Emasculation

Emasculation is the removal of the external male sex organs, which includes both the penis and the scrotum, the latter of which contains the testicles. It is distinct from castration, where only the testicles are removed. Although the terms are sometimes used interchangeably, the potential medical consequences of emasculation are more extensive due to the complications arising from the removal of the penis.^[1] There are a range of religious, cultural, punitive, and personal reasons why someone may choose to emasculate themselves or another person.

The term emasculation may be used in a metaphorical sense, referring to the perceived loss of attributes traditionally associated with masculinity, such as strength, power, or autonomy.

There are several different methods of emasculation. Both the penis and testicles may be removed simultaneously using a sharp instrument, such as a knife or razor or swords.^[2][3] Non-crushing vascular clamps may also be used in medical surgery to cut off blood circulation and reduce bleeding.^[4]

Alternatively, the penis and testicles may be removed during a series of stages. Medical surgeons use this method when performing surgery on trans women who want their genitals removed over multiple sex reassignment surgeries (male-to-female), rather than in a single operation.^[5] In these surgeries, the tissue is used and re-shaped into the neo-vagina and vulva.

Short-term consequences of emasculation include bleeding^[6] and infection.^[7] Historically, death was also a potential complication, although the prevalence is disputed.^[8]

Long term complications include incontinence,^[9] urethral stricture,^[10] urine retention,^[11] urinary tract infection,^[12] urine extravasation^[7] and bladder stones.^[13] Some studies have found that emasculation may cause a range of physiological changes, such as a shortened torso,^[14] widened stomach and hips,^[15] increased height, bowed legs,^[14] and an elongated skull.^[14] Additionally, emasculates typically have less or no facial and body hair,^[16] increased fatty tissue or gynecomastia,^[16] and a feminine fat pattern distribution.^[17] The physiological effects of emasculation are more severe for people who undergo the procedure before the onset of puberty.^[18]

Emasculation was performed in China on men to create palace eunuchs for the imperial court.^[19] The practice dates back to the Shang dynasty (1600–1046 BC)^[20] and continued up until 1924,^[21] when the eunuch system was abolished by the last emperor of China, Puyi.^[22] The last living palace eunuch, Sun Yaoting, died in 1996.^[23]

Originally, palace eunuchs were prisoners who were involuntarily emasculated. In the Qing dynasty, men began volunteering to undergo the procedure in order to gain employment, although instances of forced emasculation still occurred.^[24] One reason why recipients willingly underwent emasculation is that they saw employment as a palace eunuch as a way to acquire wealth and power. Alternatively, poverty was a reason why fathers forced their sons to undergo emasculation, and the desire for financial benefit motivated human traffickers to force emasculation on their victims.^[25]

There were several reasons why the Imperial court required its civil servants to be emasculated. Emasculation was thought to ensure a recipient's undivided loyalty to the emperor, as it severs the recipient's existing familial or social bonds and destroys their ability to produce future heirs.^[26] The choice to hire emasculated eunuchs also ensured the legitimacy of the emperor's lineage.^[27] The choice to emasculate, rather than merely castrate, was motivated by a desire to protect the chastity of women in the court, as emasculation rendered a recipient physically incapable of having sex.^[28] While emasculation was a pre-requisite for gaining employment as a palace eunuch, it did not guarantee employment.^[29]

The emasculation procedure was typically performed by a trained 'knifer', or 'knife expert'.^[30] To prepare for the operation, the recipient was bathed in cold water to numb his senses and, in some instances, his genitals were twisted to reduce blood flow.^[31] The recipient was then asked if he consented to the procedure, and if he answered yes the knifer excised the genitals with a single cut.^[32] Styptic powder was then applied to the wound to stop bleeding, and a pewter needle or spigot was inserted into the urethra to prevent stenosis (narrowing).^[33]

Some Chinese emasculates were the great historian Sima Qian, Cao Teng, the foster grandfather of Cao Cao, Zheng He, a Ming dynasty admiral of the imperial navy who sailed to Africa, and the surviving sons and grandson of rebel Yaqub Beg.^[34]

