Doctors who will perform *informed consent* orchiectomies *without any* letters

[Futurist]

I live in New Zealand and I had the orchie done 21 years ago.  The surgeon was elderly then so I don't think he would be any use to you.

Out of pure curiosity--is he already dead or simply retired right now?

[Miyuki]

Umm... have you considered just taking anti-androgens? There is a reason most surgeons will not perform an orchi without a letter, and that's because they don't want to do something irreversible to you that you end up regretting. If you talk to a gender therapist and approach things as someone who is non-binary who wants to move toward being more feminine without fully transitioning, you should be able to get a referral to an endocrinologist that can put you on an HRT regimen focused on getting your testosterone in the castrate range.  And then in a year if you feel like the results are what you wanted, they should be able to give you a letter for surgery anywhere you'd like. I don't understand why you'd want to have an orchi without trying anti-androgens anyway. Don't you think it would be better to know how you feel with castrate levels of testosterone before you have an irreversible surgery?

[Futurist]

Umm... have you considered just taking anti-androgens? There is a reason most surgeons will not perform an orchi without a letter, and that's because they don't want to do something irreversible to you that you end up regretting. If you talk to a gender therapist and approach things as someone who is non-binary who wants to move toward being more feminine without fully transitioning, you should be able to get a referral to an endocrinologist that can put you on an HRT regimen focused on getting your testosterone in the castrate range.  And then in a year if you feel like the results are what you wanted, they should be able to give you a letter for surgery anywhere you'd like. I don't understand why you'd want to have an orchi without trying anti-androgens anyway. Don't you think it would be better to know how you feel with castrate levels of testosterone before you have an irreversible surgery?

If that is all that is necessary to get a therapist letter for surgical castration, then I should certainly try following this path as soon as I can! Seriously.

[Miyuki]

I had my orchiectomy earlier this year, about a year after I first started seeing a therapist. I was doing it as a part of a full MTF transition, but these days the standards of care are much less restrictive about who can qualify for what treatments. Not every therapist is willing to work with someone who is non-binary, usually due to lack of experience or knowledge about appropriate treatment, but many therapists now are willing to work with individuals with gender dysphoria in a way that allows the person being treated to direct the care. Meaning, you are not going to be forced to present as fully female (in public or private), you won't have to take estrogen if it's not something you are interested in, you won't have to do anything you are not comfortable with. You just have to explain your dysphoria in a way that demonstrates how it has impacted your life and explain why you think having castrate levels of testosterone will help you feel better. Then you can get a letter for an endocrinologist who will help start you on the appropriate medication. The only tricky thing is finding the right therapist, but how difficult that is or isn't really depends on where you live. Here in Minnesota I go to a place called the University of Minnesota Center for Sexual Health, and they have no problems at all working with non-binary people there. Unfortunately there are places where good therapists are not quite so easy to find, but I don't really know specifically how you'd find a therapist who would be willing to help you other than just calling around and asking.

[Rachel]

I recommend seeing a gender therapist to make sure you are on the correct path and receive the needed papers. A sex hormone will need to be taken after the orchi. After an orchi your libido will drop considerably as well a the ability to achieve a full erection. Most all doctors today will want some form of referral from competent health care providers.

Good luck,

Rachel

[Futurist]

I had my orchiectomy earlier this year, about a year after I first started seeing a therapist. I was doing it as a part of a full MTF transition, but these days the standards of care are much less restrictive about who can qualify for what treatments.

If so, then that is certainly extremely great news! After all, I absolutely loathe "gate-keeping" both for transgender people and for aspiring eunuchs.

Not every therapist is willing to work with someone who is non-binary, usually due to lack of experience or knowledge about appropriate treatment, but many therapists now are willing to work with individuals with gender dysphoria in a way that allows the person being treated to direct the care. Meaning, you are not going to be forced to present as fully female (in public or private), you won't have to take estrogen if it's not something you are interested in, you won't have to do anything you are not comfortable with. You just have to explain your dysphoria in a way that demonstrates how it has impacted your life and explain why you think having castrate levels of testosterone will help you feel better. Then you can get a letter for an endocrinologist who will help start you on the appropriate medication. The only tricky thing is finding the right therapist, but how difficult that is or isn't really depends on where you live. Here in Minnesota I go to a place called the University of Minnesota Center for Sexual Health, and they have no problems at all working with non-binary people there. Unfortunately there are places where good therapists are not quite so easy to find, but I don't really know specifically how you'd find a therapist who would be willing to help you other than just calling around and asking.

OK; however, I would like to point out that I also see extremely large value in surgical castration for sterilization purposes. After all, all non-drastic forms of birth control (including vasectomies) can and sometimes do fail and thus I want a form of birth control which can never, ever fail--surgical castration. Indeed, we unfortunately have (in the words of Laura Wish Morgan) a strict liability of sperm in regards to child support here in the U.S. Also, in regards to hormones, I am certainly open to taking estrogen replacement therapy either on a full-time or on a part-time basis if I will still be able to get erections using my penis and to have penis-in-vagina sex afterwards. Else, though, I will have to take testosterone replacement therapy instead while seeking to feminize my body in other ways, such as with laser hair removal and electrolysis and maybe with facial androgynization surgery as well if my insurance is going to be willing to pay for this surgery.

[Futurist]

I recommend seeing a gender therapist to make sure you are on the correct path and receive the needed papers. A sex hormone will need to be taken after the orchi. After an orchi your libido will drop considerably as well a the ability to achieve a full erection. Most all doctors today will want some form of referral from competent health care providers.

