There are men who wish to become eunuchs in the classical definition. For them, removing the entire penis and testicles can be a remarkably fulfilling, relieving experience, even though they may still identify as male and use male pronouns. In their online enclaves, such people sometimes identify as "eunuchs," "nullos," or "smoothies." In the medical literature, they are referred to as male-to-eunuchs, suffering from their own unique form of gender dysphoria.
Some of them journal their experiences in online forums, asking others around the world where they can go to have their penis and testicles totally removed, or plaintively debating historical research about the iconic eunuchs of China who inhabited the Forbidden City and served the Emperor with great influence and esteem.
Because of the scarcity of providers, the expense, and the taboo nature of the procedure, patients who seek penile amputation have few options. Men who are seeking to nullify their sex often go to great lengths to find someone who is willing to help them. "There are very few surgeons in the world who are comfortable with this," says Dr. Curtis Crane, one of the nation's leading experts on penises. "I've done a few [full penectomies]. We get a few requests a year, and I think it's a good service to provide to the community."
Crane specializes in the treatment of transgender and gender nonconforming patients, providing everything from phalluses for female-to-male patients to vaginas for trans women. He is likely one of the only surgeons in the world who will provide nonbinary male patients with a full penectomy—and this, he says, is because of a social taboo and double standard in transgender medicine.
"I think it's a good service to provide to the community."
For example, Crane says that it is "well accepted" among surgeons who specialize in providing care to trans and gender nonconforming people that there is a subset of assigned-female-at-birth patients who "do not believe in a binary classification." These nonbinary individuals don't identify as men, but they still suffer from gender dysphoria. People in this group commonly "want the absence of female characteristics, such as breasts"—and this procedure is generally accessible for them, even if they don't want to go on Hormone Replacement Therapy, because surgeons who perform trans operations recognize their need.
"It's perfectly acceptable for a lot of us [surgeons] to go, 'OK, let's masculinize your chest even though you aren't fully transitioning,'" Crane says.
"Well, you know, what's good for the goose is good for the gander," he continues. "There are some patients that were born male who don't want to fully convert to becoming female, but they don't identify with their testicles, or they don't identify with their scrotum, or they don't identify with their phallus, but they still feel male; they want masculine pronouns. To me, it's a double standard to accept the gender fluid female, but not the gender fluid male."
A 2014 study by Thomas W. Johnson and Michael S. Irwig explored "the hidden world of self-castration and testicular self-injury," shedding light on the methods that people seeking castration resort to when they don't have access to professional surgical care. Though Johnson and Irwig wrote exclusively on castration, and not penectomy, their analysis of medical data on eunuchs is relevant to the broader group of men who seek these procedures.
The researchers define eunuchs as "biological males who have undergone voluntary castration for reasons other than male-to-female transsexualism," explaining that the taboo nature of these procedures lead "eunuch–wannabes" to "resort to self castration, castration by non-medical professionals, or self-inflicted testicular damage via injections of toxic substances." Because there are so few physicians willing to perform elective penectomies, "eunuch-wannabes" are forced to do it themselves, sometimes using cattle clamps and rings to aid their excision, or to try and find someone else will will perform the procedure for them.
Eunuchs are a secretive subculture. "According to one survey of voluntarily castrated males who identified themselves as eunuchs, only 30 percent and 11 percent had divulged this fact to close friends and family, respectively," Johnson and Irwig's study reads. Many eunuchs seem to identify as male, but others, as Crane indicated, find their identities to be less clearly defined. The study notes that "after castration, less than one-third of eunuchs continue to consider themselves as male, most consider themselves to be nether ale nor female, and a few identify themselves as female."
"What's good for the goose is good for the gander."
Of course, Crane wouldn't provide this treatment to just anyone. He follows a typical standard for patients seeking gender confirming surgeries, requiring two letters from psychiatric specialists who approve of the patient's desire, and need, to be castrated, to have their penis removed, or both. Crane says that, for some people, these treatments are truly medically necessary—which shouldn't be shocking if we can accept the medical necessity of other gender affirmative surgical procedures.
Today, Crane says, it is possible to completely remove both the entire penis and the testicles/scrotum, while rerouting the urethra down to an individual's perineum. Afterwards, patients should be taking hormone supplements. "It's not good to have no sex hormones. You get depressed; you get osteoporosis; you have no sex drive. You need either estrogen or testosterone." Most of Crane's patients begin taking a regimen of testosterone injections after their penis and testicles has been severed.
To some critics, the idea of removing an organ responsible for the primary production of testosterone in the male body, only to begin taking testosterone supplements, is illogical. However, Crane says that this is simply a misunderstanding of who these patients are, and what they need. "They don't identify with that body part—it's not that they want to have osteoporosis and be depressed. Fortunately there's a way to remove that body part and still fulfill the [body's necessary hormonal] function."
Crane says that most of patients who have this surgery live their lives as men and then, after having their penis and testicles removed, leave to continue living their lives more or less the same way. The outside world likely will never have any idea that these individuals have no genitalia.
Though the patients who seek a radical penectomy and orchiectomy vary, Dr. Curtis Crane says that they're "kind of their own category" within our classifications of known gender identities. It's just that we have not yet accepted them. "Society has a lot of issues with men wanting to castrate themselves or remove their penis," Crane said. "They just don't like it."