To create eunuchs for the Arab slave trade, young black boys from South East Africa typically had their penis and scrotum amputated.^[35] White boys, by comparison, were usually only castrated.^[35]

Emasculation was one form of genital mutilation practiced by the Skoptsy, a Russian Christian sect. For males, the other form of mutilation available was castration. Females could remove their nipples, breasts, labia majora, labia minora or clitoris.^[36] These practices may have begun sometime during the 1760s, after the sect was founded by Kondratii Selivanov, although they were only discovered by the broader community in 1772.^[37] They continued up until the 1930s, when the sect was destroyed and its members sentenced.^[38]

The Skoptsy practiced genital mutilation because they believed the genitals were the source of original sin, and that by removing them, they could attain salvation.^[39] The aim of removing the offending genitalia was to purify the body.^[40] Their belief was based on a literal reading of the verse of Matthew 19:12, which states: "There are some eunuchs, which were so born from their mother's womb: and there are some eunuchs, which were made eunuchs of men: and there be eunuchs, which have made themselves eunuchs for the kingdom of heaven's sake."^[41] In addition, the verses of Matthew 18:8,9 and Luke 23:29 were also cited as support.^[42] Of the two types of genital mutilation available to men, emasculation was called the Greater Seal. Castration, by comparison, was called the Lesser Seal.^[43] Emasculation was preferable because it rendered a recipient physically incapable of engaging in sinful sexual conduct, allowing them to attain a higher level of purity.

Originally, the emasculation procedure was performed by burning the testicles off with an iron.^[44] Later, the genitals were tied at the base and removed using a knife or razor blade. The wound was then cauterised, or a salve was applied, to prevent bleeding. Many Skoptsy were peasants and were familiar with animal husbandry, which meant their emasculation procedures were often performed with "surgical precision."^[45] In some instances, members of the Skoptsy would perform the emasculation on themselves, in an act of self-surgery, though it was more typical for the procedure to be performed by an elder during a ceremony.^[36]

Throughout the Indian subcontinent tradition, including India, Bangladesh and Pakistan, some members of the Hijra community reportedly undergo emasculation, or nirvan.^[46]

Traditionally, emasculation was a rite of passage into the Hijra community.^[47] Today it remains an important ritual, though is not mandatory or universally practiced.^[48] When it is performed, it typically occurs several years after an individual has already participated within the Hijra community. While some Hijra are emasculated, others are intersex, undeveloped in puberty or impotent.^[49]

Whether or not a Hijra undergoes emasculation is influenced by a range of considerations. Some people are not emasculated because they are fearful of surgical complications, are under financial constraints, or merely as a matter of personal choice.^[50] For Muslim Hijra, emasculation may be avoided due to the belief that genital mutilation goes against Allah's will.^[51] Others see emasculation as necessary in order to be 'reborn' as a Hijra. In this view, emasculated Hijra are seen as more 'real' than those who are not.^[52] The decision to be emasculated may also be motivated by personal beliefs about whether a Hijra can have spiritual powers without undergoing the procedure. Amongst members of the Hijra community, this issue is subject to considerable debate.^[51]

In the past, the emasculation procedure was performed by barbers or by the individual themselves (i.e. self-emasculation).^[53] Nowadays, the operation is performed by a Hijra elder, also called a dai ma (midwife).^[54] They have no medical training, but believe they operate with the power of the patron goddess, Bahuchara Mata.^[55] The operation takes place early in the morning, around 3 a.m. or 4 a.m.^[55] Anesthesia is not administered. ^[56] The penis and testes are tied together with a string, and the elder then makes two diagonal cuts with a sharp surgical knife to completely excise the organs.^[57] The elder allows the blood to gush from the wound, which is considered necessary to completely cleanse the recipient of their male parts. This is one reason why the procedure is performed by an elder rather than a medical professional, who might try to stop the haemorrhage, thus interfering with the ritual's cleansing effect.^[58] Afterwards, no stitches are taken and the wound is left exposed, although a small stick is inserted into the urethra to prevent urethral stricture.^[59]

