The Paris Review

One Word: Castration

Anonymous, Non biedt kat vis aan in ruil voor penis (detail), 1555

We defend ourselves not against castration anxiety but against death, a far more absolute castration.

—Ernest Becker, The Denial of Death

The university library at my medical school was shared with students of veterinary medicine. Sometimes I’d find myself at a desk opposite one of the vet students; we’d glance at one another’s textbooks with curiosity, occasionally open at the same subjects—hematology, say, or orthopedic surgery. It was reassuring to see how much common ground there was between medicine for humans and medicine for animals.

One day, I was revising prostate cancer: the appearance of its malignant cells under a microscope, the stages of its spread, the radiotherapy, brachytherapy (embedding of radioactive pellets into the tumor), and standard chemotherapies used to treat it. In health, the prostate gland stores semen and mature sperm; it has strong muscular walls that squeeze during ejaculation. Exposure to a lifetime of testosterone increases the growth of the gland as well as its susceptibility to cancers. Many treatments for prostate cancer work by blocking testosterone’s generation within the testicles—with no testosterone, the growth of the tumor slows.

“All that

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