Hi my lovelies,

Following a discussion on another thread I thought it might be helpful to raise this issue for discussion.

The first and most important thing from my point of view, and that in theory of the forum, is to have respect for a variety of positions on this. No-one should be telling anyone else what they should or shouldn't do or be. Whatever's right for you is right for you. I hope if this does flow we don't have to keep reminding one another of this point and we respect one another about this.

Second, though, I'm aware that my occasional references to wanting an orchi rather than full GRS may raise those beautifully arched eyebrows. Some of the reasons for this are stated over here in a tumblr blog: http://ricardhos.tumblr.com/post/136670175953/a-trans-response-to-greer-humphries
I guess for me there's a fundamental issue about gender identity. I've never subscribed to the view that this or that body part either makes or undoes a gender in or of itself. It's part of the pathway, sometimes a crucial part for people. But I personally think (and it's just my POV) we're in deep water if we go down that line in terms of reductionism and, for instance, why stop at a vagina not a womb? Gender's really complex and more than the sum of individual parts imho. I think hormones are really important, for instance, as is brain function and self-identity. For me, for instance, breasts are every bit as important as a vagina, actually more so.

I also, thirdly, therefore don't see removing my penis as critical. I'm much more vexed by my testicles since they are the testosterone production plant. Whip the buggers out and I'll be happy

I guess, fourthly, I've been helped considerably in the above by kathoey who are incredibly feminine yet often pre-operatives, although that's sometimes for financial reasons.

Fifth, my transition's a journey. My view on this may very very well continue to evolve. I think I may very well head for full GRS, just not yet: maybe in two or three years. I'm happy to be my changing as a work in progress and I want to do so many things e.g. face reshaping and nose: actually I'd rather do those first.

Sixth, and I don't want this to be crude but someone else cited this on here a long time ago as a reason for her wanting just an orchi: I have two working holes and I get huge pleasure from them being filled. Cough. Splutter. Shall I stop there?

Finally, seventh, and most importantly though my biggest issue with GRS and the reason I'm reticent right now is that it's such a massive surgical operation. I don't know if I want the aggro right now with a lot of other things going on in my life. I really don't think I would be dedicated enough to do the expansion exercises every day, in fact I know I wouldn't and therefore I'd be spoiling the moment.

So, for me, I think at this stage I'd like an orchiectomy to cut off the T supply at source. My one big worry is that I don't want to mess up future GRS, which I'm still likely to do in a few years.

I really hope folk can understand this. Feel free to discuss but in a friendly spirit. There are many paths.

I know many people who have chosen your path. Only you know what is right for you.

I certainly didn't need the full vagiplasty. I didn't have much dysphoria. But I figured if I was going to prep for surgery, find a doctor, pay for anesthesia, an OR, a hospital room, etc., I wanted to wake up with the bottom I always wished for. Fortunately I had a little money put away, so I could afford it. If not, I probably would have chosen differently.

I can understand people going for orchiectomy in the USA where it is so much cheaper than GRS, but since you will be under NHS care the cost of GRS is not an issue. Nor is the cost of GnRH analogues an issue either (about 300 / $500 per shot) as they are paid by the NHS and effectively give you an orchie without of the side effects of spiro or CA.

The advanatge of the GnRH analogue over an orchie is that if GRS might be in your future then you are guaranteed that there is no question of an orchie operation causing problems for a later surgeon doing GRS.

Another advantage is that having your T dropped to female levels reduces your "get-up-and-go" - you can feel very tired and lethargic and you have to learn to manage your energy more effectively. Some people decide that having female levels of energy is not for them, but if you have an orchie then it is a one-way trip. With GnRH you can let it wear off and refuse another one.

I was on GnRH analogues for 18 months. It was one injection in the thigh every 12 weeks and within the first month my T production was in the middle of the female range.

I cannot see any advantage to an operation (save cost, which does not apply in your case) that is not granted by use of the analogues.

Thanks Suzi - that's really great to hear. I know a few others have mentioned it on here, including UK people.

Pyhxbp, one thing is that I don't particularly want my testicles. For me the testicles are the origins of testosterone and so removing them is good. I also don't much like the idea of pumping myself full of meds, though I grant you that this is a concomitant of transitioning. If I can reduce any amount of T-blockers that rely on meds, be they oral or injected, then for me that's no bad thing. Chacun a son gout and all that. But I do take your points, especially about the fact I'll be under NHS care and, therefore, cost. That's a very good point. If I can save myself $10,000 in Thailand then ... well ...

Quote from: Richenda on January 06, 2016, 08:40:29 AM
Pyhxbp, one thing is that I don't particularly want my testicles. For me the testicles are the origins of testosterone and so removing them is good.

