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Orchiectomy For Transsexuals

 

 

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.

 

How can orchiectomy benefit a transsexual who is going to have her testicles removed in her future SRS surgery anyway?

 

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.

 

 

How can orchiectomy save me any money, especially since my SRS surgeon wonít give me a discount for having this done before my SRS?

 

Chances are, your SRS surgeon will indeed charge the same price for your SRS whether or not youíve already had an orchiectomy.Iíve 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 youíve 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 Iíve 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 werenít 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 Iíve been able to use the funds for electrolysis and hair replacement.I donít make much money at the chicken plant, yet Iíve practically completed facial electrolysis, obtained hair replacement, and legally changed my name less than four years after my castration.

 

Even if youíve 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.

 

 

How much should I reduce my hormone dosage after my orchiectomy?

 

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.

 

 

Will I still need Spironolactone or any other androgen suppressor after orchiectomy?

 

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 arenít that bad, Iíve 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.)

 

 

Would an orchiectomy be good for my health?

 

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 thereís 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.

 

 

Will an orchiectomy cause further feminization of my appearance?

 

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.

 

 

If I am already on HRT, will I feel even better after an 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 youíve already had an orchiectomy, the effects on your feelings from estrogen loss should be less traumatic because thereís no possibility that your body would resume testosterone production.

 

 

Since I am already taking estrogen, do I still need something to prevent my body from becoming any more masculine?

 

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.

 

 

Will an orchiectomy now prevent my SRS later, or would it affect my SRS results?

 

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. Spectorís 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 whoís 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 I will certainly have SRS, should I have an orchiectomy now, or would it be better to just have everything done in one surgery?

 

If you think you will have your SRS in one year or less, then orchiectomy would have little benefit for you.If you donít 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.

 

 

If I donít plan on having SRS, can I still obtain an orchiectomy?

 

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 Ďnot really a TSí.The objective of this process is not to measure up to someone elseís 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.

 

 

If I am not on hormones, can I still have an orchiectomy?

 

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 just had my orchiectomy, and now I have suddenly lost the desire to transform (or transition) any further.How common is this?

 

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 Iím 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 canít get any doctor to prescribe estrogen for me without a letter from a therapist.Will a doctor be willing to provide estrogen for me if I get the orchiectomy first?Would a therapist write a letter just because Iíve had an orchiectomy?

 

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 donít 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.

 

 

Will orchiectomy feminize me even if I donít take HRT?

 

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.

 

 

If I have an orchiectomy now, will it cause me to lose the ability to orgasm either now or after SRS?

 

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.

 

 

It will be years before I can save enough money for my SRS.Will an orchiectomy enable me to change the gender marker on my legal documents such as birth certificates, passports, Social Security records, and my drivers license?

 

I have addressed this issue on a separate essay page at:

Changing Legal Documents After Orchiectomy?

 

 

What if I am not sure I want to permanently remove my testicles?

 

Do not seek orchiectomy or SRS until you are sure that your life will be better without testicles.Back in 1999 I wasnít 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 ĎCastration and Mutilation Fetishesí.

Effects of CastrationTaking 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 FactorsMore 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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