I
have written this page for persons who are seeking treatment for gender issues,
and are considering orchiectomy as part of their treatment plan. All of my other pages have dealt with general
castration issues pertaining to anyone with or without gender issues. Those with gender issues will generally have
the same effects and share many of the issues as non-transgendered men. However, there are a number of issues unique
to those of us transitioning from male to female, and I hope this page will
address those issues.
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A personal update on me: May 4th, 2005:
Six
years after my orchiectomy, I finally have an SRS date. Now that I am actually scheduled for SRS
later this year, I do sometimes worry about how my orchiectomy might affect my
SRS results. Dr. Kamol himself has
admitted to me that my vaginal depth will be less than six inches because my
scrotum has had so much time to shrink.
However,
I am still grateful to the doctor who performed my orchiectomy for me in
1999. My orchiectomy has made my
transition so much easier, plus I was able to begin experiencing the serene
feelings from testosterone reduction six years sooner than if I had waited
until SRS. Without the financial
benefits of my orchiectomy, my wait would have probably been even longer than
the six years it has taken me to effect a successful transition and save for my
SRS.
I
still could not have endured another six or more years of testosterone
poisoning and the associated miserable feelings just to obtain an additional
inch or two of vaginal depth, which almost nobody will ever see anyway. Besides, my first priority in SRS results
will be appearance, followed by function, with depth being my lowest priority.
So
I continue to feel that having my orchiectomy before I even started HRT was one
of the best decisions I have ever made in my life.
Another personal update on me: April 29th, 2006
It
turns out that I needed a skin graft taken from my tummy for adequate vaginal
depth and satisfactory SRS results.
Despite paying this price for the benefits of my orchiectomy in 1999, I
still have no regrets for having had an orchiectomy. If I were to go back to the year 1998 and retain
foreknowledge of everything that was going to happen over the next eight years,
I would again have my orchiectomy early in my transition. For more information, read my Orchiectomy
OK Before SRS? page.
If
you anticipate having your SRS surgery in one year or less, the potential
benefits of removing the testicles beforehand may not be worth the cost of the
surgery. On the other hand,
many transsexuals will not be able to finance their SRS for years to come. In addition, there are many non-op
transsexuals and transgenderists who do not plan on
having a complete SRS procedure. Less
often, a transsexual will be unable to obtain SRS due to medical problems that
may prohibit her surgery for the balance of her lifetime.
Whether
or not orchiectomy will benefit you depends largely on how long it will be
before you have your SRS surgery, or whether or not you will have it at
all. The longer you will take to obtain
your SRS, the more you might benefit from having an orchiectomy in the near
future.
As
long as you retain your testicles, you face the issues of:
1.
Increased amounts and monetary costs of feminizing HRT.
2.
Increased health risks from your increased consumption of hormones.
3.
Partial hindrance of feminization from your HRT.
4.
A risk of future masculinization of your
body, especially if you discontinue your feminizing hormones.
Chances
are, your SRS surgeon will indeed charge the same
price for your SRS whether or not you’ve already had an orchiectomy. I’ve heard of one or two surgeons who will
give you a small discount, but most surgeons will not. Indeed, one surgeon (Dr. Suporn) will charge
you an increased price if you’ve had an orchiectomy and will apparently take a
couple more hours to perform your surgery.
One
exception to this is the SRS surgeon Dr. Schrang in
Wisconsin. If he performs your
orchiectomy and then you later return to him for the rest of the SRS procedure,
he will discount half of what he charged you for the orchiectomy, but this does
not apply if another doctor performed your orchiectomy.
However,
an orchiectomy should have a dramatic effect on your HRT expenses. The pre-op transsexual who has not been castrated
needs to take an increased amount of estrogen to offset the testosterone that
her body would still produce. More
significantly, she will probably have to take a medication to suppress the
testosterone that her body would produce, and these medications cost quite a
bit more than the hormones themselves.
Because of increased health effects and greater health risks, women who
take androgen suppressors require more frequent laboratory testing.
As
an example, I can obtain 2mg Estrace tablets from my
nearby Wal-Mart for less than $30 per 100 tablets, which will supply my daily
HRT for more than three months. I do not
take any additional medications for suppressing testosterone.