Emasculation was one of the Five Punishments used in ancient China.^[60] It was the prescribed punishment for people who engaged in licentious conduct, such as infidelity or rape.^[61] The first evidence of its use dates to the Shang dynasty (1700–1100 BC), when the characters for a knife and male genitalia were carved into oracle bones. It continued up until the Sui dynasty (581–618 CE), when it was formally abolished.^[62]

There are reports of self-emasculation cases resulting from mental disorder. Some academics claim that a majority of self-emasculations are a result of psychosis,^[63] although this finding has been challenged.^[64] Nonetheless, there are several reported cases of people with schizophrenia engaging in self-emasculation. ^[65]

It has been linked to other mental disorders such as dissociative identity disorder.^[66]

Klingsor syndrome, sometimes known as Skotpic syndrome is a condition where people mutilate their genitals as a result of psychotic religious delusions. ^[67] For example, in one case a person is reported to have mutilated his genitals after experiencing auditory hallucinations telling him he would only be allowed into the kingdom of heaven if he emasculated himself.^[68]

Body integrity dysphoria, or xenomelia, is another mental disorder that may drive a person to seek emasculation.^[69] People with this disorder are distressed by the presence of a limb that they do not identify as part of their body, including the genitals. Emasculation in this context alleviates their distress, enabling them to become 'whole'.^[70] However, the amputation of healthy limbs by medical professionals is highly controversial. The inability to acquire medically administered emasculation has driven some to self-emasculation.^[71]

Occasionally, self-emasculation is practiced by those suffering from gender dysphoria.^[72] When compared with the general population, transgender persons are at a higher risk of engaging in acts of genital self-mutilation, including self-emasculation.^[73]

In some cases, a person with a mental illness has emasculated other people.^[74]

Emasculation occurs voluntarily within the transgender community as a form of gender reassignment surgery, allowing recipients to renounce their masculine characteristics and bring their body into closer alignment with their identified gender. It may be sought by trans women (those assigned male at birth who identify as female), who wish to assume their femininity, or by non-binary transgender individuals (those assigned male at birth who identify as neither male nor female), who want to locate themselves outside of traditional gender categories.^[75]

For trans women, emasculation surgery may be performed with or without the creation of a vagina. When a vagina is created, the procedure is called a vaginoplasty,^[76] and where it is not, the procedure is called a vulvoplasty.^[77]

For non-binary transgender people, the purpose of emasculation is to make the body less congruent with one's assigned sex without the subsequent assumption of femininity. ^[78] These individuals may identify as non-binary, a third-sex, eunuch, or another gender. Some adopt the term 'nullo', meaning someone whose gender has been nullified.^[79]

In some circumstances, a person may be emasculated involuntarily as the result of an accident,^[80] as part of a ritual attack,^[81] or due to poor circumcision practice.^[82]

In these cases, the objective of medical treatment is different than for cases of voluntary emasculation. The goals of treatment are to either reattach the severed genitals or to reconstruct an artificial penis and testes.^[83]

From 1960 to 2000, involuntarily emasculated infants were surgically reassigned female, similar to the treatment received by David Reimer after his penis was burnt off during a circumcision procedure. It is now understood from cases like Reimer's that gender reassignment surgery in infancy can interfere with gender identity formation. Therefore, gender reassignment is no longer the standard practice for involuntarily emasculated infants.^[84]

Look up emasculation in Wiktionary, the free dictionary.

