissue.

In the U.S., androgen synthesis inhibitor drugs may include:

• Aminoglutethimide (Cytadren®)
• Ketoconazole (Nizoral®)
• Abiraterone (Yonsa® or Zytiga®)

Can estrogen treat prostate cancer?

At one time, healthcare providers used the sex hormone estrogen to treat prostate cancer. But because of the side effects, providers don’t usually recommend it anymore.

What happens during chemical castration to treat breast cancer?

Healthcare providers may suggest chemical castration to treat breast cancer in females. Blocking hormones can help treat breast cancer tumors that feed on estrogen and/or progesterone. But chemical castration isn’t a permanent treatment for breast cancer tumors. Providers may recommend removing your ovaries (oophorectomy). Your ovaries help make estrogen and progesterone, which can fuel certain types of breast cancer.

Other names for chemical castration to treat breast cancer include:

• Hormone therapy for breast cancer
• Endocrine therapy

What treatments affect estrogen production or use?

Medications that affect estrogen production or use include:

• Selective estrogen receptor modulators, such as tamoxifen (Nolvadex® or Soltamox®) and toremifene (Fareston®), in pill form
• Selective estrogen receptor degraders, such as fulvestrant (Faslodex®), as an injection
• Aromatase inhibitors, such as anastrozole (Arimidex®), exemestane (Aromasin®) and letrozole (Femara®), as pills

What treatments suppress the ovaries?

Treatments that suppress your ovaries include:

• LHRH analogs, including goserelin and leuprolide, which cause temporary menopause
• Chemotherapy, which may permanently damage your ovaries

What should I expect after a chemical castration?

Chemical castration drugs start working as soon as you start the treatment. They keep working as long as you take them. But over time, prostate cancers may continue to grow, even if your androgen levels are very low (castration-resistant tumors). If you have a castration-resistant tumor, a healthcare provider may recommend different treatments, such as surgically removing your prostate (prostatectomy) or testicles.

After chemical castration, you’ll have a low sex drive (libido) and a reduced response to mental or physical stimulation. For example, you may not get an erection from watching or reading erotic material or touching your genitals and other sensitive parts of your body. You also may not think about sexual intercourse as often.

What are the benefits of chemical castration?

The main benefit of chemical castration is that it’s an effective treatment for certain types of cancer.

Chemical castration also isn’t permanent. Once you finish treatment, your body will continue making hormones as it did before, and your sex drive will return to what it was before treatment.

Is chemical castration reversible?

Chemical castration is generally reversible. But there may be rare cases when it’s permanent. Healthcare providers will review all of the risks or complications with you.

What are the risks or complications of chemical castration?

There are side effects to chemical castration medications for both prostate and breast cancer therapy. Each medication has its own side effect profile that healthcare providers will review with you. But in general, long-term use of chemical castration drugs may result in the following:

• Low sex drive
• Weak bones (osteoporosis)
• Heart disease
• Problems metabolizing fats and sugar
• Depression
• Hot flashes
• Anemia
• Suicidal thoughts (ideation)
• Smaller breast glands
• Larger nipples
• Reduction in body hair
• Reduction in muscle mass

Is castration a painful process?

It depends on how healthcare providers deliver chemical castration drugs to you. You shouldn’t feel any pain if you take pills. But it’s common to feel some discomfort or pain in the injection or implant site. Some people describe it as a stinging sensation. The discomfort or pain doesn’t typically last a long time.

What is the recovery time?

There’s really no recovery time after chemical castration. You should be able to go back to school or work immediately. You can eat and drink what you like. Reach out to a healthcare provider if you have any uncomfortable side effects.

When should I call a healthcare provider?

Call a healthcare provider if you have any signs or symptoms that worry you, including existing symptoms that get worse or new symptoms that appear. In most cases, a provider will give you specific things to look out for. But it’s always a good idea to reach out if you have any questions or issues.

Is chemical castration legal in the U.S.?

Yes, chemical castration is legal in the U.S. as a treatment for certain forms of cancer. Some states and other areas of the world use chemical castration to treat or deter sex offenders.

Can you still get hard after chemical castration?

Yes, it’s still possible to get an erection after chemical castration. But your sex drive will be lower, and your erections may not:

• Be as hard
• Last as long
• Occur as often

What is surgical castration?

Surgical castration is when a surgeon removes your testicles or ovaries to reduce or stop the production of sex hormones.

Is vasectomy a form of castration?

No, vasectomy isn’t a form of castration. Vasectomy is a type of permanent birth control that prevents sperm cells from mixing with your semen and releasing when you ejaculate. It doesn’t affect your hormonal levels, sexual performance or desire.