Were
I not already castrated, I would need to take at least twice as much estrogen
and probably not have the same amount of effects that I’ve experienced in both
my physical appearance and mental state.
In addition to that, I would have to take expensive Spironolactone
to counter the testosterone in my body.
My friends tell me that only 50mg of Spironolactone
daily would cost around $30 per month, and many pre-ops need to take 100mg or
200 mg per day. As if that weren’t bad
enough, my doctor would need to perform more frequent lab testing, especially
if I were on Spironolactone, at the cost of about
$200 per test. Some endocrinologists
charge even more for these tests, and I am told that HRT with one doctor in
Tulsa costs more than $700 for three months of treatment.
I
had my orchiectomy a couple of years before I even started HRT, so I never
required the more expensive amounts of medication. I easily pay less than 20% of what HRT would
cost me had I not already been castrated, and less than 10% of what many
pre-ops are now paying for their HRT.
These immense savings have permitted me to move my transition timetable
forward by many years, because I’ve been able to use the funds for electrolysis
and hair replacement. I don’t make much
money at the chicken plant, yet I’ve practically completed facial electrolysis,
obtained hair replacement, and legally changed my name less than four years
after my castration.
Even
if you’ve already transitioned to being yourself full time, orchiectomy would
enable you to save for your SRS more quickly.
An orchiectomy could save you enough much money to pay for itself in
only one or two years.
You
will need to ask your hormone doctor about this. You will probably cut your estrogen dose by
at least half, and many of us completely discontinue androgen suppressors after
orchiectomy or SRS.
I
take only 2mg Estrace per day, which is a common dose
for a post-op but well below what a pre-op would need. I do not take any progesterone or any
androgen suppressor. Even this low dose
has had effects on my physical appearance, and even more effect on my mental
state.
Most
of us discontinue these medications after orchiectomy. However, our adrenal glands will still
produce a small amount of testosterone after orchiectomy, and some transsexuals
wish to suppress even this last little bit.
Some of us may desire a small amount of an anti-androgen to deal with
body hair. Others may take Finasteride
or Dutasteride to prevent further loss of head hair
or attempt to regrow a little bit. There is even a possibility of further hair
loss just from the little bit of adrenal testosterone. Some non-transsexual females have to deal
with thinning hair or even balding, so realize that hair loss might still be
possible even after orchiectomy or SRS.
You want to be certain that you will not lose any hair after you totally
discontinue your androgen blockers. If
you find that you still need Spironolactone after orchiectomy, you should only
need a small dose.
My
own hormone doctor has actually offered me a small dose of Spironolactone to
see if it would reduce my body hairs. I
have declined this and I am pretty sure I will not take any androgen
suppressor, because my body hairs aren’t that bad, I’ve have some decrease in
body hairs already, and my arm hairs are fine and thin enough that they do not
affect my ability to pass or blend in with other women. I have determined that it would be cheaper to
get additional electrolysis for arm and body hair than to take expensive
medication for it. Besides, the effects
of Spironolactone on body hair would be uncertain, while a competent electrologist could certainly eliminate unwanted hair.
Orchiectomy
alone did halt further loss of my head hair, but my own hair loss had already
progressed too far for androgen blockers to be of any significant benefit. I obtained a hair replacement system shortly
before I made my social transition, and I will need to use these systems until
medical science can actually reverse hair loss after it has already happened.
(Note: those of you outside the US may also be able to
obtain Androcur for testosterone suppression.)
An
orchiectomy for a pre-op would almost certainly benefit her health, especially
if it will take many years for her to finance SRS. Hormones and androgen suppressors do have
some risks of heart disease, stroke, and some cancers. These health risks are relatively small, and
the benefits we receive from these medications are more than worth the risks
that we take. But why take more risk
than necessary, especially since there’s a small chance you could end up with a
medical condition that would prevent your future SRS? An orchiectomy would permit you to have all
of the same (if not more) benefits at reduced risk to your health.
Probably. If your body can no longer produce
testosterone, your estrogen medication can work unhindered even if you reduce
your doses. Many post-ops have reported
additional feminization after their SRS, and this particular benefit can be
obtained by orchiectomy alone.
