Grs... have an orchi or not?

[SailorMars1994]

Hey this is to the ladies here's. I'm in the waiting for grs with dr brassard which should be done by end of the year!! I am wondering however should i do an orchi first? Reason being i ask is that dr brassard requires one to be off HRT for three weeks and I really do not think my mental health will be good with T back in system. I am looking an dtalking to doctors to maybe have an orchi done first mainly to avoid T later on. Is this a smart idea? Does anyone here have experience with having an orchi then getting the final surgery? And are the results still good? Thanks

[Devlyn]

I  know one thing. After having my balls operated on, I'm in no rush to have that area worked on again.

Hugs, Devlyn

[KathyLauren]

Maybe check with your HRT doctor and/or Dr. Brassard whether you can stay on blockers right up to surgery.  The risk factor they are trying to mitigate is that estrogen increases your risk of blood clots.  You ought to be able (it seems to me - I am not a doctor) to stop E for three weeks, but stay on blockers, reducing your clot risk without letting the T build up in your system.

Being off hormones (both E and T) for a long time would put you at elevated risk for osteoporosis.  But you aren't going to develop osteoporosis in three weeks.

[Colleen_definitely]

I wouldn't do it personally.  You've been on estradiol long enough that it would take months for your body to start producing testosterone in any major quantity.  Now while you will feel the lack of estradiol, and it's not going to be super pleasant, it won't be testosterone doing it.

And on top of that, you're looking at a surgery with a rather unpleasant recovery that would only really serve to complicate your SRS at this point. 

[Rachel]

I was off E for 3 weeks prior to GCS. I was able to stop Spiro 2 days before the surgery. My Potassium was always high so I gave it no thought. I could not eat for 2 days before surgery, no big deal. I had expressly low potassium in my system for the procedure. My heart beat and respiration is very low normally. They added a lot of saline to raise my bp. They washed the remaining potassium out of my system and I crashed.

My bp was 30/50 with a heart rate of 115. My heart rate is 110 on my 33rd flight of steps. So I was straining to survive. Long story short 2 IV bags of potassium and I was good to go.

I wish I was off Spiro for 2 weeks prior to the procedure and my system had a chance to balance better. I would have avoided the ICU.

As far as a an orchi I would wait. You are chemically castrated and a few more months will not matter. Being off hormones made me dull but I did not have any hot flashes.

[SailorMars1994]

Well thanks ladies! I wasn't sure, all I know is my discomfort of T. However, I want to be working 💯 for my surgery after with little complications. Thanks for the input

[Devlyn]

Modern surgeons aren't worried about orchi before GRS. That's gone the way of the Edsel and horse piss for hormones. 

My surgeon said if I came back for vaginoplasty the previous orchi would simply shave ten minutes off the surgery time.

Hugs, Devlyn

[SailorMars1994]

Modern surgeons aren't worried about orchi before GRS. That's gone the way of the Edsel and horse piss for hormones. 

My surgeon said if I came back for vaginoplasty the previous orchi would simply shave ten minutes off the surgery time.

Hugs, Devlyn

Well that's good to know!, what was recovery time from orchi?

[Devlyn]

Surgery on Friday, back to work on Tuesday.  I had an issue and the incision reopened ten days later. It wasn't pleasant but everything healed up nicely. 

Hugs, Devlyn

[Paige]

The risk factor they are trying to mitigate is that estrogen increases your risk of blood clots. 

I understand this is why they're asking patience to abstain but really is the scientific evidence there to support this?   Doesn't this derive from the premarin days?  Is it applicable to women taking estradiol?   Cis-women are operated on everyday with lots of estrogen floating in their blood.  Why wouldn't they be likely to have blood clots?

Curious,
Paige

[KathyLauren]

I understand this is why they're asking patience to abstain but really is the scientific evidence there to support this?   Doesn't this derive from the premarin days?  Is it applicable to women taking estradiol?   Cis-women are operated on everyday with lots of estrogen floating in their blood.  Why wouldn't they be likely to have blood clots?

Curious,
Paige

Yes, cis women have the same risk of blood clots as trans women on E.  The difference is that the doctors can't turn off a cis woman's E to mitigate the risk.  They can with a trans woman, so they do.  The good news is that we have a lower risk because we can stop our E.  The bad news is we have to stop our E.

