Re: Books on castration and eunuchs
Posted: Sat Jan 26, 2008 2:32 pm
1
Kathryn Ringrose
Perceiving Byzantine Eunuchs Through Modern Medicine
Byzantine eunuchs were perceived by their contemporaries as culturally,
psychologically, and physically distinctive. While eunuchs clearly were not
women, their infertility and distinctive physical appearance distanced
them from the gender construct Byzantine society assigned to adult
males. Byzantine observers routinely described eunuchs using pejorative
terminology, comparing them, unfavorably, to testiculated men. In my
earlier book,
Gender in Byzantium, I assumed that most of the pejorative comments
about the physiology and personality of eunuchs were part of a
generalized set of negative attitudes about both eunuchs and women.
More recently I have been prompted to question this assumption and I
have begun to explore current medical literature that deals with the
results of castration or with conditions that are analogous to castration.
This literature focuses on androgens and the effects of androgen therapy
and androgen deprivation on the human body and mind, on dental
research that discusses the changes in the anatomy and appearance of
the face in the absence of certain androgens, and on psychological and
neuroscientific research that explores the changes in the human brain
that take place at puberty.
It is risky to reach historical conclusions based on contemporary
evidence, but in dealing with the topic of Byzantine eunuchs we have two
problems: (1) Our primary sources are few, scattered, and often very
2
biased. (2) Our contemporary sources are limited by the fact that, unless
we believe whispers behind closed doors that will probably never be
opened, children are no longer routinely castrated in our modern world.
This rules out the possibility of direct comparison between Byzantine and
modern castrates.
Even so, modern medicine and experimental science may offer some
insights into the topic. In today's world individuals are born with
ambiguous genitalia which is often "corrected", but these children cannot
necessarily serve as a model for the Byzantine eunuch. Men with severe
prostate cancer are often castrated or treated with testosterone
destroying drugs. They can provide a partial model for us, though a
model that only deals with the later years of the adult male life. Finally,
there are a few rare genetic defects that produce males that can be
considered a kind of modern eunuch. Here, however, the literature about
these individuals, who are generally treated with testosterone, is focused
on "correcting" their defect rather than on exploring the results of nontreatment.
Despite these caveats, we can gain some intriguing insights
from today's medical and biological sciences.
Most studies of Byzantine eunuchs assert that the act of
castration, that is the removal of the testicles, penis, or both, deprives
the body of testosterone and thus changes the physical nature of the
individual. While this is an obvious truism, modern medical research
indicates that this approach is much too simplistic. A brief summary of
the findings of this research will facilitate further discussion of a number
of points.
The differentiation of the male and female begins in the womb with
the development of what is called the hypothalamic-pituitary-gonadal axis.
3
The hypothalamus and pituitary, both located at the base of the brain, are
formed by the 4th or 5th week of fetal life and soon are producing
gonadotropic hormones: luteinizing hormone (LH), follicle stimulating
hormone (FSH), and gonadotropin releasing hormone (GnRH). By the 8th
week of gestation the Leydig cells (the cells that make testosterone) in
the fetal testes have differentiated. By the 12th week these cells'
production of testosterone is at its peak, effecting the further
development of the male sexual organs. It is believed that testosterone
also is involved in brain development during this period, flooding the brain
with hormones and "priming" it in a male direction. Sex differentiation in
the embryo is regulated by at least 70 different genes that govern the
mechanisms that differentiate the primordial gonadal tissue, which is
bipotential, that is, it can become either male or female. At this point in
fetal life irregularities of the genetic makeup, or external factors, like
chemical pollution, can produce individuals with ambiguous genital
development.
By the end of the fetal period the hypothalmic-pituitary-gonadal
axis is well developed, with a regulating system called the hypothalamic
GnRH pulse generator that discharges intermittent bursts of GnRh into the
system. In infancy this system operates at a frequency that is typical of
the adult male, and it stimulates the leydig cells of the child to secrete
testosterone. At about two years of age the above system becomes
quiescent until puberty. Given that castration rarely took place this early,
this phase of testosterone-related development in male children is
something experienced by virtually all potential eunuchs. The
mechanisms for turning this system on and off are not yet completely
understood.
4
There is considerable variation in the timing of male puberty. It
begins when the hypothalamic GnRh pulse generator again begins to
release GnRh, resulting in an increase in production of LH (luteinizing
hormone) by the pituitary. In male humans an elevation of LH and
testosterone signals puberty, the testis increase in size, producing
increasing amounts of testosterone, reaching adult values at 14 or 15
years of age. Spermatogenesis can be established at some time between
the 12th and 16th year of life.1 This is the phase of testosterone related
development that is missed by eunuchs castrated prior to puberty.
Recent studies in the areas of developmental neuroscience and
neuropsychology indicate that puberty has a significant impact on the
human brain, and especially the male brain. Just as testosterone in the
infant acts to differentiate neural circuits in the brain, it continues to act
on the brain during puberty. There is evidence that the male brain,
influenced by steroid hormones, and, in the male, testosterone in
particular, is significantly remodeled during puberty in ways that impact
higher-order brain functions, including cognitive functions and emotion
regulation.2 The brain is a very "plastic" organ and it develops new
circuitry and prunes unneeded circuitry throughout puberty and young
adulthood.
1 Audrey M. Cummings and Robert J. Kavlock, "Function of Sexual Glands and Mechanism
of Sex Differentiation," The Journal of Toxicological Sciences , vol. 29, no. 3, (2004):
167 – 178.
2 Judy L. Cameron, “Interrelationships between Hormones, Behavior, and Affect during
Adolescence: Understanding Hormonal, Physical and Brain changes Occurring in
Association with Pubertal Activation of the Reproductive Axis. Introduction to Part III,”
Annals of the New York Academy of Sciences, 1021 (2004): 110-123 (2004); J. D.
Wilson, "Androgens, Androgen Receptors, and Male Gender Role Behavior," Hormone
Behavior , v. 40, no. 2 (Sept. 2001): 358-366.
5
What significance does this have for the study of eunuchs? Many
of the eunuchs in our sources are “artificial creations” in that they were
normal males who were deliberately castrated for a variety of very
specific purposes. Others, however, were individuals whose development
was congenitally faulty, leaving them with incomplete male sexual organs.
These are sometimes referred to as "natural" eunuchs in our sources.
Another group includes men who were castrated in an attempt to cure
one of several medical conditions afflicting the male genitalia. Finally,
there are eunuchs whose castration is the result of an accidental injury.
For all of these groups age of castration is critical for future physical and
neural development.
In the Byzantine world men must have known that the age at which
castration was performed effected the kind of eunuch that was formed.
Castration between infancy and puberty, for example, will profoundly
effect the appearance of the individual, but he will still be oriented in a
masculine direction, though just how is difficult to determine. He will not
experience normal puberty. His voice will remain high-pitched, he will
have little or no facial hair and the hair on his head will be thick and
luxuriant throughout his life. His face and body will have a very distinctive
appearance and his life will probably be short, since he will be afflicted
with osteoporosis, diabetes, and heart and vascular problems. He will
have little or no interest in sexual behavior. His personality will be
different from that of a normal man, though it is difficult, at this historical
distance, to determine exactly how it will be different.
On the other hand, if he is castrated at, say, 17, he will experience
much less change in appearance and, though infertile, may retain limited
sexual function. If castrated as an adult, a eunuch will retain most of the
6
qualities of an adult male, with the exception of those features that are
regulated directly by testosterone: fertility, sexual potency, maintenance
of muscular strength, and the growth patterns of body and facial hair.
When visitors from Western Europe began to visit Constantinople in
the early middle ages, one of the first things they noticed was the
presence of eunuchs. Castration was rare in the west, and the very fact
that castrations took place in Byzantium made this culture appear to be
eastern, suspect and "other." The reasons that the Byzantines castrated
healthy, normal boys and created a place for them in elite society are
complex. In my own work I have suggested that the Byzantines were
attempting to create a "perfect servant", attractive, obedient, educated,
unfailingly loyal, an individual without external family ties, and an individual
who was undefiled by sexuality (unless he was desired by his master). A
parallel construct existed within the world of the church and was validated
by the assumed ascetic qualities attached to the religious eunuch.3
While for centuries Byzantine society created important niches for
eunuchs, the authors of our sources were usually uncomfortable with the
act of castration. We know a great deal about the lives of many eunuchs,
but almost nothing is said about their castration. Even the great eunuch
patriarch Methodios claimed to have been castrated by God.4 The
historian Prokopios goes to great lengths to explain that the eunuch
Solomon had not been castrated but rather that his genitalia had been
damaged in a nursery accident.5 Rhetorically, at least, the Byzantines
claimed that they never did castrations – the castrators were always
3 Kathryn M. Ringrose,
[/quote]
Gender in Byzantium (
4 Skyl. p. 86, l. 51; Kedrenos, Compendium historiarum, vol. 2, p. 147.
5 Prokopios, Wars, vol. 3, ch. 11, l. 5.
7
“others” –usually people like the Arabs or the Persians. Likewise the
Arabs claimed that they never castrated and that their eunuchs were
prepared and purchased in Byzantium. It is interesting to compare
attitudes toward castration in Byzantium to those in China. In China
castration was practiced both as a punishment and as a route to a career.