By extension, the word emasculation has also come to mean rendering a male less masculine, including by humiliation. It can also mean to deprive anything of vigour or effectiveness. This figurative usage has become more common than the literal meaning. For example: "William Lewis Hughes voted for Folkestone's amendment to Curwen's emasculated reform bill, 12 June 1809 ... "^[85]

In horticulture, the removal of male (pollen) parts of a plant, largely for controlled pollination and breeding purposes, is also called emasculation.^[86]

• Penis removal
• Genital modification and mutilation
• Castration anxiety
• Eunuch
• Feminization (sociology)
• Masculinity

• Apeiranthitou, Vasiliki; Thomas, George; Louka, Penelope (16 May 2019). "Gender dysphoria: A critical discussion of the understanding and treatment of gender dysphoria". Dialogues in Clinical Neuroscience & Mental Health. 2 (1): 72–80. doi:10.26386/obrela.v2i1.110.
• Bellringer, J (2017a). "Surgery for Bodies Commonly Gendered as Male". In Richard, C; Bouman, W P; Barker, M (eds.). Genderqueer and Non-Binary Genders. London: Palgrave Macmillan UK. pp. 247–263. doi:10.1057/978-1-137-51053-2_12. ISBN 978-1-137-51052-5.
• Bellringer, J (2017b). "Genital surgery". In Barrett, J (ed.). Transsexual and Other Disorders of Gender Identity: A Practical Guide to Management. Oxford, UK: Radcliffe Publishing. pp. 209–220. ISBN 9781498793131.
• Bullough, Vern L. (2001). "Sterilization". Encyclopedia of birth control. ABC-CLIO. ISBN 978-1-57607-181-6.
• Chatterton, Jocelyn; Bultitude, Matthew (2008). "Castration; The eunuchs of Qing dynasty China; A Medical and Historical Review". De Historia Urologie Europace. 15: 39–47.
• Chauhan, VinaySingh; Yadav, Prateek; Goyal, Sunil; Khan, SahabazAli (2016). "Two cases of male genital self-mutilation". Industrial Psychiatry Journal. 25 (2): 228–231. doi:10.4103/0972-6748.207854. PMC 5479100. PMID 28659706.
• Chen, Mang L.; Reyblat, Polina; Poh, Melissa M.; Chi, Amanda C. (June 2019). "Overview of surgical techniques in gender-affirming genital surgery". Translational Andrology and Urology. 8 (3): 191–208. doi:10.21037/tau.2019.06.19. PMC 6626317. PMID 31380226.
• Chiang, H (2012). Chiang, H (ed.). Transgender China. New York: Palgrave Macmillan. ISBN 978-1-349-34320-1.
• Coleman, Eli; Cesnik, John (April 1990). "Skoptic Syndrome: The Treatment of an Obsessional Gender Dysphoria with Lithium Carbonate and Psychotherapy". American Journal of Psychotherapy. 44 (2): 204–217. doi:10.1176/appi.psychotherapy.1990.44.2.204. PMID 2114800.
• Dale, M. S. (1 April 2010). "Understanding Emasculation: Western Medical Perspectives on Chinese Eunuchs". Social History of Medicine. 23 (1): 38–55. doi:10.1093/shm/hkp139.
• Dale, M S (2018). Inside the World of the Eunuch A Social History of the Emperor's Servants in Qing China. Hong Kong: Hong Kong University Press. ISBN 978-988-8455-75-1.
• DeMello, M (2007). Encyclopedia of Body Adornment. California, US: ABC-CLIO. ISBN 9780313336959.
• Donnelly-Boylen, Kevin (October 2016). "Gender dysphoria, serious mental illness, and genital self-mutilation: A case report". Journal of Gay & Lesbian Mental Health. 20 (4): 376–381. doi:10.1080/19359705.2016.1209395. S2CID 147777077.