My
hormone doctor started me on only 1mg Estrace in November of 2001. After ten months he increased my dose to 2mg
daily. Even the former dose had
noticeable effects because I already had my orchiectomy.
I
cannot testify directly about this because I had my orchiectomy more than two
years before I commenced my own HRT.
However, others have told me that they did feel better after orchiectomy
even though they were already taking estrogen and Spironolactone.
One
other thing I should mention is that you will almost certainly need to
temporarily discontinue your hormones before your SRS. If you’ve already had an orchiectomy, the
effects on your feelings from estrogen loss should be less traumatic because
there’s no possibility that your body would resume testosterone production.
Estrogen
will probably slow down the masculinization of your
body, but testosterone in your body may still have some masculinizing
effects on your body. If it will be many
years before your SRS or if you do not plan on having SRS at all, then leaving
your testicles intact could result in unwanted effects such as masculinization of facial features, body hair, and loss of
head hair. In addition, you face an
increased risk of a health problem which might require you to discontinue your
estrogen, and that may allow your body to resume full testosterone production.
I
hope you never have to cease taking estrogen for any reason, but if you should
ever be so unfortunate, an orchiectomy would ensure that your body would never
produce testosterone again or revert back to the masculine. I do sleep well knowing that my testicles are
gone and that my body is now incapable of producing significant amounts of
miserable male hormones.
This
depends on how your orchiectomy is done.
If the incision through your scrotum is done properly, then the surgery
itself should have little or no effect on your SRS outcome. You will need to make sure that your
orchiectomy surgeon does the procedure properly keeping your future SRS in
mind. Still, many of Dr. Spector’s patients have later obtained SRS with no problem.
Preserving
scrotal tissue is the main issue. Dr.
Suporn states on his website that he may decline to perform SRS on a patient who’s scrotum has been damaged by improper orchiectomy. Even those who have practically destroyed
their scrotum by attempts at do-it-yourself castration can usually find a
surgeon who will perform their SRS, although they will likely have reduced
vaginal depth or reduced quality of appearance.
If you go to a qualified doctor who has experience with transsexual orchiectomy, you should have no problems with SRS later on.
Orchiectomy
may result in the shrinkage of the remaining male genitals, especially the
scrotum. On the other hand, HRT may also
cause such shrinkage, and you will almost certainly need to take HRT for at
least one year before your SRS anyway.
This is something to consider, but a properly done orchiectomy should
have little if any effect on your SRS later on.
Update April 29th, 2006:
I
ended up needing a skin graft taken from my tummy skin for adequate vaginal
depth. However, I still feel that
orchiectomy before SRS was right for me, and I have no regrets about my
decision. Orchiectomy before SRS has
both pros and cons for each person, and you need to determine for yourself
whether or not the pros outweigh the cons for you. For more on the issue of shrinkage and SRS
results, read my Orchiectomy OK Before SRS? page.
If
you think you will have your SRS in one year or less, then orchiectomy would
have little benefit for you. If you
don’t think you can afford SRS for three years or longer, the advantages may
outweigh the costs, and you will likely save at least as much money as you
spend on the surgery.
Absolutely yes. If you are not going to have SRS, then your
choice is either orchiectomy or the disadvantages of retaining your testicles
for a lifetime. Many TS/TG women who do
not get SRS do eventually obtain an orchiectomy. A few SRS surgeons may offer orchiectomy as an
alternative to complete SRS. There are
even some transgendered women who obtain an orchiectomy and then never
transition or do anything else about their gender issues.
How
far you transform or transition, and how much surgery you have should be your
decision alone and a decision based on what you will be the most comfortable
with. Never do something or go through
any procedure simply because certain TSs insist that
anyone not having such procedures are ‘not really a TS’. The objective of this process is not to
measure up to someone else’s standards of who is real, but to attain the
standards of your own personal comfort.
Go as far as you need to attain personal comfort and congruency, and no
further.
An
orchiectomy is still possible if you have not yet started HRT. I know because I had my castration more than
two years before I commenced my own HRT.
However, this will be a little tricky.