It had to be publicly proven through the display of the severed organs. In
Byzantium castration was almost never used as a punishment and the
severed organs were not preser
and was never mentioned publicly.
Despite the rhetorical façade, however, we know that castrations
were performed in the Late Antique and Byzantine worlds. The seventh
century surgeon, Paul of Aegina, has left us a detailed description of a
testicular ablation, prefaced by the comment that he hated to have to
perform this surgery and only did so under pressure. Since castrations
were technically illegal, they were often billed as surgery to correct a
serious medical condition, hernia. It is quite possible that in fact this
practice was not exceptional.
Among the treatments that could result in castration was the repair
of both inguinal hernia, scrotal hernia, and umbilical hernia. Doctors began
with a less invasive attempt to cure hernias using compression and
bandages, but if this failed, physicians did resort to surgery. Paul of
Aegina describes a surgical technique that included cauterization. It was
probably reasonably effective and spared the testicles. Skilled surgeons
8
in the Hellenistic world had long understood these techniques, which can
be found in the writings of Celsus, a surgeon of the first century AD.6
Though testicle-sparing surgery for hernias continued to be
practiced in the Byzantine empire, practitioners were increasingly of the
opinion that castration was the best hope of curing hernia. This was
certainly true in Western Europe until the Renaissance, and was probably
true in the less urbanized parts of the Byzantine empire.7 This is the
inference we can draw from the many examples in Byzantine sources of
boys and men with hernias and ailments of the genitalia whose miraculous
cures saved them from the castrator. In the life of saints David, Symeon
and George of Mitilini on the island of Lesvos8 we find the story of Leo, a
friend of the holy man, who brought his youngest son to him for healing.
The boy was suffering from a hernia and was about to be turned over to
the castrator when he was saved by the saint, who healed him. The life
of St. Artemios offers a number of healing miracles involving male
genitalia.9 In the twenty-fourth miracle10 a man named George is urged to
see a doctor and have his testicles removed to heal a testicular disorder.
The saint heals him. In the twenty-eighth miracle,11 a child injures his
testicles and is cured by the saint. When his mother realizes that he has
been cured, she runs her hands along his thighs and assumes the cure
6 Niki S. Papavramidou and Helen Christopoulou-Aletras, "Treatment of "Hernia" in the
Writings of Celsus (First Century AD)," World Journal of Surgery, 29 2005): 1343 –
1347.
7 John G. Lascaratos, Constantine Tsiamis, Alkiviadis Kostakis, "Surgery for Inguinal
Hernia in Byzantine Times (A.D. 324-1453): First Scientific Descriptions," World Journal
of Surgery 27 (2003): 1165-1169.
8 J. van den Gheyn, Acta graeca SS.Davidis, Symeonis et Georgii Mitylenae in insula
Lesbo, AB 18 (1899): p. 240, l. 11.
9 Crisafulli, "The Miracles of St. Artemios"
10 Ibid., p. 145.
11 Ibid., p. 155.
9
involved removing his testicles. The forty-third miracle12 is similar. In the
forty-fourth miracle13 a man with diseased testicles is considering having
them removed but is healed by the saint. The saint appears to him in the
guise of a physician who did hernia surgeries. The saint bound up the
man's testicles with a cord, an action that mimicked one technique for
castration.
Thus there was in Byzantine culture an acceptable medical façade
that legitimized castration. Hernia certainly offered an excuse that could
be trotted out for rhetorical purposes. It is even feasible that hernia
problems were sufficiently prevalent to account for a significant number
of medically legitimate castrations. Just last year a group of Iranian
researchers published a study of 3205 elementary-school boys, aged 6 to
12 years.14 The subjects live in the province of Lorestan, which is
situated north and west of Tehran on the eastern slope of the Zagros
mountains. The boys were examined for abnormalities of the groin or
genitalia and abnormalities were found in 6.64% of the children. The
problems included hernia, retractile testes, undescended testes,
hydrocele, and hypospadia. This is a significant percent of this study
group. In the Byzantine world, with the exception of the child with
hypospadia (a condition in which the urethra does not exit the penis in a
normal way) any of these children who received medical treatment would
probably have been made eunuchs.
12 Ibid., p. 219
13 Ibid., p. 219.
14 R. A. Yegane, A. R. Kheirollahi, M. Bashashati, N. Rezaei, M. J. Tarrahi, and J. A.
Khoshdel, "The Prevalence of Penoscrotal Abnormalities and Inguinal Hernia in
Elementary-school Boys in the West of Iran," International Journal of Urology, v. 12, no.
5 (2005): 479-483.
10
A certain number of Byzantine eunuchs are identified as "natural
eunuchs" who presumably were not actually castrated. While these
individuals are rare in any culture, they do exist. They usually suffer from
genetic deformities that suppress the formation of external genitalia or
the utilization of testosterone. Ever since the publication of the Pulitzer
Prize winning novel Middlesex15 we have become more familiar with one of
these rare genetic conditions called 5alpha-Reductase Deficiency. In the
male it is the cause of male hereditary pseudohermaphroditism. During
fetal development, at the cellular level testosterone is converted to
5alpha-dihydrotestosterone and binds to a high-affinity receptor protein
in the cell nuclei. From embryogenesis through puberty 5alphadihydrotestosterone
is responsible for: (1) the development of the male
external genitalia, urethra, and prostate (2) at puberty, the growth of
facial and body hair and the maturation of the external genitalia (3) the
loss of scalp hair later in life. At birth individuals with this defect appear
to be girls or hermaphrodites with minimal male genitalia since they have
had little or no chance for the development of male genitalia during the
prenatal period. At puberty, however, the male external genitalia begin to
develop and these children are increasingly virilized. As children, if their
condition is not recognized, they are reared as females. After puberty,
when they develop noticeable male genitalia, some elect to live as infertile
males, following their chromosome makeup, others as females in
accordance with their rearing.
15 Jeffrey Eugenides, Middlesex: A Novel (New York: Picador, 2002).
11
In the Byzantine world individuals of this sort would be classified as
"natural eunuchs."16 In today's world, where infant and childhood
castration are no longer practiced, these individuals are the subjects of
much research, since their experience directly addresses questions about
the importance of nature versus nurture. Though most of these
individuals are reared as females, more than half of them elect to live as
males after puberty.17 For historians they serve as a research "stand-in"
for eunuchs.
Another group of potential "natural eunuchs" includes individuals
with the more severe forms of Klinefelter Syndrome. These men have the
usual 47 chromosomes, but have an added X chromosome (47XXY).
Today we know that about 1 in 1000 males are born with this genetic
anomaly, and it is a disorder that accounts for 3% of male infertility. Men
who are affected typically suffer from, in decreasing order of frequency:
infertility, small testes, decreased facial hair, gynecomastia, (the
development of small breasts) decreased pubic hair, and a small penis.
They have unusually long legs and may have a feminized body. In
adulthood, without diagnosis and androgen replacement therapy, they can
suffer from loss of libido, decreased muscle bulk and tone, decreased
bone mineral density, and a tendency to suffer from thromboembolism,
diabetes and cardiovascular complications. Most of these symptoms
16 Jean D. Wilson, James E. Griffin, and David W. Russel, "Steroid 5alpha-Reductase 2
Deficiency," Endocrine Reviews, v. 14, no. 5 (1993): 577-593; B. B. Mendonca, M.
Inacio, I. J. Arnhold, E. M. Costa, W. Bloise, R. M. Martin, F. T. Denes, F. A. Silva, S.
Andersson, A. Lindquist, and J. D. Wilson, "Male Pseudohermaphrodistism due to 17
Beta-hydroxysteroid Dehydrogenase 3 Deficiency. Diagnosis, Psychological Evaluation,
and Management," Medicine, v. 79, no.5 (Baltimore, 2000): 299-309.
17 P. T. Cohen-Kettenis, "Gender Change in 46,XY Persons with 5alpha-Reductase-2
Deficiency and 17 beta-Hydroxysteroid Dehydrogenase-3 Deficiency," Archives of Sexual
Behavior , v. 34, no. 4 (2005): 399-410.
12
match traits associated with eunuchs in our sources. In one regard,
however, they do not resemble eunuchs, who are often presented as
intellectually a
cognitive deficits, especially in language comprehension, speech, and
gross and fine motor coordination18
In the Late Antique and Byzantine worlds natural eunuchs were
rarely identified as such. An exception to this, however, was the famous
second century eunuch Favorinus. Favorinus appears to have been born
with at lease one of the many androgen insensitivity syndromes described
above. He is described as a eunuch having a penis but no testicles.
Rather than hiding his affliction, Favorinus capitalized on his unusual
appearance and high voice, setting a new style for orators of the period.
He is the eunuch who is the subject of Lucian's The Eunuch.19
Unless some hagiographer or biographer wanted to clean up the
origins of a famous eunuch by citing accident or medical necessity, our
sources rarely say much about how a man became a eunuch. Thus there
is no way of knowing how many eunuchs there were in Byzantium at any
given time, nor can we know what percentage of them were "natural"
eunuchs as opposed to eunuchs who were the result of deliberate
castration.
However ambivalent our sources are about eunuchs, it is clear that
a significant number were deliberately castrated before puberty, when the
surgery is much easier and safer than later in life. Eunuchs castrated
18 Daniel J. Wattendorf and Maximilian Muenke, "Klinefelter Syndrome," American Family
Physician, v. 72, no. 11 (2005).
