It is difficult to put into words the fear and anxiety we feel when we learn that we have cancer. But thanks to the advanced medical science that has come to us today, there are very effective treatments for cancer. Did you know, there are some types of cancer that grow by "feeding" our own body's own chemicals called hormones? When treating such cancer, controlling the production of those hormones is very important. Today we are going to talk about one such special treatment. The name is 'Chemical Castration'. Although the name may sound a little scary, this is actually a treatment that brings relief to many cancer patients.
Simply put, what is Chemical Castration?
Okay, let's explain this simply. 'Chemical Castration' is the use of drugs or chemicals to stop the production of sex hormones in our body. These hormones are released into the bloodstream by various glands in our body. These hormones control many things in our body; things like energy, growth, and mood. Sex hormones are especially essential for things like puberty and reproductive health.
However, some types of cancer, such as prostate cancer and some types of breast cancer, depend on these sex hormones to grow. Just as a plant needs water to grow, these cancer cells need hormones to grow. So, Chemical Castration treatment reduces the amount of these sex hormones in the body. Then the cancer cells lose the "food" they need, and their growth stops or slows down.
There are several other names used for this treatment. When you hear them, this will become clearer to you:
- Medical Castration
- Hormone Therapy
- Androgen Depressive/Deprivation/Suppression Therapy
All of these names mean the same thing: they reduce the level of sex hormones in the body.
What conditions is this treatment used for?
Doctors mainly use this treatment for tumors that are dependent on sex hormones, specifically:
- Prostate Cancer: This cancer in men is often caused by the male hormone testosterone.
- Breast Cancer: The female hormones estrogen and progesterone influence the growth of some types of breast cancer in women.
- Male Breast Cancer: Although this is rare, hormone therapy is also used for this.
Another common name for sex hormones is androgens . Everyone produces androgens in their bodies, but men produce more of them. Testosterone is a major androgen. This hormone is essential for the growth and function of the prostate gland. When cancer develops, this hormone also drives the cancer to grow.
What happens before treatment starts?
Before your doctor recommends hormone therapy, they need to know exactly whether your type of cancer will respond well to it. This will involve several tests. These tests can determine the type of cancer and the stage at which it has spread.
Some of the tests performed for this purpose are:
- CT scan
- PET scan
- Endoscopy
- Biopsy - Taking a small sample of cancer cells for examination.
- Blood tests for cancer
In some cases, especially if you want to permanently lower your testosterone levels, your doctor may discuss a surgical procedure called an orchiectomy . This involves surgically removing one or both testicles. This is a permanent solution. Another option is surgery to remove only the tissue that makes testosterone. However, what we are talking about here is chemical castration, not surgery. It is a temporary treatment with medication.
What happens during treatment?
This is not a one-time treatment. This is a continuous process. Usually, your doctor will give you these medications as an injection or as a small device placed under your skin (implant). However, some medications are also available as pills.
Depending on the type and dosage of medication you are given, you may need to repeat this treatment once a month, once every three months, or once a year.
When treating prostate cancer, there are several ways in which this medication works:
- It reduces the production of androgens (especially testosterone) from the testicles.
- It blocks the ability of androgens in the body to bind to and work with cancer cells.
- It stops the production of androgens from other parts of the body (not just the testicles).
What medications are used for this?
There are several main classes of drugs used for prostate cancer. Let's take a closer look at them.