You will have far fewer options of surgeons who would be willing to
remove your testicles. Indeed, you will
have only the same options and the same circumstances as the non-transgendered
man who seeks castration to relieve himself from his oppressive libido. If you are not on HRT, then the only option
for an orchiectomy surgeon that I know of in North America is Dr. Kimmel in
Philadelphia. You may have additional
possibilities in Thailand.
If
you do not take any hormones after your orchiectomy, you will risk
osteoporosis. There may also be other
health risks from not taking hormones after orchiectomy. You must be certain that the effects of
orchiectomy will be worth whatever risks you take. Without any HRT you will have the same effects
and all of the issues as a non-transgendered man.
I
have recently heard about a few transgendered women who obtained enough relief
after orchiectomy that they did not plan to continue their transition
process. Brianne has posted a
webpage about her surgery and her feelings afterwards that she was no longer
interested in further transition. I have
corresponded with another recent orchiectomy patient who is considering the
discontinuation of her process toward transition even though she was already on
HRT.
Many
TG/TS women who have E-Mailed me while considering orchiectomy or who had
already scheduled the surgery in their near future have not written to me since
their surgery, so I’m not sure exactly how often the patient obtaining
orchiectomy had enough relief from just getting rid of testosterone that they
needed to transition no farther. I do
get to follow the progress of other sisters on mailing lists, and some sisters
did contact me again sometime after the surgery. It seems to me that a large majority desired
to continue their process despite feeling tremendously relieved for not having
testosterone in their bodies any longer, and many continued all the way to
their SRS surgery.
Another
thing one must consider is that gender issues have a tendency to feel more and
more demanding as the person with such issues ages. So I think there is a possibility that the
transsexual or transgendered person who feels content with herself as is just
after her orchiectomy today might end up resuming her transition process years
later.
Looking
back at the last several months prior to my own orchiectomy in 1999, when I was
not on any HRT and had done nothing else at all toward transition, I do recall
wondering if I myself might be content with only an orchiectomy. I actually hoped that I could get relief from
just castration, and then go on with my life and forget about gender
issues. What actually happened was that
I did feel tremendous relief as my testosterone levels plummeted following my
surgery, but all the underlying gender issues seemed to remain. Only two months after my castration I sought
to make contact with other transgendered persons, and before long I found
myself subconsciously conserving funds with the foreknowledge that I would need
lots of money for electrolysis and other major expenses of transition. Eventually I did end up transitioning in
December 2002, which was 3 years and 8 months after my orchiectomy.
The
way I see it, getting the orchiectomy did not cure my gender issues, but it did
buy me a little time to deal with those issues.
The true cure for my gender issues was to alter my appearance toward the
feminine, and then to socially and legally transition. Now I feel a lot more content with my life,
though I still need to get rid of the other remaining male parts.
So
what if you feel enough contentment to discontinue your transition
process? I would suggest that you do
stop wherever you are, but be open to the possibility that you might end up
resuming your journey years from now.
I
can testify from personal experience that an orchiectomy will probably not
provoke a doctor or therapist into providing your HRT.
I
went without HRT for more than two years after my own orchiectomy. Every so often a concerned
TS would suggest that otherwise unwilling endocrinologists might grant me
estrogen because of my hypogonadal status, or that a
therapist might instantly grant me a letter for HRT. I eventually had to seek a letter from a
therapist who was already familiar with my gender issues. Until I had the letter, doctors still
declined to prescribe estrogen for me.
Doctors
and especially therapists tend to resist blackmail. I don’t know of any TS or TG who was able to
obtain estrogen without a therapist letter just for having had an
orchiectomy. On the other hand, a
transsexual once reported to me in E-Mail that her therapist threatened to discontinue
therapy and not help her any more if she went and obtained an orchiectomy.
Orchiectomy
surgery should be done for personal comfort, not to pressure a doctor or
therapist into providing hormones or other treatment. Having had an orchiectomy and not being on
HRT might get sympathy and concern from other TG/TS sisters, but this strategy
seems to have no such effect on doctors and therapists.
