Most, though not all, of us aspire to full vaginoplasty. The path to that holy grail is often difficult on our bodies and sometimes dangerous.

I want to put the case for bilateral orchiectomy instead of anti-androgen drugs.

I have a vested interest: I've had one.

To me anti-androgens are a poison. Okay, that's a bit strong. But they really did my body no good. None of the medications used by MtF transgender are intended for the purpose. Their use as anti-androgens is secondary to their clinically approved usage.

Some people are fine on them but it's only since I came off them that I've fully appreciated how damned awful they made me feel. I had elevated blood pressure, was breathless, dizzy, scratchy and that's before the nasty reactions on top:

Spironolactone very nearly killed me (very very low blood pressure).
Bicalutamide set off a horrible and dangerous chest infection
Dutasteride made me totally spin out with dizziness and poor circulation
Finasteride made me anxious and irritable
Cypterone Acetate gave me awful depression

... in other words they all had their downsides. They are drugs that fight against what the body is producing and, for me, that was both physiologically and psychologically damaging.

Now, I know that for many of us it's our only option. We have to take them and the dysphoria is worse than many of those side effects. So they are the lesser of two evils.

But I want to sing the praises of a bilateral orchiectomy. Yes it costs money. Yes it can cause some scarring for the tissue that will go into your new vagina but these days the latter is fairly obsolete with good surgeons. Re. the former: well, yes, it cost me $3800 at what I consider the best clinic in Thailand (PAI) but that's offset against the cost of medication. Surgery does, needless to say, always carry some risk so I praise the surgery only in the sense that you should consider it through your normal medical guidance. But it's one of the best decisions of my life.

I feel absolutely wonderful. Estrogen dosage can now be lower too of course. And as an added bonus I've been lucky not to lose any libido. Actually the opposite seems to have happened.

This post is put out to stimulate thinking that there is an alternative to anti-androgens. For those who are fine with the medications then I say: all power and praise to you. That's genuinely great. But for the rest of us: at least consider the orchiectomy option.

Love, Chen x

Have you found any psychological benifit in having surgery? In knowing you've taken such. Big step, or that it's permanent, or any other reason?

I certainly agree with your assessment Richenda and had my orchiectomy this spring with no complications.  The surgery itself with a local block and sedation was a piece of cake and recovery meant soreness but well worth it. To AnonyMS i would emphatically say yes!  The unexpectedly wonderful sense of permanence, no more AAs, no possibility of slipping back has been very reassuring.  I was certain of my decision and gave myself years to consider it.  I am less certain about any next surgical steps but have greater confidence if that choice becomes more obvious.  I am happy for now.

It took some time to recover from years on AAs with some pedal edema and a rebalancing of body fluids.  Very happy to be off those drugs and have a more simple regimen for going forward. 

The orchi might be the only surgery I would ever consider; I have a weird attachment to some older sets of ethics about healthy tissue and necessary cosmetic surgery.

For an MTF trans, I think the testicles cross the line into unhealthy territory; behaving in a way that is incompatible with normal psych function, making life essentially unlivable.   Keep breathing till you die, then stop, and your last thoughts are, "finally, that's over!".  NOT an indicator of healthy tissue.

The others... I dunno. Not in the sense of not being ok for other folks, but just for myself in my restricted set of acceptable options.

For now, I'm ok with the AA's; and don't really want to move the ball (lol, I pun) anywhere further at the moment.

In my case, E caused my testes to retract, to the normal position for ovaries. The stress on the vas deferens caused great physical pain. It became medically necessary to have the orchiectomy done, and I am grateful.

The peace of mind is phenomenal. Not having to take anti-androgens is also a blessing. It also allowed me to have all my documents changed to Female, since it is surgical castration. I am aware some states do not require SRS or castration to get your birth certificate changed, but the state in which I was born does.

So for someone who is hoping to start hormones soon, instead of AA I should  consider an orchiectomy and estrogen?


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An Orchiectomy may require as much paper work a SRS so start with the blockers as most people tolerate them well. If you qualify for SRS but lack the money, it is an option to consider.

Quote from: AnonyMs on August 17, 2016, 09:54:26 AM
Have you found any psychological benifit in having surgery? In knowing you've taken such. Big step, or that it's permanent, or any other reason?

Hugely. As Lady Sarah and Tessa say there's an overwhelming peace of mind. It's a permanent surgical castration so effectively it's the hormonal equivalent of a full SRS. I've had a permanent smile for the last fortnight x

p.s. it's irreversible though so you do need to be as sure as you can be!