Fair enough - but check that you do not preclude further operations. If you decline GRS for an orchie then if the NHS does the orchie it may decide that you have had your publicly funded operation and further ones are your problem.

Ask at the GIC and be clear before you commit yourself. Get it writing from them so that any changes in policy do not affect you.

[Edit: I did not want my testicles either, but GRS took care of them]

Very very good point(s) pyhxbp.

I think I also need to tread carefully as to why I'm not at the moment necessarily wanting to go for full GRS.

Actually, do you or anyone know the likely waiting list time for one? I mean, maybe I should just ask for it and it will take a year or more anyway?

One other thing: Thai surgeons are now renowned for their technique which gives an amazing clitoral hood. Does that even exist in the UK under the NHS I wonder?

Oooh by the way I should probably also partly explain that all this has happened very fast. I recognise I'm quite lucky. I began my self-meds 18 months ago, about which I feel I should repeat my warning to anyone else NOT to do it, but went to my GP only the week before Christmas. I was due to be on the year-long waiting list for London but my rather brilliant surgery secretary asked if I wanted her to ring round. Not only did she do so, but she got me in on a cancellation next week at one of Britain's other centres. I think I owe her a bunch of flowers!

Quote from: Richenda on January 06, 2016, 08:57:36 AM
One other thing: Thai surgeons are now renowned for their technique which gives an amazing clitoral hood. Does that even exist in the UK under the NHS I wonder?

If you want a fashionable vagina then Thailand is the place, but it is a long way away and you have to go all the way back there to correct any problems. I have read that the thai operation is very long (5 to 7 hours) and the recovery times are longer as well. The UK surgeons do penile inversion with a scrotal flap which has the advantage that blood vessels and nerves are kept intact so post-op feeling is good and recovery is quicker

My vagina looks like any other woman's vagina, there is nothing special about it. Internally it feels good. Also, not all women have clitoral hoods, some have no inner labia, some have giant labia and others have lopsided labia. They come in all shapes and sizes.

It was 2 years from turning up at the GIC to having GRS which is faster than some people seem to manage. Keep asking for cancellations and it is amazing how much time you can shave off the wait. Your GP definitely is owed flowers or chocolates

That's so encouraging to read about your vagina. Gosh that seems a terribly personal sentence to write! I spend almost half my life in Thailand, love the country, think one or two of the hospitals are incredible, but I'm very nervy about a big op there so I'm with you on this. In fact, it's reading some stories on here about GRS out there that has partly put me off the GRS. That was the thrust of my final point above: it's the aggro of it that some, dare I say so many (?), seem to experience. I know there are great success stories but I would panic horribly if I thought things were going awry out there, this despite having friends who live there who could scoop me up if needed.

I went to the Bumrungrad hospital in Bangkok for something unrelated and it was gobsmacking. I've never seen anything like it. But it's private and even if they did SRS, which I doubt, it would doubtless cost a fortune there.

I like the sound of the NHS op on this ... hmmm ...

If you have an orchi it need not rule you out from Suporn, depending on how its done. I think you'd have to email him to find out exactly how, and also trust your orchi surgeon not to screw it up. No idea about the other Thai surgeons.

Quote from: Richenda on January 06, 2016, 09:30:14 AM
I went to the Bumrungrad hospital in Bangkok for something unrelated and it was gobsmacking. I've never seen anything like it. But it's private and even if they did SRS, which I doubt, it would doubtless cost a fortune there.

Apparently PAI is a top class Thai hospital and Preecha and/or his students do SRS from there. There's discussions in the forums about it. I'm not sure, but I think the price is reasonable as well.

There are several reasons to opt for an orchiectomy vs a vaginoplasty.  It's a very personal decision.  I remember struggling to come to a decision myself.  At my age and being in a committed same-sex relationship, the orchi would have suited me fine, I'm sure.  Still, I elected to go with the full GRS anyway.  I may be old, but I'm not dead, and one can never tell what the future has in store.  Now that it's done, I'm glad I have a vagina.  It's something that I didn't think much about beforehand.  Twice a day we get together for our dilation exercise, and just knowing that she's down there is a great comfort to me.  You just never know....

Quote from: Richenda on January 06, 2016, 08:57:36 AM
Very very good point(s) pyhxbp.

I think I also need to tread carefully as to why I'm not at the moment necessarily wanting to go for full GRS.

Actually, do you or anyone know the likely waiting list time for one? I mean, maybe I should just ask for it and it will take a year or more anyway?

Currently if you go to charring cross gender clinic the waiting list for GRS is roughly 18 months when you get on that list.

