Hi, guys. I'm sorry I tend to do more lurking than posting here, but I was hoping if any of you could help me make some sense out of something.

I live in Raleigh, North Carolina, and I'm trying to find a surgeon that will perform an orchiectomy on male to female transgender patients. I've met absolutely nothing but confusion. To start, I've been seeing a therapist for several years. She recommended me to an endocrinologist that I can only see once a year because apparently she's too busy most of the time.

When the time came when I needed to look for a surgeon, she recommended a local surgeon nearby in Cary. The therapist I had been seeing said that she could write a recommendation letter for surgery and even recommended a local surgeon, but the local surgeon that she personally recommended me to rejected the letter she wrote due to the fact that she apparently wasn't qualified to write it. I was told that they needed a letter from a psychotherapist that had an MD. She then recommended me to a therapist with a PHD who worked out of the same building, but he rejected that letter too.

So I start looking for surgeons that would accept the letters and I haven't had any luck. I called a surgeon named "Harold M. Reed" who told me the following: The state of Florida (where his practice is based) requires a letter from a psychotherapist and then a referral to another psychotherapist in order to get two letters, as well as well documented evidence that I had been living full time as a female before I could be considered for surgery. That's exactly what she told me. I couldn't find any information about the state of Florida dictating how many recommendation letters are required for surgery for transgender patients seeking surgery.

So now I'm looking for a "psychologist" instead of a "therapist" ( I didn't know there was a difference between a therapist and a psychologist, let alone that it mattered ) with an MD because the letter from my therapist has been rejected by every surgeon that I've called. I've spent some time calling psychologists in the area that fit the description, but none of them were actually as experienced with transgender issues as my therapist. What am I supposed to do?

Does the fact that I've been living full time for so long mean nothing unless I had been living full time AND seeing a therapist that just happened to have an MD? Do I have to start all over again see a psychotherapist regularly for another 3 years? The last time I had talked to my therapist, she told me that I needed to get my name changed at the state level before I get the surgery. I don't know if she just doesn't know what she's talking about or what but that's actually the other way around in the state of North Carolina. Either way, I have to admit that I'm beginning to caution her judgment as though I've wasted a lot of time.

After all of this, I still don't know what I want, and I don't even what I should do anymore or where I should go. Information online seems misleading and unhelpful to me. There's so much confusing information, there's no real sort of standard among surgeons (WPATH has been useless as far as I'm concerned) and no one in my area seems to know what they're talking about. What on earth am I supposed to do?

That is insane that you would need a letter for an orchi anyway. I had mine done via informed consent.

Which surgeon did you go to?

It was a surgeon in Indianapolis. But when I looked him up, he isn't practicing at the same hospital anymore. Any urologist or oncologist should be able to do the surgery. The place I went to primarily treated genetic males for testicular cancer, but the procedure is the same (assuming it's a bi-lateral procedure, of course).

But the idea that you would need a letter for that is absolutely ridiculous. I remember when I spoke with my surgeon about this, he did bring up the idea of the testicles being "healthy tissues". But when I pointed out that: 1. they were being affected by the estrogen therapy 2. I was never going to have GRS and 3. I didn't want to be on Spiro for the rest of my life and risk damaging my kidneys (which are healthy), he understood where I was coming from. I just signed the usual paperwork, went in several weeks later and was in and out the same day.

That wasn't my experience. At some point I took the time to call every urologist office in the wake county triangle area and I couldn't find one that would even schedule an appointment or consultation if it was about orchiectomy for MTF transgenders. I'm not finding any of these surgeons out there who are apparently willing to perform this operation

Quote from: Apricot on February 06, 2014, 03:15:00 PM
That wasn't my experience. At some point I took the time to call every urologist office in the wake county triangle area and I couldn't find one that would even schedule an appointment or consultation if it was about orchiectomy for MTF transgenders. I'm not finding any of these surgeons out there who are apparently willing to perform this operation

Maybe it's just your area, I don't know. You may need to look into going elsewhere.

The "2 letters" thing is pretty much standard ass covering by surgeons who follow the WPATH SOC.
https://www.susans.org/wiki/Standards_of_Care_for_Gender_Identity_Disorders

Some of them (McGinn) will go as far as to want the letter to specifically recommend surgery. From what I know of practitioners in the triangle it would probably be best to check other cities.

Good luck

    DR Marc Arnkoff   myorchie.com

Thanks for the information. I had no idea it was going to be that complicated. I feel as though I did everything right - I went to therapy for years - I basically live full time right now. I have been doing this for years, any gatekeeper I run into isn't about me at this point. If I have to do this all over again then I can't help but consider all of this to be an entirely a broken system.

I'm talking to my doctor about taking Zoladex or Decapeptyl injections in the meantime. To be honest, I've learned not to hold my breath for a positive response. Dr Marc Arnkoff sounds like a decent solution, but he's gotten pretty expensive now and he increases his prices so often.

Does anyone know of any psychiatrists (with an MD) that accept phone sessions?

PLUS

If you're trying to be funny, I don't exactly appreciate the response.

That's a bit ridiculous really, I got one in Portland, Oregon back in 2001 with a letter from my VA PTSD counselor and another from my endocrinologist. I walked in with a man's haircut, jeans and T-shirt and it was a done deal in 41 minutes flat. There are those  who just want to become a eunuch for some religious or personal reasons and they aren't expected to dress as women. Guess we still have medical professionals who want to play gate keeper. Such dinosaurs!

Have you thought about a chemical orchie?  Mine got taken out of the picture (although still physically there but very small). 

Hugs,

Jen