Medically necessary Orchiectomy

[JennJenn]

I'm in the USA.

So my PCP referred me to a local urologist; I see him next week -- supposedly a really good one. I get to tell him about my medical history and transition and all; as if that isn't enough, I need to tell him why it is medically necessary I get an orchiectomy ASAP:

1) diuretics interfere with excretion of uric acid -- I have bad hyperuricemia & gouty arthritis (chief complaint) and already taking max dose of allopurinol.
2) I am at higher risk for DVT and thrombophlebitis due to excessive obesity -- smaller estradiol dose would be beneficial.
3) I am diabetic and I don't need the added stress on kidneys

Due to Gender Dysphoria, I don't think it'd be fair for them to say it isn't medically necessary, because if I quit spiro without the orchiectomy then facial and body hair would start growing again, and my figure would change etc.. it'd be too depressing.  I've been legally female for over 10 years, and pass with no problems at all.

Then if he agrees to do it, I need to make sure he cuts midline instead of underneath the scrotal tissue, since I'll be having vaginoplasty later.

If I go through him it'd be covered by my insurance.

There is another doctor that will do it (no insurance coverage) for $4500 or so and he follows Marci Bowers guidelines for proper orchiectomy for future vaginoplasty. He has a table limit and I'm too heavy at the moment.   I need to lose like 50 more pounds.  But here is the thing, it's hard to lose weight, because when I lose it the uric acid levels increase.. then I start hurting everywhere with the gouty arthritis.   

I need the orchi so I can get of spiro, so I don't have uric acid build up, so I can prevent worsened degenerative arthritis & allow me to lose weight.  However to get the orchi for $4500, I have to lose weight for the table, which will raises my uric acid while on spiro.  I'm stuck. Depressing. :/

Isn't this medically necessary?  I suppose I can keep going as I am and deal with this nasty gouty arthritis eating up my joints as i attempt to lose another 50 pounds.  Think I am about to cry.

[Gertrude]

Would a change in diet and weight loss do a lot of it? Diet affects gout, iirc, as it does weight and diabetes. There are other t suppressors as well. What type of diabetes do you have? Do you drink enough water?


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[JennJenn]

Thanks for the reply.

I eat a low carb diet to manage my type 2 diabetes; my A1C is 5.5 [used to be 9.8]  I've lost a lot of weight so far.  The more I lose weight the higher the uric acid levels.   If I stopped the spiro then my uric acid levels should fall.  I am going to try this in a couple days as I'll be on a decent dose of progesterone cream in a couple days (my luteal phase began on the full moon). Progesterone also block testosterone I read.  Going to quit spiro for 3-4 days before seeing urologist on Friday.  That way I can report to Urologist that my uric acid levels fell to normal after stopping spiro.

I doubt stopping spiro for 3-4 days is going to make me lose all my hair and grow whiskers on my face right?   lol.

I think I drink enough water.  Over a gallon a day.  I only drink water and 2 mugs of coffee per day.  No other beverages.

[Gertrude]

Ok. I eat low carb(30g a day or less) in order to lose weight. 70lbs in 20 weeks. I don't have diabetes or gout, although I did get joint pain in places I never do early on and I was eating a lot of pork, so I shifted my protein sources and drank more water. I had read on a keto forum some have those issues. It helps that I know what I'm eating. I weigh most things, so I know what's going in me and I keep s journal on it. The only meds I take are for bp and thyroid. Last blood work up, my cholesterol was 146, triglycerides 128, sugar 79 and a1c 5. Normally my cholesterol is 165-170 and triglycerides 200-280. I still have another 72-92lbs to go, depending on where I end feeling right and BMI is good. After that, we can talk about hormones. I've had 3 DVTs at one time and because of that I have a greenfield filter in me. All in time.


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[Dena]

I am not sure the effect that spiro would have on uric.  What I suspect is the low carb diet is causing you to eat foods that contribute to your gout. You might want to talk to a dietician to get a diet thats balanced for both diabetes and gout. I looked at a gout diet and I can see where it might be difficult to treat both conditions at the same time.

[Subbie]

hi JennJenn

it appears that the point in your argument that is causing you the most trouble is the issue of gender dysphoria.
since, however, GD is a medically diagnosable condition, and depression too, i think that, as long as you can provide records of prior diagnoses of these conditions, then they have to be seriously considered when weighing up the medically viable options.


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[Meghan]

hi JennJenn

it appears that the point in your argument that is causing you the most trouble is the issue of gender dysphoria.
since, however, GD is a medically diagnosable condition, and depression too, i think that, as long as you can provide records of prior diagnoses of these conditions, then they have to be seriously considered when weighing up the medically viable options.


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I already diagnose as Transgender and it is officially in my medical records for life, and I eventually will get Orchidectomy procedure done.

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