One of the main reasons I want GRS is that I dislike all of my lowers lol, also I would be able to wear female stuff without having to worry about them anymore. So bikini time will come then

Richenda the post is one vs the other but I trust any reasonable dialogue will provide more light than heat:-)  I very much agree that none of us need be apologetic about our unique course on this journey.  I see many advantages for my pending orchi and know enough about surgery and anesthesia to be all too well informed about the potential for complications and risks.  Hopefully our continued discussions about this will help us consider our personal best choices and be well informed about the possibilities. 

Our testes are the T factory and that hormone is poison to me and I will remove the source with a very simple surgery under local anesthesia with sedation.  Maybe a half hour, out patient, procedure.   We can all reserve the right to make additional choices in the future as our transition progresses.  One size still only fits a few

Thank you so much for your comments Tessa, Kayla, Clara and Anonyms. These are really insightful and helpful thoughts.

Gosh, there are so many variables and options. Isn't it hard? I know what I want to be: fully an out woman. I guess if I could wave a magic wand I'd have an orchi tomorrow to whip the bloody things out, then have a full GRS in due course, but it doesn't quite work like that. Maybe I'm leaning towards the NHS GRS option. I guess they wouldn't agree to doing both!

Today has been really helpful for me in thinking this through. I think the bottom line is that I'm scared about the full GRS in Thailand. I love the country so much but I know what I'm like even with a minor ailment out there :/ All of which points massively towards me having it done here and, heck, if it's on the NHS then that's a big saving. Having said that, I need to be accepted through the checks etc.

Thank you again everyone: love these helpful insights.

Quote from: Richenda on January 06, 2016, 01:35:57 PM
if it's on the NHS then that's a big saving. Having said that, I need to be accepted through the checks

The "checks" are easy:

1) BMI under 30 and preferably under 28, waistline under 1 metre
2) No heart conditions or murmurs
3) High blood pressure is a no-no so if it is high, bring it down and keep it there.
4) No smoking

Nuffield (Thomas) seems to be the most stringent, Methley (Fenton) the least stringent.

That's a relief: I'm good for all 4 of those. The GP checked me. I was wondering about the psychological checks too: I mean do they grill you and try and test to see how many years you have felt this way etc.? I knew when I was 4, when I used to put on my sisters' undies. And I sent off to Holland for female hormones when I was 16. My GP was fantastic and accepted all that, but I can't prove those things :/

Quote from: Richenda on January 06, 2016, 02:00:39 PM
That's a relief: I'm good for all 4 of those. The GP checked me. I was wondering about the psychological checks too: I mean do they grill you and try and test to see how many years you have felt this way etc.? I knew when I was 4, when I used to put on my sisters' undies. And I sent off to Holland for female hormones when I was 16. My GP was fantastic and accepted all that, but I can't prove those things :/

I think you misunderstand. The GIC will not stop you. If you are certain that surgery is what you want and that you understand the circumstances then surgery you will get. The GICs merely ask you to examine your own motives. I spent my interview telling them why I needed GRS, what my reasons where and how it would improve my life. I also brought up the risks and hardships that I knew about. I showed that I understood what I was getting into and that it was a one-way ticket.

In my surgery confirmation they said "She feels that if she had female genitalia she would be better able to engage sexually. She is aware is the need to dilate and the risk that sexual sensation may be reduced in surgery... I see her as having completed her social transition and is now ready and eligible to  be put forward for gender surgery ..."

When you see them for the start of the process, just tell them you life story. They are not trying to trick you or trip you up but it is publicly funded and they will want to be sure that any help they give will help you rather than cause bigger, more expensive problems further down the line.

To a large extent you diagnose yourself as TG/TS by simply turning up at the GIC. They just want to be sure that you are sure.

That's really helpful and encouraging again. Thank you

And for all its problems, the NHS is pretty amazing really.

If the possibility of having GRS in the future is part of your plan and the prospective surgeons require/recommend hair removal from the testicular sack, I recommend you consider having electrolysis done prior to the Orchiectomy. An electrologist I know personally who has many transgender clients preparing for GRS has found it takes much more time to properly treat the hairs on the testicular sack after an Orchiectomy.

Now that's brilliant advice Cindi. I've read about that elsewhere and totally forgotten in (there's sooooo much to remember isn't there?). That's a brilliant reminder which I've put on my notepad for Monday.

I believe it can cause some big problems if it's not done or not done properly?

I'm definitely going to ask for full GRS. I've been thinking about this over the past 48 hours. My referral came so fast, via a cancellation, that I was caught slightly unawares. But I still think if I could have an orchiectomy tomorrow followed by the GRS at the end of the inevitable waiting list (12-18 months?) then I would leap at it. I'd like to cut the T source off right now, preferably not via meds or analogues. But that may be wishful thinking.