It can be argued that genital surgery to males to alter their sexual role goes back many thousands of years, with numerous well-documented examples of eunuchs created by bilateral orchidectomy. It is recorded, for example, that Alexander the Great took at least one eunuch as a sexual partner. It is unlikely that all of these people chose to be surgically castrated, but for some it may have been a free choice. This practice continues today in India, where there is a group of biological males who are brought up in the female role, and who are surgically castrated in adolescence. The penis and scrotum are usually removed with the testes. Many of these people work as ‘female’ prostitutes, and usually live in communities with others who have undergone castration.