I have some of those symptoms also which is why I am ready for it all to be gone ...

Glad to see this being discussed here!
I just "passed" my pre-surgical psychological assessment for an orchiectomy (literally got the email a couple of hours ago).
Not sure how long the waiting list is here, but have been told by other girls 8-9 months.

Quote from: supergirl23 on August 17, 2016, 05:31:14 PM
So for someone who is hoping to start hormones soon, instead of AA I should  consider an orchiectomy and estrogen?

I'd personally not do that, as it's rather permanent in a way that AA's are not. I don't like to take unnecessary risks, and what if you found out it's not right for you?

Quote from: supergirl23 on August 17, 2016, 05:31:14 PM
So for someone who is hoping to start hormones soon, instead of AA I should  consider an orchiectomy and estrogen?


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I'm sure everywhere is different ... Where I live (Midwestern Canada), you need to be on HRT (an AA and estrogen) for at least one year before "they" would even consider approving you for an orchiectomy. That could have to do with the fact that it's 100% covered by health care though. I'm sure it's different when you're paying out of your own pocket.

Quote from: AnonyMs on August 19, 2016, 10:53:47 AM
I'd personally not do that, as it's rather permanent in a way that AA's are not. I don't like to take unnecessary risks, and what if you found out it's not right for you?

I take your point. The thing is, many of us aspire to and go through with, full GRS which is also somewhat permanent 

Quote from: Rachel Richenda on September 22, 2016, 11:12:43 AM
I take your point. The thing is, many of us aspire to and go through with, full GRS which is also somewhat permanent 

The question I was answering was about starting HRT and having an orchi at the same time. You'd not normally have start HRT and have GRS immediately. I think it would be less risky to use AA for a while before any kind of surgery, partly beacause there's not a lot of risk to doing that.

Another advantage, if minor, to being on AAs for a year or so prior to an orchiectomy is shrinkage.  The atrophy of testes on AAs makes them smaller and a smaller incision is then needed to remove the little nuggets 

I originally I was going to get an orchi (compromise with my wife). I had been on AA's for 2 years. At the time I wanted GCS but compromised. When divorce became a reality then so did GCS. My only concern is the invasiveness of GCS and increased potential complications.

When I scheduled the orchi I wanted GCS. I knew GCS would be years later and I really dislike spiro. I really hate my genitals so I was somewhat ok taking care of the gonads and then later GCS.

Quote from: Lady Sarah on August 17, 2016, 03:20:06 PM
In my case, E caused my testes to retract, to the normal position for ovaries. The stress on the vas deferens caused great physical pain. It became medically necessary to have the orchiectomy done, and I am grateful.

The peace of mind is phenomenal. Not having to take anti-androgens is also a blessing. It also allowed me to have all my documents changed to Female, since it is surgical castration. I am aware some states do not require SRS or castration to get your birth certificate changed, but the state in which I was born does.

Is that what happened to me??  The right one died and caused A LOT OF *** PAIN ***, and the left one was going, too.  They had to be taken out.  Because it was a medical issue and not a transition issue, insurance covered it.  Ahhh, no more AA's...  I had it done 10 years ago this summer.  No regrets!

I have been on spiro and estrogen for about six weeks and it had been a wonderful experience for me. I had blood pressure that was a little high to begin with and taking the spiro made it just about perfect. It has greatly decreased the male sex drive to the point that it is totally nonexistent. My testicles are a lot smaller and I fit really well now into panties. I am very happy with taking the pills. My wife says I am a better person taking them. Much more relaxed and happy. I also do not like the idea of surgery, if there is another route I will always try that first. 

Just a thought: even orchiectomy may not totally remove the need for antiandrogens. I had one over a decade ago, partially to be able to stop antiandrogens, and found that my body hair reduced a lot but not to the level I wanted. About 3 years ago, after being "stable" for a long time, my doctor and I decided to try me on a trial run of spironolactone and finasteride. Lo and behold, my body hair reduced even more and I noticed other subtle signs of increased feminization. There is research out there demonstrating that antiadrogens are still effective in treating hirsutism even in cases where testosterone levels are normal or even low, and that was certainly true for me. I continue to take spironolactone daily and probably will for the forseeable future.

That's kind-of curious. I have no T at all. Or, at least, it's virtually undetectable: 1.2 pnmo/L or 0.35 ng/mL. Estrogen levels have been fairly high of late: 577 pmoL.

cis-females do often have some body hair as you suggest though.

But if you have no testosterone what will a T blocker achieve?

x