19 Maud
(Princeton; Princeton University Press, 1995). p. 3.
13
before puberty or during early puberty developed a distinctive appearance
that, I would argue, was aesthetically favored at court. Here, too, modern
medical research supports some of the ambiguous evidence for
physiological distinctiveness. Individuals who suffer from extreme
testosterone deprivation develop a distinctive physical appearance.
During the neonatal period androgens react with growth hormones to
produce the male growth pattern that will emerge at puberty. At
puberty, after a quiescent childhood, growth and development begins
again. What triggers puberty is still a matter of conjecture.20
"In an uncastrated male puberty is characterized by a striking
increase in circulating testosterone, which is converted to
dihydrotestosterone, increases in circulating androgens associated
with an increase in muscle mass, enlargement of the testicles and
phallus, development of acne, and a male pattern of hair
development including facial hair, axillary hair, and pubic hair, as well
as an overall increase in the size and darkening color of most other
body hairs."21
At puberty various sex steroids mediate both the development and
maintenance of long-bone tissues and the development of the bones in
the face. Both estrogen and testosterone are important for this process,
and the lack of testosterone in eunuchs at puberty results in the
development of bone material that is porous. Since testosterone
regulates the circumference of the long-bones, in its absence they will
tend to be unusually thin and fragile, a condition I will come back to when
I discuss the aging of eunuchs. At the end of puberty testosterone
20 G. Bradley Schaefer, "Neuroendocrine and Neurophysiologic Changes of Adolescence,"
Cleft Palate-Craniofacial journal, v. 32, no.2 (1995): 95-98.
21 Ibid., p. 97.
14
regulates the closing of the epiphyseal (growth) plates in the long bones.
Lacking testosterone, these growth plates do not close promptly after
puberty. This is especially apparent in the long bones of the arms and
legs which, in a eunuch, appear to be unusually long compared to the rest
of the body.22 At the same time, in a eunuch, the bones of the jaw and
the part of the face that extends from the lower jaw to the ear tend not
to develop during puberty, creating an individual whose face appears to
be abnormally wide. In fact, its width is correct, since the measurement
between the eyes does not change from infancy. The eunuchoid face
appears to be wide because the lower face has not lengthened at
puberty. In our world of modern medicine, if a boy with a condition that
severely reduces the levels of his testosterone is diagnosed early enough
testosterone treatments will "normalize" facial growth in the vertical
dimension and will increase the anterior facial height.23
I am convinced that the Byzantines aesthetically appreciated the
appearance of boys at the cusp of puberty. Such boys were
stereotypically graceful, feminine without being female, and sexually pure.
Their skin was still clear, they had no beards, their voices were highpitched,
their faces, which had not yet taken on a masculine appearance,
were short and broad. Given the normal inevitability of puberty, these
22 D. Vanderschueren, L. Vandenput, and S. Boonen, "Reversing Sex Steroid Deficiency
and Optimizing Skeletal Development in Adolescents with Gonadal Failure, Endocrine
Development, v. 8 (2005): 150-165; M. K. Lindberg, L. Vandenput, S. Moverare, S.
Skritic, D. Vanderschueren, S. Boonen, R. Bouillon, and C. Ohlsson, "Androgens and the
Skeleton," Minerva Endocrinology, v. 30, n. 1 (2005): 15-25.
23 A. Verdonck, M. Gaethofs, C. Carels, and F. Zegher, "Effect of Low-dose Testosterone
Treatment on Craniofacial Growth in Boys with Delayed Puberty," European Journal of
Orthodontics , v. 21 (1999): 137-143; Ronald N. Spiegel, A. Howard Sather, and Alvin B.
Hayles, "Cephalometric Study of Children with Various Endocrine Diseases," American
Journal of Orthodontics, v. 59, n. 4, (1971): 362-375.
15
qualities were recognized to be ephemeral – present in a boy today and
gone from the young man tomorrow.
These are also the physical attributes of individuals who
transcended the pollution of the mundane physical world. Through
castration this aesthetic could be captured and preserved, at least for a
time. It is important that we not impose our cultural biases on the
Byzantine world. The eunuchoid face may not be desirable today, but it
seems to have had positive connotations in the past. Current
investigations of facial shape and its relationship to testosterone show
that, at least subconsciously, people notice facial shape as an indication
of "manliness." Women today, despite what we might assume, find
pictures of the faces of men who have very high testosterone levels to be
unattractive.24 The pubescent face of the Byzantine eunuch is readily
seen in the images of angels and youthful warrior saints in Byzantine art.
It is unmistakable in our one good portrait of a Byzantine eunuch, Leo the
Sakellarios.25 It is worth noting in this connection that Byzantine art
clearly contrasts that society’s two categories of non-reproductive
individuals. One, the ascetic holy man, is depicted with a long, narrow,
bearded face that would be typical of an individual with high levels of
testosterone. This reinforces the trope that says that holiness lies in
overcoming the pleasures of the world, including sexual pleasures. The
alternative image of holiness is the beardless, almost triangular eunuchoid
24 John P. Swaddle and Gillian W. Reierson, "Testosterone Increases Perceived Dominance
but not Attractiveness in Human Males," The Royal Society, Proceedings in Biological
Sciences, Nov. 2002: 2285-2289.
25 Die bibel des Patricius Leo: Codex Rginensis Graecus 1 B, ed. Suzy Dufrenne and Paul
Canart (Zurich, 1988), fol. 2v.
16
face we find in images of angels –beings by definition free of human
sexuality.
The use of castration to prolong youthful innocence is
complimented in Byzantine sources by the fact that they rarely talk about
the aging or death of eunuchs. For the Late Antique period, where our
sources are dominated by tales of evil eunuchs like Eutropius, we
occasionally learn how they died. Valentinian burned his chief eunuch in
the Hippodrome.26 Ammianus Marcellinus mentions Eutherius, whom he
considers an exception to the rule that all eunuchs are evil, who died in
comfortable retirement in Rome.27 Similarlty, not much is said about
eunuchs' health. An exception to this is found in Ammianus Marcellinus,
who describes "the throng of eunuchs beginning with the old men and
ending with the boys, sallow and disfigured by the distorted form of their
members."28 Ammianus is clearly making observations about the health
of eunuchs. There is also an intriguing tradition that compares a eunuch
to a rose – he is beautiful in youth, flowers, then withers and dries up. His
skin is compared to a crumpled, drying flower. He becomes wrinkled and
dried up with age. Themes like this appear in John Chrysostom's Vanity
of Vanities sermon on the eunuch Eutropius.29 This raises two interesting
questions. First, what can modern medical science tell us that might shed
light on the aging process among eunuchs, and second why do our later
Byzantine sources say so little about the end of life among eunuchs?
Recent advances in the treatment of prostate cancer have led to a
flood of relevant articles. Androgen destroying medications are now used
26 Eunapius of Sardis, Fragmenta historicorum graecorum, ed. K. Muller, vol. 4, n. 30.
27 Ammianus Marcellinus. Ed. and trans. John C. Rolfe. Vol. 1 (1935), XVI 7, 2-5.
28 Ammianus Marcellinus, vol. 1, 1935, XIV 6, 17.
29 PG 52, cols. 392-414.
17
to shrink the prostate and retard the growth of the tumor, a technique
that allows fragile elderly patients to avoid surgery. This has led to other
medical problems that appear to parallel those suffered by eunuchs as
they age. Osteoporosis is the most prominent. The bulk of adult bone
mass is laid down during puberty. If a child is castrated before puberty,
his chance of retaining sufficient bone mass to last into old age is slim.
Modern studies of prepubertal boys suffering from hypogonadism indicate
that with testosterone supplements bone mass can be rapidly laid down
during young adulthood.30 Conversely for elderly men treated with
androgen destroying drugs, bone mass is lost rapidly, even if it was
adequately laid down at puberty. The degree to which osteoporosis
might disable the Byzantine eunuch clearly depends on the age at which
castration took place. Chinese eunuchs, for example, seem not to suffer
from osteoporosis because they were usually castrated after puberty.
Since Byzantine eunuchs were castrated at a variety of ages, only some
of them would suffer from osteoporosis. Court eunuchs, were probably
castrated before puberty, both to preserve their youthful appearance and
to preserve their voices, which were valued in the imperial choirs.
Osteoporosis would be a serious problem for them. Peter Phocas,
however, a great eunuch soldier whose exploits on the field of battle are
described in several sources, was almost certainly castrated as an adult.31
For him osteoporosis would be a lesser issue, at least until extreme old
age.
30 Eishin Ogwa, Uriko Katsushima, Ikuma Fuiwara, and Kazuie Iinuma, "Testosterone-
Induced Changes in Markers of Bone Turnover in Adolescent Boys with Testicular
Dysfunction," Clinical Pediatric Endocrinology, v. 12, n.2 (2003): 81-85.
31 Leo the Deacon, Leonis diaconi Caloensis historie libri decem. ed. C.B.Hase, Bonn,
1828, pg. 107.
18
Elderly men treated with androgen destroying drugs often suffer
from weight gain, the result of a decrease in lean muscle mass and an
increase in fat. This is a phenomenon characteristic of castrated men and
animals. They also frequently suffer from anemia, perhaps explaining why
Ammianus Marcellinus describes eunuchs as sallow. With anti-androgen
therapy the body's metabolism changes, especially its sugar metabolism.