The
elimination of testosterone by itself will probably have some feminizing
effects, but not as much as if you take estrogen afterwards. You may experience some changes in fat
distribution toward the feminine and some softening of your skin and
features. You will notice many internal
changes such as greatly decreased libido, freedom from the oppressive male sex
drive, and a general serene feeling about life.
But you will probably not experience any significant breast development.
Even
the changes you do experience would be more pronounced if you took
estrogen. After two years of no
hormones, I started taking estrogen and experienced breast development, further
softening of skin and facial features, and an enhancement of my feelings of
serenity and contentment.
I
advise many non-transsexual men who are considering orchiectomy to realize that
not only will their sex drive drastically decrease, but they may totally lose
the ability to orgasm. This same truth
also applies to transsexuals and transgenderists. Each person will have a different individual
response to the elimination of testosterone from their body.
Many
people who are considering orchiectomy, not only non-transgendered men but also
transsexual women, have been asking me in E-Mail whether or not they will still
have any ability at all to orgasm. I
cannot predict what your individual sexual effects of orchiectomy will be,
neither can I tell you whether you will have some degree of ability to have
orgasms or end up being completely unable to have orgasms.
Before
you have any degree of surgery on your genitals, whether a mere orchiectomy or
the complete SRS procedure, you must understand that there is a risk that you
might never orgasm ever again. Even if
you have not had an orchiectomy prior to your SRS, you must still consider the
possibility that you might not be orgasmic after SRS. Would you regret your
surgery if you turned out to be one of those individuals who could not have any
orgasm afterwards? If you would
regret orchiectomy or SRS in the event of inability to orgasm, then you should
not seek genital surgery.
I
hate to report that six years after my orchiectomy, and more than three years
on estrogen, I still have occasional orgasms in my sleep, sometimes with
erections and sometimes without. But my
own individual effects of orchiectomy do not guarantee that you will have the
same effect, and they do not guarantee that you will have any function.
If
you do continue to be orgasmic after orchiectomy, there will probably be
changes afterwards such as less frequent orgasms, feeling a lot less demand for
them, and taking longer to reach orgasm.
I
do understand that almost all transsexuals wish to have sexual function and the
ability to orgasm after their SRS, and some transitioners
claim that remaining orgasmic all the way until SRS increases the chances of
being orgasmic post-op. If you do have
SRS, I hope that you will end up being able to sexually function and be
orgasmic. Competent SRS surgeons will
try their best to create functional female genitals for you, and give you the
best odds possible of being orgasmic after your surgery. I myself have chosen a surgeon who has had
his patients testify that they were functional and orgasmic after surgery.
But
I completely understand that no matter which surgeon performs my surgery, there
is a chance I might never be functional.
If I do end up with non-functional female genitals and an inability to
orgasm, for me that would still be a dramatic improvement over the remaining
parts that I now have. I hated the way
my male parts functioned, and easily determined that no function was far better
than male function.
Do
strive for post-op function and orgasmic ability, but ask yourself whether
non-functional female parts would be preferable to what you have now. Before you seek any irreversible genital
surgery, be certain that your quality of life post-op will be better than what
it is now, whether or not you will be functional after such surgery.
I
have addressed this issue on a separate essay page at:
Changing Legal
Documents After Orchiectomy?
Do
not seek orchiectomy or SRS until you are sure that your life will be better
without testicles. Back in 1999 I wasn’t
yet sure just what I would do about my own gender issues, but I was in fact
certain that my life would be a lot better if I had an orchiectomy. It is imperative that you know for sure that
you will feel better after orchiectomy than you do without it. To learn more about orchiectomy, read my
pages about:
Why have
an orchiectomy? I would particularly encourage you to read
under ‘Castration and Mutilation Fetishes’.
Effects of
Castration Taking estrogen would
prevent osteoporosis and maybe prevent hot flashes, but otherwise you will have
to accept all of the effects of castration, both the advantages and any
disadvantages.
Castration Factors More things to consider before you have this
irreversible surgery.
I
do hope that orchiectomy will become more of an option for transsexuals and the
transgendered. It should not be
mandatory for transition, because of its permanency, but I do wish that this
option were more easily available because I myself have benefited from it so
much. Not only did I transition more
effectively because of it, but I also transitioned sooner than I would have
without it.
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