• Emeliantseva, Ekaterina (2009). "Icons, portraits, or types? Photographic images of the Skoptsy in late Imperial Russia (1880-1917)". Jahrbücher für Geschichte Osteuropas. 57 (2): 189–204. doi:10.25162/jgo-2009-0009. JSTOR 41052249. S2CID 152152285.
• Engelstein, L (1997). "From Heresy to Harm: Self-Castrators in the Civic Discourse of Late Tsarist Russia". In Teruyuki, H; Kimitaka, M (eds.). Empire and Society: New Approaches to Russian History. Hokkaido, Japan: Slavic Research Center, Hokkaido University. pp. 1–22.
• Engelstein, L (1999). Castration and the Heavenly Kingdom: A Russian Folktale. Ithaca, London: Cornell University Press.
• Evens, Starling C.; Whittle, Tom; Rous, Stephen N. (November 1977). "Self-Emasculation: Review of the Literature, Report of a Case and Outline of the Objectives of Management". Journal of Urology. 118 (5): 775–776. doi:10.1016/s0022-5347(17)58190-2. PMID 916099.
• Gearhart, John P.; Rock, John A. (September 1989). "Total Ablation of the Penis After Circumcision with Electrocautery: A Method of Management and Longterm Followup". Journal of Urology. 142 (3): 799–801. doi:10.1016/s0022-5347(17)38893-6. PMID 2769863.
• Goldberg, B Z (1930). The Sacred Fire: The Story of Sex in Religion. Norwich, UK: Jarrold Publishing.
• Hedhly, A; Hormaza, J I; Herrero, M (2009). "Flower emasculation accelerates ovule degeneration and reduces fruit set in sweet cherry". Scientia Horticulturae. 119 (4): 455–457. Bibcode:2009ScHor.119..455H. doi:10.1016/j.scienta.2008.08.020.
• Hoeckelmann, Michael (21 June 2019). "To Rot and Not to Die: Punitive Emasculation in Early and Medieval China" (PDF). T'oung Pao. 105 (1–2): 1–42. doi:10.1163/15685322-10512p01. hdl:20.500.11820/a903bc02-1c0e-4e1f-8b6b-caf5a8eaf49b. S2CID 198643536.
• Hossain, Adnan (December 2012). "Beyond Emasculation: Being Muslim and Becoming Hijra in South Asia". Asian Studies Review. 36 (4): 495–513. doi:10.1080/10357823.2012.739994. S2CID 143636760.
• Hossain, Adnan (2 December 2017). "The paradox of recognition: hijra , third gender and sexual rights in Bangladesh". Culture, Health & Sexuality. 19 (12): 1418–1431. doi:10.1080/13691058.2017.1317831. hdl:11245.1/4b35820e-309a-4ecf-be63-e618467cb19b. PMID 28498049. S2CID 5372595.
• Jackowich, Robyn A.; Vale, Rachel; Vale, Kayla; Wassersug, Richard J.; Johnson, Thomas W. (August 2014). "Voluntary Genital Ablations: Contrasting the Cutters and Their Clients". Sexual Medicine. 2 (3): 121–132. doi:10.1002/sm2.33. PMC 4184492. PMID 25356309.
• Johnson, Thomas W.; Wassersug, Richard J. (June 2010). "Gender Identity Disorder Outside the Binary: When Gender Identity Disorder-Not Otherwise Specified Is Not Good Enough". Archives of Sexual Behavior. 39 (3): 597–598. doi:10.1007/s10508-010-9608-1. PMID 20182785. S2CID 412586.
• Johnson, Thomas W.; Wassersug, Richard J.; Roberts, Lesley F.; Sutherland, Michelle Brett; First, Michael B. (February 2010). "Desire for Castration Is Not a Body Integrity Identity Disorder (BIID): A Response". The Journal of Sexual Medicine. 7 (2): 853–855. doi:10.1111/j.1743-6109.2009.01603.x.
• Kaggwa, Sam; Galukande, Moses (December 2014). "Male genital mutilation (amputation) and its complications: a case report". BMC Research Notes. 7 (1): 519. doi:10.1186/1756-0500-7-519. PMC 4266893. PMID 25112277.