[SailorMars1994]

Yes, cis women have the same risk of blood clots as trans women on E.  The difference is that the doctors can't turn off a cis woman's E to mitigate the risk.  They can with a trans woman, so they do.  The good news is that we have a lower risk because we can stop our E.  The bad news is we have to stop our E.

Interesting, thanks. I was on the same page as Paige in wondering

[Stella Alexis]

Yes, cis women have the same risk of blood clots as trans women on E.  The difference is that the doctors can't turn off a cis woman's E to mitigate the risk.  They can with a trans woman, so they do.  The good news is that we have a lower risk because we can stop our E.  The bad news is we have to stop our E.

To add to that, when we take the E in pill form we have actually a slightly higher risk of blood clots then cis women. But that's the same for cis women on birth control medication.
Due to that, in the Netherlands, its no longer required to stop the HRT prior to the GCS, as their not asking cis women to stop their birth control prior to any surgery and the increased risks seems minimal.

[Paige]

Interesting, thanks. I was on the same page as Paige in wondering

Hi SailorMars,

It looks like if you switch to transdermal there is no risk at all.   Even oral seems to be little risk if it's just estrogen.  Birth control pills aren't a good comparison because they usually aren't just estrogen.

Blood clot risk lower for estrogen-only, transdermal, and vaginal estrogen at menopause

A Swedish population study is helping answer lingering questions about hormone therapy safety. The study shows that estrogen-only therapy carries a lower risk of blood clots than combined estrogen-progestogen therapy, but there is no significantly increased risk of clots with combination therapy when the estrogen is transdermal, and vaginal estrogen doesn't raise the risk at all. ....

https://www.sciencedaily.com/releases/2016/03/160330085613.htm

[KayXo]

Maybe check with your HRT doctor and/or Dr. Brassard whether you can stay on blockers right up to surgery.  The risk factor they are trying to mitigate is that estrogen increases your risk of blood clots.

It's been stated in a very recent study that transdermal estradiol does not increase the risk of blood clots so you can share this study with Dr. Brassard, if you wish. Also, one should question why ciswomen who produce estrogen are allowed to continue producing estrogen while undergoing surgery while we are denied the same hormone if taken non-orally. This should be discussed with the surgeon. Finally, it's been admitted recently in a study that there is actually no evidence supporting this approach. I would urge you to go and visit the transhealth section of the University of California San Francisco where they discuss this more in detail and state that first, there has been no study of the risk of thromboembolism with the use of bio-identical estradiol during, before and after surgery and that, second, there is no actual evidence to show that transwomen should cease estrogen prior to surgery if risk factors are absent.

Also, certain anti-androgens and other hormones have been found to not affect the development of clots such as bicalutamide, LhRh agonists, progesterone and finasteride/dutasteride so if you are taking any of these, you should ask the surgeon why you need to stop them. As far as spironolactone goes, some doctors insist it must be stopped due to its effect on electrolytes and as the above poster shows, it would be wise to follow their recommendations.

Be smart, stay safe and talk with your surgeon if you have any concerns.

To add to that, when we take the E in pill form we have actually a slightly higher risk of blood clots then cis women. But that's the same for cis women on birth control medication.

The risk with birth control pills according to some studies would appear to be greater than on oral bio-identical estradiol, especially considering the doses we typically take them at.

Due to that, in the Netherlands, its no longer required to stop the HRT prior to the GCS, as their not asking cis women to stop their birth control prior to any surgery and the increased risks seems minimal.

That is indeed strange that if birth control pills can be continued, transwomen are denied estradiol before surgery, which is a lower risk. 

Birth control pills aren't a good comparison because they usually aren't just estrogen.

Birth control pills contain ethinyl estradiol as opposed to bio-identical estradiol which we take. Ethinyl estradiol (EE) has a far greater impact on the liver and coagulation. Some progestins contained in birth control pills may apparently further increase the risk of clots.

vaginal estrogen doesn't raise the risk at all.

It seems to me, based on all the studies I've come across, that when bio-identical estradiol is taken non-orally, the risk of clots/thromboembolism is negligible, even in individuals at greater risk. As always, verify with your doctor, follow their recommendations and do your own research, if you wish.