You or someone close to you may have been a little taken aback when your doctor told you about a treatment called 'Chemical Castration'. When we hear the word 'castration', something completely different comes to mind. But don't be afraid. This is not a surgical removal of the genitals as you might think. This is a very important treatment method that uses drugs, that is, medications, to control some types of cancer. Today, we will talk about this in a simple and friendly way.
Simply put, what is Chemical Castration?
Simply put, chemical castration is the process of stopping or greatly reducing the production of sex hormones in our body through medication.
Now think about it, the hormones in our bodies are like messengers. These hormones are released into the bloodstream from different glands. These messengers travel throughout the body and tell various organs to "do this." For example, these hormones affect things like controlling our energy, growth, and mood. Sex hormones are a special type of hormone. They are essential for things like puberty and the functioning of the reproductive system.
But, sometimes there is a problem. Some types of cancer, especially prostate cancer and some types of breast cancer, use these sex hormones as "food". That is, as long as these hormones are present, the cancer cells grow well. So, chemical castration treatment cuts off the "food" that the cancer gets, that is, the supply of hormones. Then the growth of the cancer stops or is largely controlled.
Several other names are used for this. For example:
- Hormone Therapy
- Androgen Deprivation Therapy
What are the uses of this treatment?
Doctors mainly use this therapy to treat tumors that are dependent on sex hormones.
Speaking of men, the main group of sex hormones produced in our bodies are androgens . Although these are also produced in women's bodies to some extent, they are found in the majority in men's bodies. Testosterone is the main androgen hormone that you have probably heard of. This hormone is essential for the growth and function of the prostate gland. However, when prostate cancer occurs, the cancer cells also use this testosterone to grow. That is when treatment to reduce this hormone is needed.
In women's breast cancer, some types of cancer depend on the hormones estrogen and progesterone . Treatments that control these hormones are used for such cancers as well.
What do you do before starting treatment?
Before your doctor prescribes this treatment for you, he or she will need to know exactly whether your type of cancer will respond well to hormone therapy. This will require several tests.
- CT scan
- PET scan
- Endoscopy
- Biopsy - taking a piece of tissue for examination
- Cancer-related blood tests
The important thing is that this treatment is not permanent. That is, after stopping the medication, hormone production returns to normal. However, sometimes the doctor may also talk about a permanent solution. That is a surgery called orchiectomy . That is, the surgical removal of one or both testicles. This permanently reduces testosterone levels.
Treatment method and medications used
This is not a one-time treatment. This is an ongoing treatment. The way the medication is given is also different.
- Injections: The most commonly used method.
- Implants: A small device is placed under the skin.
- Pills: Some medications are available in pill form.
Depending on the type of medication and dosage, you may need to repeat this treatment once a month, once every three months, or once a year.
The table below lists some of the main classes of drugs used to treat prostate cancer. The names are a bit complicated, but this should help you get a rough idea.
| Drug category | How it works and examples |
|---|---|
| GnRH agonists | These affect the pituitary gland and stop the signal to the testicles to make testosterone. Initially, hormone levels may increase slightly (testosterone flare). For example: Goserelin, Leuprolide. |
| GnRH antagonists | These stop testosterone production without increasing the hormones mentioned above. For example: Degarelix. |
| Antiandrogen treatments | These block the androgen hormones produced in the body so that cancer cells cannot use them. For example: Bicalutamide, Enzalutamide. |
| Androgen synthesis inhibitors | These stop the production of androgens anywhere in the body, not just in the testicles. For example: Abiraterone. |
What are the advantages, disadvantages, and side effects of this treatment?
Like any treatment, this has both benefits and side effects.
Main advantages
- Cancer Control: The main advantage of this is that it is a very effective way to control hormone-dependent cancers.
- Reversible: This is a big advantage. It is not permanent like surgery. After you stop treatment, your body's hormone levels and sexual function will gradually return to normal.
Possible side effects
Some side effects may occur when taking this treatment for a long time. However, your doctor will discuss all of these with you and give you the necessary advice to manage them.
- Low sex drive/libido
- Hot flashes
- Osteoporosis
- Problems with fat and sugar metabolism in the body
- Depression
- Decreased body mass
- Anemia
- Laboriousness
Is this painful? Taking the pills is not painful. However, when you get an injection or an implant, you may feel a little pain or burning. But that usually goes away after a while.
Some frequently asked questions
Is this like surgical castration?
No. Surgical castration is the permanent removal of the testicles or ovaries. Chemical castration is the temporary cessation of hormone production using medication. Once the medication is stopped, hormone production resumes.
Is this what a vasectomy is for?
Absolutely not. A vasectomy is a permanent birth control method for men. It only stops the ejaculation of semen. It has no effect on your hormone levels, sex drive, or sexual function.
Can I have sex after treatment?
Yes. But you may feel less sexual desire and less desire to have sex. Also, your erections may not be as hard, last as long, or come as often as they used to. Talk to your doctor about this openly.
Take-Home Message
- 'Chemical castration' is a scary name, but it refers to a drug treatment for hormone-dependent cancers.
- This is not a permanent surgery. Body function will most likely return to normal after treatment is stopped.
- This reduces the levels of sex hormones that help cancer cells grow.
- Side effects may occur, but your doctor will help you manage them.
- Feel free to talk to your doctor about any fears, doubts, or concerns you may have. It is your right.
👩🏽⚕️ Additional questions (FAQs)
💬 What is Heavy Menstrual Bleeding / Menorrhagia?
Heavy Menstrual Bleeding is a dangerous condition where the amount of blood that comes out during a normal menstrual period is about 30-40 ml, but if it is double/triple (more than 80 mL), you have to change your pad/tampon every hour, if you have large blood clots (larger than a rupee coin), and if you bleed for more than 7 days, this can lead to anemia and the patient may become seriously ill!
💬 What are the main causes of menstrual bleeding (Menorrhagia)?
There are 4 main causes of this: 1) 'Uterine Fibroids' - Although these are non-cancerous tumors, they cause the uterus to not contract and cause heavy bleeding (this is the most common cause). 2) Endometrial Polyps and Adenomyosis. 3) Hormonal imbalance (PCOS/thyroid). 4) Small family planning loops (IUDs) and the most dangerous cause: 'Endometrial/Cervical Cancer'.
💬 When bleeding heavily during menstruation, what are the 'life-threatening/emergency situations' that require immediate hospitalization/show to a VOG without taking medication from the pharmacy?
If you bleed more than usual for a day or two, you can show it to a VOG (gynecologist) in a few weeks (for an ultrasound scan). But the biggest danger! 1) If this bleeding causes 'severe anemia / hypovolemic shock', 2) If you have unbearable abdominal pain (severe pelvic pain), 3) If a pregnant woman bleeds like this (miscarriage / ectopic), the uterus can burst and the patient can die, so she needs to be hospitalized immediately!
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