There is a rise in insulin indicating a decrease in insulin sensitivity, leaving
low androgen individuals at risk for diabetes. Recently scientists are
learning that there may be associations between low androgen and heart
and circulatory problems. Lack of androgens seems to lead to a stiffening
of the arteries as indicated by elevated blood pressure. In studies based
on castrated rats, lack of androgens leads to serious heart problems.32
As interesting as the physiological results of castration may be, the
most intriguing questions that modern medical science may help us with
involve the cognitive skills and personality of eunuchs. Today there is a
great deal of interest in the effect of gonadotrophic hormones on
puberty. This has been driven by the observation that some neurological
32 L. X. Oian, L. Hua, H. G. Wu, Y. G. Sui, S. G. Cheng, W. Zhang, J. Li, and X. R. Wang,
"Anemia in Patients on Combined Androgen Block Therapy for Prostate Cancer," Asian
Journal of Andrology, v. 6, n. 4 (2004): 383-384; T.
Metabolism in Patients with Prostate Cancer," Journal of Clinical Endocrinology and
Metabolism, v. 90, n. 2 (2005): 657-660; K. L. Golden, J. D. Marsh, Y. Jiang, and J.
Moulden, "Gonadectomy Alters Myosin Heavy Chain Composition in Isolated Cardiac
Myocytes," Endocrine, v. 24, n. 2 (2004); 137-140; J. C. Smith, S. Bennet, L. M. Evans,
H. G. Kynaston, M. Parmar, M. D. Mason, J. R. Cockcroft, M. F. S
Metabolic Parameters in Males with Prostate Cancer," Journal of Clinical Endocrinology
and Metabolism, v. 86, n. 9 (2001): 4261-4267; M. R. Smith, "Changes in Fat and Lean
Body Mass During Androgen-deprivation Therapy for Prostate Cancer," Urology, v. 63, n.
4 (2004): 742-745; F. Debruyne, "Hormonal Therapy of Prostate Cancer," Seminar on
Urology and Oncology, v. 20, n. 3, supl. 1 (2002); D. Baltogiannis, X. Giannakopoulos, K.
Charalabopoulos, and N. Sifikitis, "Monotherapy in Advanced Prostate Cancer: An
Overview," Experimental Oncology, v. 26, n. 3 (2004): 185-191.
19
diseases, like schizophrenia, appear at puberty, and by the elevated death
rate of teen-agers in much of the world. Scientists have begun to ask
whether the use of steroids by young athletes or the delayed puberty
found among gymnasts and ballet dancers can effect the development of
personality and adult behavior.33 Studies of animals indicate that, in many
species, the neurotransmitter systems of the brain, and especially the
pre-frontal cortex, are significantly remodeled during puberty. In humans
this rearrangement is thought to be connected to adolescent changes in
decision-making, risk taking, planning, drug sensitivity and reward
incentive. Clearly, a male who fails to go through puberty will not have a
typically masculine personality – an aspect of the Byzantine eunuch that
is noted in many sources.
Scientists are still not clear about exactly what triggers puberty in
humans. It seems to be related to GnRH, a decapeptide produced by
specialized neurons in the hypothalamus. These act on the pituitary,
causing it to release LH and FSH which make the testes and ovaries
develop. These then release hormones that act on the brain. Obviously
this has serious implications for those eunuchs who are castrated before
puberty. Since they lack testes this circular hormone-driven system
cannot develop. To what extent might castration reshape these eunuchs'
mental processes and personalities? Perhaps the pejorative writings that
say that eunuchs have personalities that differ from those of testiculated
men should be given some credence.34
33 Russell D. Romeo, Heather N. Richardson, and Cheryl L.Sisk, "Puberty and the
Maturation of the Male Brain and Sexual Behavior: Recasting a Behavioral Potential,"
Neuroscience and Biobehavioral Reviews, v. 26 (2002): 381-391.
34 L.P. Spear, "The Adolescent Brain and Age-related Behavioral Manifestations,"
Neuroscience and Biobehavioral Review, v. 24 (2000): 417-463; C. L. Sisk, and D. L.
20
The most obvious neural developments that are of interest
regarding eunuchs are those that shape sexual behavior. The neural
circuitry that differentiates males from females is laid down during the
prenatal period. At puberty, however, the gonadal steroids both activate
and further organize this neural circuitry. If this does not take place, no
amount of hormone replacement or sexual experience can reverse this
deficit. This is clear in modern studies of animal models. Those castrated
before puberty never become sexually active, nor do they develop
behaviors that are associated with mating behavior, even if they are
treated with hormones. Those castrated after puberty, if treated with
hormones, develop some measure of sexual behavior. The ancients
realized this,35 even though they rarely make a linguistic distinction
between eunuchs castrated before puberty and those castrated after
puberty – at least they do not make a distinction that we can detect.
Leaving aside sexual behavior, which is fairly obvious, does lack of
normal puberty in the pre-pubertial castrate lead to any other differences
in cognitive ability or personality? Studies using tests that target the
orbital prefrontal cortex, an area that is extensively remodeled at puberty,
show that men with low levels of testosterone approach problems in a
careful, conservative way and resist the temptation to take chances.36
They also perform better when faced with spatial tasks, and may have
Foster, "The Neural Basis of Puberty and Adolescence," Nature Neuroscience, v. 7, n. 10
(2004): 1040-1047.
35 See, for example, Alexander of Aphrodisias, Problematum physicorum et medicorum
eclogae. Libri 1-2. In Physici et medici graeci minores, ed. J. L. Ideler, vol. I: p. 8, sec. 9.
1841-42. (Reprint, Amsterdam, 1963).
36 Rebecca Reavis and William H. Overman, "Adult Sex Differences on a Decision-Making
Task Previously Shown to Depend on the Orbital Prefrontal Cortex," Behavioral
neuroscience, v. 115, n. 1 (2001): 196-206.
21
superior mathematical ability.37 In rats lack of testosterone leads to an
increased fear response.38 These reflect characteristics attributed to the
Byzantine eunuch. He is credited with having certain specific intellectual
gifts and assumed to be "cowardly" in his behavior. As to the eunuch's
personality, modern neurosciences do not as yet offer enough information
for us to make any inferences. There is speculation, however, that during
adolescence a network develops in the brain that regulates the processing
of social information. If this regulatory process does not develop and
work properly, an individual can develop mood and anxiety disorders.39
It is easy to assume that the pejorative language that our sources
use about eunuchs reflects a social world that is dominated by masculine
values and thus devalues anything or any one who exhibits traits that
might appear to be feminine. It is also easy to assume that this
pejorative language has its roots in envy. Yet medical science offers
insights that urge us to reevaluate some of the rhetoric that our sources
use about eunuchs. To some Byzantine observers they appear to be
unhealthy and deformed. To others they exhibit youthful grace and
beauty. Both are medically possible, reflecting stages in a eunuch's life.
It is clear that many Byzantine observers find eunuchs' personalities
disagreeable. Given what medical science can tell us so far, it is quite
possible that many eunuchs had immature, unstable personalities.
37 Catherine Gouchie and Doreen Kimura, "The Relationship Between Testosterone Levels
and Cognitive Ability Patterns," Psychoneuroendocrinology, v. 16, n. 4 (1991): 323-
334.
38 J. A. King, W. L. De Oliveira, and N. Patel, "Deficits in Testosterone Facilitate Enhanced
Fear Response," Psychoneuroendocrinology, v. 30, n. 4 (2005): 333-340.
39 E. E. Nelson, E. Leibenluft, E. B. McClure EB, and D. S. Pine, "The social re-orientation
of adolescence: a neuroscience perspective on the process and its relation to
psychopathology," Psychological Medicine, v. 35, n. 2 (2005): 163-174.
22
In any case, it is clear that the Byzantine eunuch is different from a
normal man. His is a constructed gender category, and he, himself, is the
result of a deliberate act of creation, an act of man rather than of God.
This leaves us with a wealth of questions that can still be asked about the
Byzantine eunuch. To what extent did Byzantine society consider
castration to be a creative act? To what extent did the Byzantines
understand the importance of the age at which castrations took place?
Did they create eunuchs specifically for particular social roles – perfect
servant, skilled warrior, bureaucrat, attractive court decoration, etc.?
Why are the Byzantines so reluctant to talk about castrations, eunuchs'
medical problems, their deaths? Is it because eunuchs are perceived to
be created beings who are ephemeral, who live outside the normal human
life cycle of birth, reproduction, and death, with the result that these
facets of their lives cannot be mentioned? What does all of this suggest
about the Byzantines' attitudes about what is natural and unnatural,
whether it is morally right to manipulate a mans' body and use it to create
something new? Finally, what does it tell us about the Byzantines'
attitude toward sexuality? If we are to judge by the presence of eunuchs
in Byzantine society, sexuality is a privilege, not a right. It is something
that can legitimately be dispensed with in order to achieve higher spiritual
and aesthetic goals.