Good luck,

Rachel

Can't one or both kinds of hormone replacement therapy and/or Viagra help deal with the erections part, though?

Also, I am certainly willing to see a gender therapist if this is not going to be a never-ending process which is never going to result in me getting a therapist letter for my desired and planned orchiectomy.

[AnonyMs]

I've a feeling you're making it seem more complicated than it is. Unless you have no money its not going to be impossible (and even then maybe not). I'm absolutely sure I could do what you're trying to do if I wanted to. I've been looking about how to get SRS without presenting female; I'm sure I can do that and I'd think that would be more difficult than getting an orchi. There's so many ways of working the system.

Personally I'd find a decent psych to talk to with the intent of getting letters, plus the therapy can he helpful. No harm done it that proves not useful.

If you have any psychological issues apart from gender then I'm not sure what will happen. I don't so I've not considered it. You'd really want to find a good psych in that case.

Get on anti-androgens and see how you feel about that. If you want some feminisation get on estrogen and see how you feel about it. The main thing is to start and see how it goes. Personally I'd not get an orchi without trying that as its such an easy step along the path. I never understood what it would be like to have HRT until I did it. Reading other peoples stories only takes you so far.

[Miyuki]

Can't one or both kinds of hormone replacement therapy and/or Viagra help deal with the erections part, though?

It may or may not surprise you to find out, it is possible you may be able to continue getting erections even after an orchiectomy, without additional treatment. Usually it will be softer than it was before, and it won't happen spontaneously like it used to, but if you focus on it and try you should be able to get an erection hard enough to perform sexually. Personally this is not something I'm interested in, and I don't see keeping my ability to have erections as a positive thing, but I actually think people who completely lose the ability to have erections on MTF HRT are in the minority.

Also, I am certainly willing to see a gender therapist if this is not going to be a never-ending process which is never going to result in me getting a therapist letter for my desired and planned orchiectomy.

I really doubt this would be the case. The only way that would happen is if you got involved with a bad therapist that was big on gate-keeping or just trying to drag things out for money. I got my letter for HRT at my very first appointment, although that was mostly because I had already been self medicating, and usually my therapist did like to have a few more appointments before writing a letter. Another bonus of getting an official letter which I forgot to mention, is that it opens up the possibility of getting an orchiectomy covered by insurance. While an orchiectomy to treat gender identity issues is usually put under the same category as SRS by insurance companies and not covered, there are a few that do cover those types of surgeries and there are many more that will cover an orchiectomy if it is coded as a treatment for the "testicular atrophy" that usually occurs after enough time on HRT. That's how I got it covered.

[Futurist]

I've a feeling you're making it seem more complicated than it is. Unless you have no money its not going to be impossible (and even then maybe not). I'm absolutely sure I could do what you're trying to do if I wanted to. I've been looking about how to get SRS without presenting female; I'm sure I can do that and I'd think that would be more difficult than getting an orchi. There's so many ways of working the system.

Care to please elaborate on this part?

Personally I'd find a decent psych to talk to with the intent of getting letters, plus the therapy can he helpful. No harm done it that proves not useful.

If you have any psychological issues apart from gender then I'm not sure what will happen. I don't so I've not considered it. You'd really want to find a good psych in that case.

Get on anti-androgens and see how you feel about that. If you want some feminisation get on estrogen and see how you feel about it. The main thing is to start and see how it goes. Personally I'd not get an orchi without trying that as its such an easy step along the path. I never understood what it would be like to have HRT until I did it. Reading other peoples stories only takes you so far.

OK.

[Futurist]

It may or may not surprise you to find out, it is possible you may be able to continue getting erections even after an orchiectomy, without additional treatment. Usually it will be softer than it was before, and it won't happen spontaneously like it used to, but if you focus on it and try you should be able to get an erection hard enough to perform sexually. Personally this is not something I'm interested in, and I don't see keeping my ability to have erections as a positive thing, but I actually think people who completely lose the ability to have erections on MTF HRT are in the minority.

OK, and thank you very much for sharing this information with me!

I really doubt this would be the case. The only way that would happen is if you got involved with a bad therapist that was big on gate-keeping or just trying to drag things out for money. I got my letter for HRT at my very first appointment, although that was mostly because I had already been self medicating, and usually my therapist did like to have a few more appointments before writing a letter. Another bonus of getting an official letter which I forgot to mention, is that it opens up the possibility of getting an orchiectomy covered by insurance. While an orchiectomy to treat gender identity issues is usually put under the same category as SRS by insurance companies and not covered, there are a few that do cover those types of surgeries and there are many more that will cover an orchiectomy if it is coded as a treatment for the "testicular atrophy" that usually occurs after enough time on HRT. That's how I got it covered.

Thank you very much for all of this information! Also, the reason that I mentioned "gate-keeping" here is because I know that some aspiring eunuchs were unfortunately unable to get surgically castrated (as in, get an orchiectomy) in a safe, medical setting and thus had to perform dangerous self-orchiectomies or seek dangerous "back-alley" orchiectomies instead.

[AnonyMs]

Care to please elaborate on this part?

I think I already did in my other post. By the way what's the problem with using Dr. Arnkoff? Have you called him?

[Futurist]

I think I already did in my other post.

OK.

By the way what's the problem with using Dr. Arnkoff?

In theory? Nothing. However, I dislike the fact that he is located so far away from me (indeed, I myself live in Orange Country, California).

Have you called him?

No, not yet. However, I will certainly call him after the New Year's (I would prefer to wait until then because I suspect that he might not be at work right now due to the fact that this time is vacation time for many people due to Christmas and the New Year's).