Chemical castration

Overview

Chemical castration, also referred to as medical castration, involves the administration of chemicals or medications to halt the production of sex hormones. While commonly recognized as a method to prevent sexual offenses, medical castration serves as a treatment for tumors dependent on sex hormones. This therapy, also known as hormone therapy, can be employed in the management of breast cancer and prostate cancer.

Risks

Generally, use of any medicine has an adverse effect. This include medication used in hormone therapy for breast cancer and prostate cancer. Potential side effects include:

  • Osteoporosis
  • Cardiovascular disease
  • A decline in sexual desire, or libido
  • Hot flashes
  • Issues with the metabolism of sugar and lipids
  • Anemia
  • Depression

Before the procedure

Before recommending chemical castration, your healthcare provider will evaluate whether your cancer type is responsive to hormone therapy.

For instance, to decrease testosterone levels, they might suggest an orchiectomy, a surgical procedure involving the permanent removal of one or both testicles. Another surgical option is a subcapsular orchiectomy, which selectively removes the testosterone-producing tissue.

During the procedure

With chemical castration, several medications may be used to stop sex hormone production. These medications also vary depending on the condition being treated.

  • Prostate cancer: Hormone therapy for prostate cancer, also called, androgen deprivation therapy aims to reduce the production of androgens and prevent them from stimulating cancer growth.

This hormone therapy is achieved by decreasing androgen production in the testicles, blocking androgen action in the body, or halting androgen production in other locations.

Chemical castration medications used for prostate cancer treatment include:

    • Gonadotrophin-releasing hormone (GnRH) agonists or GnRH analogs: Also known as luteinizing-hormone releasing hormone (LHRH) agonists or LHRH analogs. These medications inhibit the pituitary gland from releasing luteinizing hormone, which signals the testicles to produce testosterone. Initially, these drugs cause a surge in hormone levels, known as a testosterone flare, which is eventually suppressed. To manage the side effects of this initial surge, antiandrogen therapy may be prescribed concurrently. These medications are administered through injections or implants under the skin. The following drugs in this category are available in the U.S.: Goserelin, Histrelin, Leuprolide, Triptorelin.
    • Antiandrogen treatments: Also known as complete androgen blockage, these medications are typically combined with androgen deprivation therapy (ADT). These drugs, which include flutamide, bicalutamide, apalutamide, nilutamide, enzalutamide, and darolutamide block the body from using androgens and are often used when ADT is no longer effective on its own.
    • Androgen synthesis inhibitors: These inhibitors, taken as pills, include aminoglutethimide, ketoconazole, and abiraterone. These drugs prevent the production of androgens throughout the body by blocking an enzyme called CYP17, which is essential for making testosterone in any tissue, including prostate cancer cells.
    • GnRH antagonists or LHRH antagonists: Medications of this type include degarelix, an injection, and relugolix, a pill. They prevent testosterone production without causing a flare and are used to treat advanced prostate cancer.
  • Breast cancer: Although not permanent like oophorectomy, which involves the removal of ovaries, hormone therapy is a strategy utilized for individuals with breast cancer tumors that rely on estrogen and/or progesterone for growth. This therapy, also known as endocrine therapy, works by blocking hormones.

Treatments are often categorized into two:

    • Medications that inhibit the ovaries: Chemotherapy medications can damage the ovaries, potentially causing permanent suppression of their function. While luteinizing hormone-releasing hormone (LHRH) analogs, such as goserelin and leuprolide, can induce temporary menopause.
    • Medications that influence the production or utilization of estrogen: Selective estrogen receptor modulators like tamoxifen and toremifene are available in pill form, while selective estrogen receptor degraders such as fulvestrant are administered via injection. Additionally, aromatase inhibitors like anastrozole, exemestane, and letrozole are also taken orally.

Outcome

Chemical castration, despite its effectiveness in treating specific cancer types, is not a permanent procedure. As with all medical interventions, there are potential complications or risks. It’s crucial to monitor for symptoms, whether they exacerbate existing conditions or present new concerns. If side effects become intolerable, consulting a healthcare provider is advisable.

Typically, after undergoing chemical castration, there is minimal downtime, enabling individuals to promptly resume their daily activities, including work or school, and maintain their regular diet.