Kathryn Ringrose
USA
Perceiving Byzantine Eunuchs Through Modern Medicine
Byzantine eunuchs were perceived by their contemporaries as culturally,
psychologically, and physically distinctive. While eunuchs clearly were not
women, their infertility and distinctive physical appearance distanced
them from the gender construct Byzantine society assigned to adult
males. Byzantine observers routinely described eunuchs using pejorative
terminology, comparing them, unfavorably, to testiculated men. In my
earlier book,
construction of
Gender in Byzantium, I assumed that most of the pejorative comments
about the physiology and personality of eunuchs were part of a
generalized set of negative attitudes about both eunuchs and women.
More recently I have been prompted to question this assumption and I
have begun to explore current medical literature that deals with the
results of castration or with conditions that are analogous to castration.
This literature focuses on androgens and the effects of androgen therapy
and androgen deprivation on the human body and mind, on dental
research that discusses the changes in the anatomy and appearance of
the face in the absence of certain androgens, and on psychological and
neuroscientific research that explores the changes in the human brain
that take place at puberty.
It is risky to reach historical conclusions based on contemporary
evidence, but in dealing with the topic of Byzantine eunuchs we have two
problems: (1) Our primary sources are few, scattered, and often very
2
biased. (2) Our contemporary sources are limited by the fact that, unless
we believe whispers behind closed doors that will probably never be
opened, children are no longer routinely castrated in our modern world.
This rules out the possibility of direct comparison between Byzantine and
modern castrates.
Even so, modern medicine and experimental science may offer some
insights into the topic. In today's world individuals are born with
ambiguous genitalia which is often "corrected", but these children cannot
necessarily serve as a model for the Byzantine eunuch. Men with severe
prostate cancer are often castrated or treated with testosterone
destroying drugs. They can provide a partial model for us, though a
model that only deals with the later years of the adult male life. Finally,
there are a few rare genetic defects that produce males that can be
considered a kind of modern eunuch. Here, however, the literature about
these individuals, who are generally treated with testosterone, is focused
on "correcting" their defect rather than on exploring the results of nontreatment.
Despite these caveats, we can gain some intriguing insights
from today's medical and biological sciences.
Most studies of Byzantine eunuchs assert that the act of
castration, that is the removal of the testicles, penis, or both, deprives
the body of testosterone and thus changes the physical nature of the
individual. While this is an obvious truism, modern medical research
indicates that this approach is much too simplistic. A brief summary of
the findings of this research will facilitate further discussion of a number
of points.
The differentiation of the male and female begins in the womb with
the development of what is called the hypothalamic-pituitary-gonadal axis.
3
The hypothalamus and pituitary, both located at the base of the brain, are
formed by the 4th or 5th week of fetal life and soon are producing
gonadotropic hormones: luteinizing hormone (LH), follicle stimulating
hormone (FSH), and gonadotropin releasing hormone (GnRH). By the 8th
week of gestation the Leydig cells (the cells that make testosterone) in
the fetal testes have differentiated. By the 12th week these cells'
production of testosterone is at its peak, effecting the further
development of the male sexual organs. It is believed that testosterone
also is involved in brain development during this period, flooding the brain
with hormones and "priming" it in a male direction. Sex differentiation in
the embryo is regulated by at least 70 different genes that govern the
mechanisms that differentiate the primordial gonadal tissue, which is
bipotential, that is, it can become either male or female. At this point in
fetal life irregularities of the genetic makeup, or external factors, like
chemical pollution, can produce individuals with ambiguous genital
development.
By the end of the fetal period the hypothalmic-pituitary-gonadal
axis is well developed, with a regulating system called the hypothalamic
GnRH pulse generator that discharges intermittent bursts of GnRh into the
system. In infancy this system operates at a frequency that is typical of
the adult male, and it stimulates the leydig cells of the child to secrete
testosterone. At about two years of age the above system becomes
quiescent until puberty. Given that castration rarely took place this early,
this phase of testosterone-related development in male children is
something experienced by virtually all potential eunuchs. The
mechanisms for turning this system on and off are not yet completely
understood.
4
There is considerable variation in the timing of male puberty. It
begins when the hypothalamic GnRh pulse generator again begins to
release GnRh, resulting in an increase in production of LH (luteinizing
hormone) by the pituitary. In male humans an elevation of LH and
testosterone signals puberty, the testis increase in size, producing
increasing amounts of testosterone, reaching adult values at 14 or 15
years of age. Spermatogenesis can be established at some time between
the 12th and 16th year of life.1 This is the phase of testosterone related
development that is missed by eunuchs castrated prior to puberty.
Recent studies in the areas of developmental neuroscience and
neuropsychology indicate that puberty has a significant impact on the
human brain, and especially the male brain. Just as testosterone in the
infant acts to differentiate neural circuits in the brain, it continues to act
on the brain during puberty. There is evidence that the male brain,
influenced by steroid hormones, and, in the male, testosterone in
particular, is significantly remodeled during puberty in ways that impact
higher-order brain functions, including cognitive functions and emotion
regulation.2 The brain is a very "plastic" organ and it develops new
circuitry and prunes unneeded circuitry throughout puberty and young
adulthood.
1 Audrey M. Cummings and Robert J. Kavlock, "Function of Sexual Glands and Mechanism
of Sex Differentiation," The Journal of Toxicological Sciences , vol. 29, no. 3, (2004):
167 – 178.
2 Judy L. Cameron, “Interrelationships between Hormones, Behavior, and Affect during
Adolescence: Understanding Hormonal, Physical and Brain changes Occurring in
Association with Pubertal Activation of the Reproductive Axis. Introduction to Part III,”
Annals of the New York Academy of Sciences, 1021 (2004): 110-123 (2004); J. D.
Wilson, "Androgens, Androgen Receptors, and Male Gender Role Behavior," Hormone
Behavior , v. 40, no. 2 (Sept. 2001): 358-366.
5
What significance does this have for the study of eunuchs? Many
of the eunuchs in our sources are “artificial creations” in that they were
normal males who were deliberately castrated for a variety of very
specific purposes. Others, however, were individuals whose development
was congenitally faulty, leaving them with incomplete male sexual organs.
These are sometimes referred to as "natural" eunuchs in our sources.
Another group includes men who were castrated in an attempt to cure
one of several medical conditions afflicting the male genitalia. Finally,
there are eunuchs whose castration is the result of an accidental injury.
For all of these groups age of castration is critical for future physical and
neural development.
In the Byzantine world men must have known that the age at which
castration was performed effected the kind of eunuch that was formed.
Castration between infancy and puberty, for example, will profoundly
effect the appearance of the individual, but he will still be oriented in a
masculine direction, though just how is difficult to determine. He will not
experience normal puberty. His voice will remain high-pitched, he will
have little or no facial hair and the hair on his head will be thick and
luxuriant throughout his life. His face and body will have a very distinctive
appearance and his life will probably be short, since he will be afflicted
with osteoporosis, diabetes, and heart and vascular problems. He will
have little or no interest in sexual behavior. His personality will be
different from that of a normal man, though it is difficult, at this historical
distance, to determine exactly how it will be different.
On the other hand, if he is castrated at, say, 17, he will experience
much less change in appearance and, though infertile, may retain limited
sexual function. If castrated as an adult, a eunuch will retain most of the
6
qualities of an adult male, with the exception of those features that are
regulated directly by testosterone: fertility, sexual potency, maintenance
of muscular strength, and the growth patterns of body and facial hair.
When visitors from Western Europe began to visit Constantinople in
the early middle ages, one of the first things they noticed was the
presence of eunuchs. Castration was rare in the west, and the very fact
that castrations took place in Byzantium made this culture appear to be
eastern, suspect and "other." The reasons that the Byzantines castrated
healthy, normal boys and created a place for them in elite society are
complex. In my own work I have suggested that the Byzantines were
attempting to create a "perfect servant", attractive, obedient, educated,
unfailingly loyal, an individual without external family ties, and an individual
who was undefiled by sexuality (unless he was desired by his master). A
parallel construct existed within the world of the church and was validated
by the assumed ascetic qualities attached to the religious eunuch.3
While for centuries Byzantine society created important niches for
eunuchs, the authors of our sources were usually uncomfortable with the
act of castration. We know a great deal about the lives of many eunuchs,
but almost nothing is said about their castration. Even the great eunuch
patriarch Methodios claimed to have been castrated by God.4 The
historian Prokopios goes to great lengths to explain that the eunuch
Solomon had not been castrated but rather that his genitalia had been
damaged in a nursery accident.5 Rhetorically, at least, the Byzantines
claimed that they never did castrations – the castrators were always
3 Kathryn M. Ringrose,
chs and the Social Construction of
[/quote]
Gender in Byzantium (
2003), ch. 5.
4 Skyl. p. 86, l. 51; Kedrenos, Compendium historiarum, vol. 2, p. 147.
5 Prokopios, Wars, vol. 3, ch. 11, l. 5.
7
“others” –usually people like the Arabs or the Persians. Likewise the
Arabs claimed that they never castrated and that their eunuchs were
prepared and purchased in Byzantium. It is interesting to compare
attitudes toward castration in Byzantium to those in China. In China
castration was practiced both as a punishment and as a route to a career.
It had to be publicly proven through the display of the severed organs. In
Byzantium castration was almost never used as a punishment and the
severed organs were not preser
vil,
and was never mentioned publicly.