| Drug category | How it works simply | Examples (brand names of medicines) |
|---|---|---|
| GnRH Agonists | These first cause a sudden increase in testosterone levels (a testosterone flare). Then the body begins to ignore the signal to produce the hormone. After a few days, testosterone production almost stops completely. | Goserelin (Zoladex®), Leuprolide (Lupron®), Triptorelin (Trelstar®) |
| GnRH Antagonists | This medication does not suddenly increase hormone levels like the previous type. It directly stops the production of testosterone. Therefore, the 'Testosterone Flare' does not occur. | Degarelix (Firmagon®), Relugolix (Orgovyx®) |
| Anti-androgen Treatments | Rather than stopping hormone production, these prevent the androgen hormones in the body from binding to cancer cells. In other words, there is a key, but the lock (receptor) that it fits into is blocked. | Bicalutamide (Casodex®), Enzalutamide (Xtandi®), Apalutamide (Erleada®) |
| Androgen Synthesis Inhibitors | This medication stops the production of androgens anywhere in the body (testicles, adrenal glands, even cancer cells). | Abiraterone (Zytiga®), Ketoconazole (Nizoral®) |
Is this method also used for breast cancer?
Yes. Doctors also recommend this hormone therapy for breast cancer that is estrogen and/or progesterone-dependent. It works by blocking the production of female hormones or stopping them from acting on cancer cells. There are different types of medications for this as well:
- Medications like Tamoxifen work by stopping the hormone estrogen from attaching to cancer cells.
- Aromatase inhibitors (e.g. Anastrozole, Letrozole) work by blocking an enzyme that produces estrogen in the body.
- Medications like Goserelin and Leuprolide (also used for prostate cancer) temporarily stop the ovaries from working and reduce estrogen production. This is like a temporary menopause.
What can you expect after treatment?
These medications start working as soon as you start taking them. They have an effect as long as you take them.
The main effect is a decrease in sex drive/libido. The response to mental or physical stimulation may be reduced. For example, the frequency of thoughts about sex may decrease.
But the most important thing here is the main advantage of this. Chemical Castration is not permanent. It is reversible.
After you stop treatment, your body starts producing hormones again. Along with this, your sex drive returns to its previous level. This is the biggest advantage of this over surgical removal of the testicles or ovaries.
Are there any risks and side effects to this treatment?
Like any medication, hormone therapy can have side effects. Not everyone gets all of them. And the severity of these effects varies from person to person. Your doctor will talk to you about the side effects of the medication you are taking.
In general, these are some of the common side effects that can occur when taking this treatment for a long time:
- Low sex drive
- Sudden feeling of heat in the body (Hot flashes)
- Osteoporosis
- Reduction in muscle mass
- Increased body fat deposition
- Increased risk of heart disease
- Depression or mood swings
- Anemia
- Decreased body hair
- Smaller breast glands in men
Don't be alarmed by these side effects. Many of them can be managed. For example, your doctor may recommend calcium and vitamin D supplements and exercise to help with bone weakness. So it's important to be open with your doctor about any discomfort you may be experiencing.
Some frequently asked questions
Is this a painful treatment?
If you take the medicine as a pill, there is no pain. If you take it as an injection, you may feel a little pain or burning when the injection is given. But it usually doesn't last long.
Is it possible to have an erection after treatment?
Yes, arousal can occur. But because of low sexual desire, it may not happen as often as before. And the nature of the arousal may also change.
- Not as strong as before
- Inability to maintain for long periods of time
- Decreased frequency of occurrence
Is vasectomy also a type of castration?
No. Not at all. A vasectomy is a form of birth control. It only prevents sperm from coming out of the penis with semen. It has no effect on your hormone levels, sexual desire, or sexual function.
The most important thing is that cancer treatment is a journey. It's normal to have questions, concerns, and fears during this journey. Talk about all of these with your doctor. If necessary, you can also seek services like counseling. You are not alone.
Take-Home Message
- Chemical castration is not a surgical procedure. It is a cancer treatment that uses medication to temporarily stop the body's production of sex hormones.
- This is mainly used for prostate cancer and some types of breast cancer.
- One of the biggest advantages of this treatment is that it is reversible . Once the medication is stopped, hormone levels return to normal.
- Side effects such as decreased sexual desire, hot flashes, and bone weakness may occur, but your doctor can help you manage them.
- Talk openly with your doctor about any questions, concerns, or fears you may have. Accurate information and support are very important during this journey.
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