Doctors at a loss for how to treat eunuchs

The Swedish health care system has come under criticism for not having a system in place to serve men who want to become eunuchs, according to medical journal Dagens Medicin.

People who want sex reassignment surgery can have their testicles removed after undergoing thorough examinations, but a corresponding examination process does not exist for those who want to remove healthy testicles, reports Dagens Medicin.

Maria Hermann, a urologist who works at Stockholm’s Karolinska University Hospital, told Dagens Medicin that the Swedish health-care system needs to be more aware that this group of people exists and that they have certain needs.

"We want to know how we should help them so that they don't get so desperate that they remove their testicles themselves," Hermann said, proposing an evaluation process for would-be eunuchs to determine if they meet criteria for a third sex that is neither male nor female. 

According to Dagens Medicin, Hermann and her colleagues first became aware of the issue when a patient came in complaining that his testicles were hurting. After many examinations and several biopsies, the man admitted that he had been injecting alcohol into his testicles for a year, in the hope that the health-care system would offer to help him have them surgically removed.

The man felt that his testicles were alien to his body, and before Hermann and her colleagues could get an answer from the National Board of Health and Welfare about how to handle his case, he had removed his testicles on his own.

There are a number of reasons why a person might want to remove their testicles - one might be to reduce the amount of testosterone in the body; another might be that the person feels they do not belong to either the male or female sex, the Dagens Medicin article explains.

While Hermann wants more guidance, Åsa Lindberg, a lawyer at the National Board of Health and Welfare, said there is no particular rule preventing health-care providers from removing healthy testicles in cases that do not have to do with sex-reassignment surgery.

Lindberg said decisions should be made on a case-by-case basis and she added that there are no plans for the time being to create guiding principles that health-care providers can refer to in the event of having to treat would-be eunuchs.