• Kenyon, Herbert R.; Hyman, RM (17 January 1953). "Total autoemasculation; report of three cases". Journal of the American Medical Association. 151 (3): 207–210. doi:10.1001/jama.1953.02940030041010a. PMID 12999539.
• Khan, Shahnaz (June 2016). "What is in a Name? Khwaja Sara, Hijra and Eunuchs in Pakistan". Indian Journal of Gender Studies. 23 (2): 218–242. doi:10.1177/0971521516635327. S2CID 148253442.
• Khan, Shahnaz (September 2017). "Khwaja sara, hijra, and the Struggle for Rights in Pakistan". Modern Asian Studies. 51 (5): 1283–1310. doi:10.1017/s0026749x16000068. S2CID 148748286.
• Khan, Sharful Islam; Hussain, Mohammed Iftekher; Parveen, Shaila; Bhuiyan, Mahbubul Islam; Gourab, Gorkey; Sarker, Golam Faruk; Arafat, Shohael Mahmud; Sikder, Joya (16 September 2009). "Living on the Extreme Margin: Social Exclusion of the Transgender Population (Hijra) in Bangladesh". Journal of Health, Population, and Nutrition. 27 (4): 441–451. doi:10.3329/jhpn.v27i4.3388. PMC 2928103. PMID 19761079.
• Khan, S I; Khan, N M; Rahman, M; Gourab, G (2016). "Hijra/Heijra". In Naples, N A (ed.). The Wiley Blackwell Encyclopedia of Gender and Sexuality Studies. Chicester, United Kingdom: John Wiley & Sons. pp. 1–2. doi:10.1002/9781118663219. ISBN 9781118663219.
• Kim, Chin; LeBlang, Theodore (1975). "The Death Penalty in Traditional China". Georgia Journal of International & Comparative Law. 5 (1): 77–105.
• Lipshultz, L I (1980). "Orchiectomy, Penectomy, Vaginoplasty for the Male Transsexual". In Lipshultz, L I; Corriere, J N; Hafez, E S E (eds.). Surgery of the Male Reproductive Tract. Dordrecht: Springer. pp. 169–173. ISBN 978-94-009-8849-1.
• Majno, G (1991). The Healing Hand: Man and Wound in the Ancient World. Harvard University Press. ISBN 978-0-674-38331-9.
• Mellon, Charles David; Barlow, Carrolee; Cook, Joshua; Clark, Lincoln (February 1989). "Autocastration and autopenectomy in a patient with transsexualism and schizophrenia". Journal of Sex Research. 26 (1): 125–130. doi:10.1080/00224498909551496.
• Money, John (16 June 1988). "The Skoptic Syndrome: Castration and Genital Self-Mutilation as an Example of Sexual Body-Image Pathology". Journal of Psychology & Human Sexuality. 1 (1): 113–128. doi:10.1300/J056v01n01_09.
• Mora, William; Drach, George W. (August 1980). "Self-Emasculation and Self-Castration: Immediate Surgical Management and Ultimate Psychological Adjustment". Journal of Urology. 124 (2): 208–209. doi:10.1016/s0022-5347(17)55375-6. PMID 7401234.
• Murray, G (1989). Slavery in the Arab World. Companions to Asian Studies. Rowman & Littlefield. ISBN 9780941533300.
• Nanda, S (1999). Neither Man Nor Woman: The Hijras of India. Massachusetts: Cengage. ISBN 978-0534509033.
• Nanda, S (1984). "The hijras of India. A preliminary report". Medicine and Law. 3 (1): 59–75. PMID 6538636.
• Ochoa, Bernardo (September 1998). "Trauma of the external genitalia in children: amputation of the penis and emasculation". The Journal of Urology. 160 (3 Pt 2): 1116–1119. doi:10.1097/00005392-199809020-00040. PMID 9719288.
• Orakwe, J.C.; Undie, C.U. (June 2012). "Male genital injuries caused by ritual attacks in Nigeria: Problems of management". African Journal of Urology. 18 (2): 75–77. doi:10.1016/j.afju.2012.08.002.