Despite the rhetorical façade, however, we know that castrations
were performed in the Late Antique and Byzantine worlds. The seventh
century surgeon, Paul of Aegina, has left us a detailed description of a
testicular ablation, prefaced by the comment that he hated to have to
perform this surgery and only did so under pressure. Since castrations
were technically illegal, they were often billed as surgery to correct a
serious medical condition, hernia. It is quite possible that in fact this
practice was not exceptional.
Among the treatments that could result in castration was the repair
of both inguinal hernia, scrotal hernia, and umbilical hernia. Doctors began
with a less invasive attempt to cure hernias using compression and
bandages, but if this failed, physicians did resort to surgery. Paul of
Aegina describes a surgical technique that included cauterization. It was
probably reasonably effective and spared the testicles. Skilled surgeons
8
in the Hellenistic world had long understood these techniques, which can
be found in the writings of Celsus, a surgeon of the first century AD.6
Though testicle-sparing surgery for hernias continued to be
practiced in the Byzantine empire, practitioners were increasingly of the
opinion that castration was the best hope of curing hernia. This was
certainly true in Western Europe until the Renaissance, and was probably
true in the less urbanized parts of the Byzantine empire.7 This is the
inference we can draw from the many examples in Byzantine sources of
boys and men with hernias and ailments of the genitalia whose miraculous
cures saved them from the castrator. In the life of saints David, Symeon
and George of Mitilini on the island of Lesvos8 we find the story of Leo, a
friend of the holy man, who brought his youngest son to him for healing.
The boy was suffering from a hernia and was about to be turned over to
the castrator when he was saved by the saint, who healed him. The life
of St. Artemios offers a number of healing miracles involving male
genitalia.9 In the twenty-fourth miracle10 a man named George is urged to
see a doctor and have his testicles removed to heal a testicular disorder.
The saint heals him. In the twenty-eighth miracle,11 a child injures his
testicles and is cured by the saint. When his mother realizes that he has
been cured, she runs her hands along his thighs and assumes the cure
6 Niki S. Papavramidou and Helen Christopoulou-Aletras, "Treatment of "Hernia" in the
Writings of Celsus (First Century AD)," World Journal of Surgery, 29 2005): 1343 –
1347.
7 John G. Lascaratos, Constantine Tsiamis, Alkiviadis Kostakis, "Surgery for Inguinal
Hernia in Byzantine Times (A.D. 324-1453): First Scientific Descriptions," World Journal
of Surgery 27 (2003): 1165-1169.
8 J. van den Gheyn, Acta graeca SS.Davidis, Symeonis et Georgii Mitylenae in insula
Lesbo, AB 18 (1899): p. 240, l. 11.
9 Crisafulli, "The Miracles of St. Artemios"
10 Ibid., p. 145.
11 Ibid., p. 155.
9
involved removing his testicles. The forty-third miracle12 is similar. In the
forty-fourth miracle13 a man with diseased testicles is considering having
them removed but is healed by the saint. The saint appears to him in the
guise of a physician who did hernia surgeries. The saint bound up the
man's testicles with a cord, an action that mimicked one technique for
castration.
Thus there was in Byzantine culture an acceptable medical façade
that legitimized castration. Hernia certainly offered an excuse that could
be trotted out for rhetorical purposes. It is even feasible that hernia
problems were sufficiently prevalent to account for a significant number
of medically legitimate castrations. Just last year a group of Iranian
researchers published a study of 3205 elementary-school boys, aged 6 to
12 years.14 The subjects live in the province of Lorestan, which is
situated north and west of Tehran on the eastern slope of the Zagros
mountains. The boys were examined for abnormalities of the groin or
genitalia and abnormalities were found in 6.64% of the children. The
problems included hernia, retractile testes, undescended testes,
hydrocele, and hypospadia. This is a significant percent of this study
group. In the Byzantine world, with the exception of the child with
hypospadia (a condition in which the urethra does not exit the penis in a
normal way) any of these children who received medical treatment would
probably have been made eunuchs.
12 Ibid., p. 219
13 Ibid., p. 219.
14 R. A. Yegane, A. R. Kheirollahi, M. Bashashati, N. Rezaei, M. J. Tarrahi, and J. A.
Khoshdel, "The Prevalence of Penoscrotal Abnormalities and Inguinal Hernia in
Elementary-school Boys in the West of Iran," International Journal of Urology, v. 12, no.
5 (2005): 479-483.
10
A certain number of Byzantine eunuchs are identified as "natural
eunuchs" who presumably were not actually castrated. While these
individuals are rare in any culture, they do exist. They usually suffer from
genetic deformities that suppress the formation of external genitalia or
the utilization of testosterone. Ever since the publication of the Pulitzer
Prize winning novel Middlesex15 we have become more familiar with one of
these rare genetic conditions called 5alpha-Reductase Deficiency. In the
male it is the cause of male hereditary pseudohermaphroditism. During
fetal development, at the cellular level testosterone is converted to
5alpha-dihydrotestosterone and binds to a high-affinity receptor protein
in the cell nuclei. From embryogenesis through puberty 5alphadihydrotestosterone
is responsible for: (1) the development of the male
external genitalia, urethra, and prostate (2) at puberty, the growth of
facial and body hair and the maturation of the external genitalia (3) the
loss of scalp hair later in life. At birth individuals with this defect appear
to be girls or hermaphrodites with minimal male genitalia since they have
had little or no chance for the development of male genitalia during the
prenatal period. At puberty, however, the male external genitalia begin to
develop and these children are increasingly virilized. As children, if their
condition is not recognized, they are reared as females. After puberty,
when they develop noticeable male genitalia, some elect to live as infertile
males, following their chromosome makeup, others as females in
accordance with their rearing.
15 Jeffrey Eugenides, Middlesex: A Novel (New York: Picador, 2002).
11
In the Byzantine world individuals of this sort would be classified as
"natural eunuchs."16 In today's world, where infant and childhood
castration are no longer practiced, these individuals are the subjects of
much research, since their experience directly addresses questions about
the importance of nature versus nurture. Though most of these
individuals are reared as females, more than half of them elect to live as
males after puberty.17 For historians they serve as a research "stand-in"
for eunuchs.
Another group of potential "natural eunuchs" includes individuals
with the more severe forms of Klinefelter Syndrome. These men have the
usual 47 chromosomes, but have an added X chromosome (47XXY).
Today we know that about 1 in 1000 males are born with this genetic
anomaly, and it is a disorder that accounts for 3% of male infertility. Men
who are affected typically suffer from, in decreasing order of frequency:
infertility, small testes, decreased facial hair, gynecomastia, (the
development of small breasts) decreased pubic hair, and a small penis.
They have unusually long legs and may have a feminized body. In
adulthood, without diagnosis and androgen replacement therapy, they can
suffer from loss of libido, decreased muscle bulk and tone, decreased
bone mineral density, and a tendency to suffer from thromboembolism,
diabetes and cardiovascular complications. Most of these symptoms
16 Jean D. Wilson, James E. Griffin, and David W. Russel, "Steroid 5alpha-Reductase 2
Deficiency," Endocrine Reviews, v. 14, no. 5 (1993): 577-593; B. B. Mendonca, M.
Inacio, I. J. Arnhold, E. M. Costa, W. Bloise, R. M. Martin, F. T. Denes, F. A. Silva, S.
Andersson, A. Lindquist, and J. D. Wilson, "Male Pseudohermaphrodistism due to 17
Beta-hydroxysteroid Dehydrogenase 3 Deficiency. Diagnosis, Psychological Evaluation,
and Management," Medicine, v. 79, no.5 (Baltimore, 2000): 299-309.
17 P. T. Cohen-Kettenis, "Gender Change in 46,XY Persons with 5alpha-Reductase-2
Deficiency and 17 beta-Hydroxysteroid Dehydrogenase-3 Deficiency," Archives of Sexual
Behavior , v. 34, no. 4 (2005): 399-410.
12
match traits associated with eunuchs in our sources. In one regard,
however, they do not resemble eunuchs, who are often presented as
intellectually a
suffer from
cognitive deficits, especially in language comprehension, speech, and
gross and fine motor coordination18
In the Late Antique and Byzantine worlds natural eunuchs were
rarely identified as such. An exception to this, however, was the famous
second century eunuch Favorinus. Favorinus appears to have been born
with at lease one of the many androgen insensitivity syndromes described
above. He is described as a eunuch having a penis but no testicles.
Rather than hiding his affliction, Favorinus capitalized on his unusual
appearance and high voice, setting a new style for orators of the period.
He is the eunuch who is the subject of Lucian's The Eunuch.19
Unless some hagiographer or biographer wanted to clean up the
origins of a famous eunuch by citing accident or medical necessity, our
sources rarely say much about how a man became a eunuch. Thus there
is no way of knowing how many eunuchs there were in Byzantium at any
given time, nor can we know what percentage of them were "natural"
eunuchs as opposed to eunuchs who were the result of deliberate
castration.
However ambivalent our sources are about eunuchs, it is clear that
a significant number were deliberately castrated before puberty, when the
surgery is much easier and safer than later in life. Eunuchs castrated
18 Daniel J. Wattendorf and Maximilian Muenke, "Klinefelter Syndrome," American Family
Physician, v. 72, no. 11 (2005).
19 Maud
resentation in Ancient Rome,
(Princeton; Princeton University Press, 1995). p. 3.
