Orchiectomy with Possible Later GRS

[VanguardVivian]

Hi, I'm new to this forum, but I've been in transition for three years, and I've been active in Twitter's trans community for longer, currently with the same username as this — @VanguardVivian.

Anyway, I want to stop taking antiandrogens. I'm on spironolactone and finasteride, in addition to sublingual estradiol 17-beta. My T is around the bottom of the recommended range for cis women, 22.7 ng/dL, and my E is around 150 pg/dL, smack dab in the middle of the recommended range for cis women.

I keep reading more and more people say that antiandrogens cause/contribute to mental illness, and my various mental illnesses (depression, anxiety, ADHD, PTSD) have been extremely resistant to treatment with medication, despite six years of going from psychiatrist to psychiatrist and drug to drug. Maybe the AAs are impeding treatment. And even if they're not directly affecting my psyche, it can't be good for the body to take these T blockers every day for the rest of one's life.

Additionally, and perhaps more importantly, I am terrified of the possibility of being forced to go off my HRT for whatever reason (cost, situation, or even prison, god forbid). If that were to happen, I want it to be IMPOSSIBLE for my body to resume masculinization. I want these testicles gone ASAP, so that no matter what happens, I never have to have testosterone flood my body again. I want menopause to be the worst thing that could possibly happen to me hormonally.

The reason I'm hesitating on the orchi is because I would also really like to eventually have a vagina. Current GRS techniques are unattractive to me because I don't think I could keep up with the dilation schedule for the rest of my life — I want to wait until the techniques have improved to a point where dilation is only absolutely required initially, and I can stop after healing has finished; even better if dilation isn't required at all. My genital dysphoria is just not severe enough to outweigh the stress of having to either dilate all the time, or have the vagina close up/permanently lose depth. Thankfully, I'm only 22 years old, so I have time to wait. Maybe those lab-grown vaginas will be feasible for girls like us within my lifetime.

With all of this in mind: Does it matter who performs my orchiectomy, as long as they're reputable and qualified? Is there a major enough difference in orchiectomy technique (incision placement, length, etc) to warrant going to, say, Dr. Bowers instead of whatever doctor my insurance might prefer to stick me with? I can find a way to pay for orchiectomy with Bowers, if so, or maybe I could even somehow get my insurance to pay for an orchi from her.

My top priority here is to keep my options open in the future.

Thanks for the help.




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[V M]

Hi Vivian 

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V M

[V]

I would say that there are pros and cons with your approach.
It's absolutely the right idea to not have SRS if you don't think you could cope with dilating. It's a pretty ridiculous thing to have to do, if you think about it. Unfortunately I was unable to deal with the dilation side of SRS, due in no small part to immense pain and constant infection. So I lost all depth and am now unable to have intercourse. It certainly messes with your brain big time being stuck in that situation, I can tell you. I feel like a 'thing' rather than a woman, 'down there'.

The downsides I can see are twofold, firstly you may suffer accelerated atrophy of your remaining male genitalia, making future SRS more difficult. Secondly there is no guarantee that dilation-free SRS or "lab-grown vaginas" ever become a viable option in your lifetime.

Most competent surgeons could perform a Bilateral Orchidectomy though. I wouldn't have thought that you'd need to go to one specialising in SRS operations.

[BeverlyAnn]

My urologist did my orchiectomy for a couple of reasons (Medicare and my insurance paid for it for one).  He actually consulted with Dr. McGinn regarding incision placement to minimize scar tissue with future GRS in mind.  So any surgeon you go to should be willing to consult regarding where to do the incision.

[Dena]

Welcome to Susan's Place. Dilation isn't exactly  a difficult life time commitment. Yes, the first year is somewhat intensive but you can do other things while dilating. In my case, I catch up on the news but I could watch TV or read. I am at the point where I can maintain what I have with once a week though if I were sexually active, I wouldn't need that. In addition, I have gone 10 years without dilation and it took me a few months but I  am back where I should be. It will be your decision how you wish to proceed but dilation isn't going to be intensive forever.

[Lady Sarah]

An orchiectomy can be done by just about any urologist, such as mine was. I might never have SRS, purely due to financial reasons. I am happy I had the orchiectomy done. As much as I would like to recommend it, it is not for everybody. I advise taking to a counselor about it.