• Patwardhan, Sujata; Sawant, Ajit; Nagabhushana, M; Varma, Radheshyam; Ismail, Mohammed (2007). "Chronic urinary retention in eunuchs". Indian Journal of Urology. 23 (3): 317–318. doi:10.4103/0970-1591.33733. PMC 2721615. PMID 19718339.
• Samm, Bill J; Steiner, Mitchell S (February 1999). "Penectomy: a technique to reduce blood loss". Urology. 53 (2): 393–396. doi:10.1016/s0090-4295(98)00508-1. PMID 9933061.
• Rana, A.; Johnson, A. D. (June 1993). "Sequential Self-castration and Amputation of Penis". British Journal of Urology. 71 (6): 750. doi:10.1111/j.1464-410x.1993.tb16079.x. PMID 8343905.
• Scheidel, W (2009). Rome and China: Comparative Perspectives on Ancient World Empires. Oxford University Press. ISBN 978-0-19-533690-0.
• Schweitzer, Isaac (December 1990). "Genital Self-Amputation and the Klingsor Syndrome". Australian & New Zealand Journal of Psychiatry. 24 (4): 566–569. doi:10.3109/00048679009062914. PMID 2073234. S2CID 35323291.
• Shaw, Matthew B. K.; Sadove, A. Michael; Rink, Richard C. (March 2003). "Reconstruction After Total Penile Amputation and Emasculation". Annals of Plastic Surgery. 50 (3): 321–324. doi:10.1097/01.sap.0000029629.81612.2e. PMID 12800913.
• Singh, H; Kumar, P (2020). "Hijra: An Understanding". Journal of Psychosocial Research. 15 (1): 79–89. doi:10.32381/JPR.2020.15.01.6. S2CID 229027899.
• Stief, Matthew (January 2017). "The Sexual Orientation and Gender Presentation of Hijra, Kothi, and Panthi in Mumbai, India". Archives of Sexual Behavior. 46 (1): 73–85. doi:10.1007/s10508-016-0886-0. PMID 27878410. S2CID 44767139.
• van der Sluis, Wouter B.; Steensma, Thomas D.; Bouman, Mark-Bram (2 April 2020). "Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes". International Journal of Transgender Health. 21 (2): 176–181. doi:10.1080/26895269.2020.1749921. PMC 7430475. PMID 33015667.
• Vale, Kayla; Johnson, Thomas W.; Jansen, Maren S.; Lawson, B. Keith; Lieberman, Tucker; Willette, K. H.; Wassersug, Richard J. (7 May 2010). "The Development of Standards of Care for Individuals with a Male-to-Eunuch Gender Identity Disorder". International Journal of Transgenderism. 12 (1): 40–51. doi:10.1080/15532731003749095. S2CID 144853784.
• Wibowo, J E; Johnson, T W; Wassersug, R J (2016). "Infertility, impotence, and emasculation - psychosocial contexts for abandoning reproduction". Asian Journal of Andrology. 18 (3): 403–408. doi:10.4103/1008-682X.173937. PMC 4854090. PMID 26924280.
• Wilson, Jean D.; Roehrborn, Claus (December 1999). "Long-Term Consequences of Castration in Men: Lessons from the Skoptzy and the Eunuchs of the Chinese and Ottoman Courts". The Journal of Clinical Endocrinology & Metabolism. 84 (12): 4324–4331. doi:10.1210/jcem.84.12.6206. PMID 10599682.
• Wilson, Jennifer (1 November 2018). "Dostoevsky's Timely Castration". TSQ: Transgender Studies Quarterly. 5 (4): 565–573. doi:10.1215/23289252-7090031. S2CID 132954102.
• Zhang, E Y (2001). "Goudui and the State: Constructing Entrepreneurial Masculinity in Two Cosmopolitan Areas of Post-Socialist China". In Hodgson, D L (ed.). Gendered Modernities. New York: Palgrave Macmillan. pp. 235–265. doi:10.1007/978-1-137-09944-0_9. ISBN 978-1-137-09944-0.