13
before puberty or during early puberty developed a distinctive appearance
that, I would argue, was aesthetically favored at court. Here, too, modern
medical research supports some of the ambiguous evidence for
physiological distinctiveness. Individuals who suffer from extreme
testosterone deprivation develop a distinctive physical appearance.
During the neonatal period androgens react with growth hormones to
produce the male growth pattern that will emerge at puberty. At
puberty, after a quiescent childhood, growth and development begins
again. What triggers puberty is still a matter of conjecture.20
"In an uncastrated male puberty is characterized by a striking
increase in circulating testosterone, which is converted to
dihydrotestosterone, increases in circulating androgens associated
with an increase in muscle mass, enlargement of the testicles and
phallus, development of acne, and a male pattern of hair
development including facial hair, axillary hair, and pubic hair, as well
as an overall increase in the size and darkening color of most other
body hairs."21
At puberty various sex steroids mediate both the development and
maintenance of long-bone tissues and the development of the bones in
the face. Both estrogen and testosterone are important for this process,
and the lack of testosterone in eunuchs at puberty results in the
development of bone material that is porous. Since testosterone
regulates the circumference of the long-bones, in its absence they will
tend to be unusually thin and fragile, a condition I will come back to when
I discuss the aging of eunuchs. At the end of puberty testosterone
20 G. Bradley Schaefer, "Neuroendocrine and Neurophysiologic Changes of Adolescence,"
Cleft Palate-Craniofacial journal, v. 32, no.2 (1995): 95-98.
21 Ibid., p. 97.
14
regulates the closing of the epiphyseal (growth) plates in the long bones.
Lacking testosterone, these growth plates do not close promptly after
puberty. This is especially apparent in the long bones of the arms and
legs which, in a eunuch, appear to be unusually long compared to the rest
of the body.22 At the same time, in a eunuch, the bones of the jaw and
the part of the face that extends from the lower jaw to the ear tend not
to develop during puberty, creating an individual whose face appears to
be abnormally wide. In fact, its width is correct, since the measurement
between the eyes does not change from infancy. The eunuchoid face
appears to be wide because the lower face has not lengthened at
puberty. In our world of modern medicine, if a boy with a condition that
severely reduces the levels of his testosterone is diagnosed early enough
testosterone treatments will "normalize" facial growth in the vertical
dimension and will increase the anterior facial height.23
I am convinced that the Byzantines aesthetically appreciated the
appearance of boys at the cusp of puberty. Such boys were
stereotypically graceful, feminine without being female, and sexually pure.
Their skin was still clear, they had no beards, their voices were highpitched,
their faces, which had not yet taken on a masculine appearance,
were short and broad. Given the normal inevitability of puberty, these
22 D. Vanderschueren, L. Vandenput, and S. Boonen, "Reversing Sex Steroid Deficiency
and Optimizing Skeletal Development in Adolescents with Gonadal Failure, Endocrine
Development, v. 8 (2005): 150-165; M. K. Lindberg, L. Vandenput, S. Moverare, S.
Skritic, D. Vanderschueren, S. Boonen, R. Bouillon, and C. Ohlsson, "Androgens and the
Skeleton," Minerva Endocrinology, v. 30, n. 1 (2005): 15-25.
23 A. Verdonck, M. Gaethofs, C. Carels, and F. Zegher, "Effect of Low-dose Testosterone
Treatment on Craniofacial Growth in Boys with Delayed Puberty," European Journal of
Orthodontics , v. 21 (1999): 137-143; Ronald N. Spiegel, A. Howard Sather, and Alvin B.
Hayles, "Cephalometric Study of Children with Various Endocrine Diseases," American
Journal of Orthodontics, v. 59, n. 4, (1971): 362-375.
15
qualities were recognized to be ephemeral – present in a boy today and
gone from the young man tomorrow.
These are also the physical attributes of individuals who
transcended the pollution of the mundane physical world. Through
castration this aesthetic could be captured and preserved, at least for a
time. It is important that we not impose our cultural biases on the
Byzantine world. The eunuchoid face may not be desirable today, but it
seems to have had positive connotations in the past. Current
investigations of facial shape and its relationship to testosterone show
that, at least subconsciously, people notice facial shape as an indication
of "manliness." Women today, despite what we might assume, find
pictures of the faces of men who have very high testosterone levels to be
unattractive.24 The pubescent face of the Byzantine eunuch is readily
seen in the images of angels and youthful warrior saints in Byzantine art.
It is unmistakable in our one good portrait of a Byzantine eunuch, Leo the
Sakellarios.25 It is worth noting in this connection that Byzantine art
clearly contrasts that society’s two categories of non-reproductive
individuals. One, the ascetic holy man, is depicted with a long, narrow,
bearded face that would be typical of an individual with high levels of
testosterone. This reinforces the trope that says that holiness lies in
overcoming the pleasures of the world, including sexual pleasures. The
alternative image of holiness is the beardless, almost triangular eunuchoid
24 John P. Swaddle and Gillian W. Reierson, "Testosterone Increases Perceived Dominance
but not Attractiveness in Human Males," The Royal Society, Proceedings in Biological
Sciences, Nov. 2002: 2285-2289.
25 Die bibel des Patricius Leo: Codex Rginensis Graecus 1 B, ed. Suzy Dufrenne and Paul
Canart (Zurich, 1988), fol. 2v.
16
face we find in images of angels –beings by definition free of human
sexuality.
The use of castration to prolong youthful innocence is
complimented in Byzantine sources by the fact that they rarely talk about
the aging or death of eunuchs. For the Late Antique period, where our
sources are dominated by tales of evil eunuchs like Eutropius, we
occasionally learn how they died. Valentinian burned his chief eunuch in
the Hippodrome.26 Ammianus Marcellinus mentions Eutherius, whom he
considers an exception to the rule that all eunuchs are evil, who died in
comfortable retirement in Rome.27 Similarlty, not much is said about
eunuchs' health. An exception to this is found in Ammianus Marcellinus,
who describes "the throng of eunuchs beginning with the old men and
ending with the boys, sallow and disfigured by the distorted form of their
members."28 Ammianus is clearly making observations about the health
of eunuchs. There is also an intriguing tradition that compares a eunuch
to a rose – he is beautiful in youth, flowers, then withers and dries up. His
skin is compared to a crumpled, drying flower. He becomes wrinkled and
dried up with age. Themes like this appear in John Chrysostom's Vanity
of Vanities sermon on the eunuch Eutropius.29 This raises two interesting
questions. First, what can modern medical science tell us that might shed
light on the aging process among eunuchs, and second why do our later
Byzantine sources say so little about the end of life among eunuchs?
Recent advances in the treatment of prostate cancer have led to a
flood of relevant articles. Androgen destroying medications are now used
26 Eunapius of Sardis, Fragmenta historicorum graecorum, ed. K. Muller, vol. 4, n. 30.
27 Ammianus Marcellinus. Ed. and trans. John C. Rolfe. Vol. 1 (1935), XVI 7, 2-5.
28 Ammianus Marcellinus, vol. 1, 1935, XIV 6, 17.
29 PG 52, cols. 392-414.
17
to shrink the prostate and retard the growth of the tumor, a technique
that allows fragile elderly patients to avoid surgery. This has led to other
medical problems that appear to parallel those suffered by eunuchs as
they age. Osteoporosis is the most prominent. The bulk of adult bone
mass is laid down during puberty. If a child is castrated before puberty,
his chance of retaining sufficient bone mass to last into old age is slim.
Modern studies of prepubertal boys suffering from hypogonadism indicate
that with testosterone supplements bone mass can be rapidly laid down
during young adulthood.30 Conversely for elderly men treated with
androgen destroying drugs, bone mass is lost rapidly, even if it was
adequately laid down at puberty. The degree to which osteoporosis
might disable the Byzantine eunuch clearly depends on the age at which
castration took place. Chinese eunuchs, for example, seem not to suffer
from osteoporosis because they were usually castrated after puberty.
Since Byzantine eunuchs were castrated at a variety of ages, only some
of them would suffer from osteoporosis. Court eunuchs, were probably
castrated before puberty, both to preserve their youthful appearance and
to preserve their voices, which were valued in the imperial choirs.
Osteoporosis would be a serious problem for them. Peter Phocas,
however, a great eunuch soldier whose exploits on the field of battle are
described in several sources, was almost certainly castrated as an adult.31
For him osteoporosis would be a lesser issue, at least until extreme old
age.
30 Eishin Ogwa, Uriko Katsushima, Ikuma Fuiwara, and Kazuie Iinuma, "Testosterone-
Induced Changes in Markers of Bone Turnover in Adolescent Boys with Testicular
Dysfunction," Clinical Pediatric Endocrinology, v. 12, n.2 (2003): 81-85.
31 Leo the Deacon, Leonis diaconi Caloensis historie libri decem. ed. C.B.Hase, Bonn,
1828, pg. 107.
18
Elderly men treated with androgen destroying drugs often suffer
from weight gain, the result of a decrease in lean muscle mass and an
increase in fat. This is a phenomenon characteristic of castrated men and
animals. They also frequently suffer from anemia, perhaps explaining why
Ammianus Marcellinus describes eunuchs as sallow. With anti-androgen
therapy the body's metabolism changes, especially its sugar metabolism.
There is a rise in insulin indicating a decrease in insulin sensitivity, leaving
low androgen individuals at risk for diabetes. Recently scientists are
learning that there may be associations between low androgen and heart
and circulatory problems. Lack of androgens seems to lead to a stiffening
of the arteries as indicated by elevated blood pressure. In studies based
on castrated rats, lack of androgens leads to serious heart problems.32
As interesting as the physiological results of castration may be, the
most intriguing questions that modern medical science may help us with
involve the cognitive skills and personality of eunuchs. Today there is a
great deal of interest in the effect of gonadotrophic hormones on
puberty. This has been driven by the observation that some neurological
32 L. X. Oian, L. Hua, H. G. Wu, Y. G. Sui, S. G. Cheng, W. Zhang, J. Li, and X. R. Wang,
"Anemia in Patients on Combined Androgen Block Therapy for Prostate Cancer," Asian
Journal of Andrology, v. 6, n. 4 (2004): 383-384; T.
K. Takahashi, "The Influence of Androgen Deprivation Therapy onvesal_mas (imported) wrote: Sat Jan 26, 2008 2:27 pm Nishiyama, F. Ishizaki, T. Anraku, H.
Shimura, and
Metabolism in Patients with Prostate Cancer," Journal of Clinical Endocrinology and
Metabolism, v. 90, n. 2 (2005): 657-660; K. L. Golden, J. D. Marsh, Y. Jiang, and J.
Moulden, "Gonadectomy Alters Myosin Heavy Chain Composition in Isolated Cardiac
Myocytes," Endocrine, v. 24, n. 2 (2004); 137-140; J. C. Smith, S. Bennet, L. M. Evans,
H. G. Kynaston, M. Parmar, M. D. Mason, J. R. Cockcroft, M. F. S
ypogonadism on Arterial Stiffness, Body Composition, andvesal_mas (imported) wrote: Sat Jan 26, 2008 2:27 pm canlon, and J. S. Davies,
"The Effects of Induced H
Metabolic Parameters in Males with Prostate Cancer," Journal of Clinical Endocrinology
and Metabolism, v. 86, n. 9 (2001): 4261-4267; M. R. Smith, "Changes in Fat and Lean
Body Mass During Androgen-deprivation Therapy for Prostate Cancer," Urology, v. 63, n.
4 (2004): 742-745; F. Debruyne, "Hormonal Therapy of Prostate Cancer," Seminar on
Urology and Oncology, v. 20, n. 3, supl. 1 (2002); D. Baltogiannis, X. Giannakopoulos, K.
Charalabopoulos, and N. Sifikitis, "Monotherapy in Advanced Prostate Cancer: An
Overview," Experimental Oncology, v. 26, n. 3 (2004): 185-191.
19
diseases, like schizophrenia, appear at puberty, and by the elevated death
rate of teen-agers in much of the world. Scientists have begun to ask
whether the use of steroids by young athletes or the delayed puberty
found among gymnasts and ballet dancers can effect the development of
personality and adult behavior.33 Studies of animals indicate that, in many
species, the neurotransmitter systems of the brain, and especially the
pre-frontal cortex, are significantly remodeled during puberty. In humans
this rearrangement is thought to be connected to adolescent changes in
decision-making, risk taking, planning, drug sensitivity and reward
incentive. Clearly, a male who fails to go through puberty will not have a
typically masculine personality – an aspect of the Byzantine eunuch that
is noted in many sources.
Scientists are still not clear about exactly what triggers puberty in
humans. It seems to be related to GnRH, a decapeptide produced by
specialized neurons in the hypothalamus. These act on the pituitary,
causing it to release LH and FSH which make the testes and ovaries
develop. These then release hormones that act on the brain. Obviously
this has serious implications for those eunuchs who are castrated before
puberty. Since they lack testes this circular hormone-driven system
cannot develop. To what extent might castration reshape these eunuchs'
mental processes and personalities? Perhaps the pejorative writings that
say that eunuchs have personalities that differ from those of testiculated
men should be given some credence.34
33 Russell D. Romeo, Heather N. Richardson, and Cheryl L.Sisk, "Puberty and the
Maturation of the Male Brain and Sexual Behavior: Recasting a Behavioral Potential,"
Neuroscience and Biobehavioral Reviews, v. 26 (2002): 381-391.
34 L.P. Spear, "The Adolescent Brain and Age-related Behavioral Manifestations,"
Neuroscience and Biobehavioral Review, v. 24 (2000): 417-463; C. L. Sisk, and D. L.
20
The most obvious neural developments that are of interest
regarding eunuchs are those that shape sexual behavior. The neural
circuitry that differentiates males from females is laid down during the
prenatal period. At puberty, however, the gonadal steroids both activate
and further organize this neural circuitry. If this does not take place, no
amount of hormone replacement or sexual experience can reverse this
deficit. This is clear in modern studies of animal models. Those castrated
before puberty never become sexually active, nor do they develop
behaviors that are associated with mating behavior, even if they are
treated with hormones. Those castrated after puberty, if treated with
hormones, develop some measure of sexual behavior. The ancients
realized this,35 even though they rarely make a linguistic distinction
between eunuchs castrated before puberty and those castrated after
puberty – at least they do not make a distinction that we can detect.
Leaving aside sexual behavior, which is fairly obvious, does lack of
normal puberty in the pre-pubertial castrate lead to any other differences
in cognitive ability or personality? Studies using tests that target the
orbital prefrontal cortex, an area that is extensively remodeled at puberty,
show that men with low levels of testosterone approach problems in a
careful, conservative way and resist the temptation to take chances.36
They also perform better when faced with spatial tasks, and may have
Foster, "The Neural Basis of Puberty and Adolescence," Nature Neuroscience, v. 7, n. 10
(2004): 1040-1047.
35 See, for example, Alexander of Aphrodisias, Problematum physicorum et medicorum
eclogae. Libri 1-2. In Physici et medici graeci minores, ed. J. L. Ideler, vol. I: p. 8, sec. 9.
1841-42. (Reprint, Amsterdam, 1963).
36 Rebecca Reavis and William H. Overman, "Adult Sex Differences on a Decision-Making
Task Previously Shown to Depend on the Orbital Prefrontal Cortex," Behavioral
neuroscience, v. 115, n. 1 (2001): 196-206.
21
superior mathematical ability.37 In rats lack of testosterone leads to an
increased fear response.38 These reflect characteristics attributed to the
Byzantine eunuch. He is credited with having certain specific intellectual
gifts and assumed to be "cowardly" in his behavior. As to the eunuch's
personality, modern neurosciences do not as yet offer enough information
for us to make any inferences. There is speculation, however, that during
adolescence a network develops in the brain that regulates the processing
of social information. If this regulatory process does not develop and
work properly, an individual can develop mood and anxiety disorders.39
It is easy to assume that the pejorative language that our sources
use about eunuchs reflects a social world that is dominated by masculine
values and thus devalues anything or any one who exhibits traits that
might appear to be feminine. It is also easy to assume that this
pejorative language has its roots in envy. Yet medical science offers
insights that urge us to reevaluate some of the rhetoric that our sources
use about eunuchs. To some Byzantine observers they appear to be
unhealthy and deformed. To others they exhibit youthful grace and
beauty. Both are medically possible, reflecting stages in a eunuch's life.
It is clear that many Byzantine observers find eunuchs' personalities
disagreeable. Given what medical science can tell us so far, it is quite
possible that many eunuchs had immature, unstable personalities.
37 Catherine Gouchie and Doreen Kimura, "The Relationship Between Testosterone Levels
and Cognitive Ability Patterns," Psychoneuroendocrinology, v. 16, n. 4 (1991): 323-
334.
38 J. A. King, W. L. De Oliveira, and N. Patel, "Deficits in Testosterone Facilitate Enhanced
Fear Response," Psychoneuroendocrinology, v. 30, n. 4 (2005): 333-340.
39 E. E. Nelson, E. Leibenluft, E. B. McClure EB, and D. S. Pine, "The social re-orientation
of adolescence: a neuroscience perspective on the process and its relation to
psychopathology," Psychological Medicine, v. 35, n. 2 (2005): 163-174.
22
In any case, it is clear that the Byzantine eunuch is different from a
normal man. His is a constructed gender category, and he, himself, is the
result of a deliberate act of creation, an act of man rather than of God.
This leaves us with a wealth of questions that can still be asked about the
Byzantine eunuch. To what extent did Byzantine society consider
castration to be a creative act? To what extent did the Byzantines
understand the importance of the age at which castrations took place?
Did they create eunuchs specifically for particular social roles – perfect
servant, skilled warrior, bureaucrat, attractive court decoration, etc.?
Why are the Byzantines so reluctant to talk about castrations, eunuchs'
medical problems, their deaths? Is it because eunuchs are perceived to
be created beings who are ephemeral, who live outside the normal human
life cycle of birth, reproduction, and death, with the result that these
facets of their lives cannot be mentioned? What does all of this suggest
about the Byzantines' attitudes about what is natural and unnatural,
whether it is morally right to manipulate a mans' body and use it to create
something new? Finally, what does it tell us about the Byzantines'
attitude toward sexuality? If we are to judge by the presence of eunuchs
in Byzantine society, sexuality is a privilege, not a right. It is something
that can legitimately be dispensed with in order to achieve higher spiritual
and aesthetic goals.