To preface – I had an orchiectomy, the removal of the testicles, on April 28th of this year. My life has improved significantly in the months after. My testosterone now sits at 10 ng/dL, meaning I no longer have to worry about it. Not only that, but taking my first step into genital reconstruction surgery has helped to alleviate some of my dysphoria. However, my bottom dysphoria will still be present until a vaginoplasty. Furthermore, I have experienced significantly more feminization post orchiectomy. I highly recommended an orchiectomy if you are considering it
Consultations – I had 2 consultations with the American Institute of Plastic Surgery based in Plano, Texas. My therapist recommended me to Dr.Dulin, who is a surgeon there. In the first consultation, I went alone. We discussed therapist notes, complications, pricing, the procedure, insurance, hormones, and how long I lived as my preferred gender. My insurance did cover gender-affirming orchiectomies; however, they needed 3 notes from health professionals, including psychologists, psychiatrists, and HRT providers. In total, it would not have been cheaper to get the procedure covered by insurance. I decided to pay out of pocket because of that. Not only that, but I had to be off of HRT for 2 weeks before surgery to decrease my risk of blood clots.
One of the reasons I decided on the American Institute of Plastic Surgery was how they performed their orchiectomies. For gender-affirming orchiectomies, two main options exist. For simple orchiectomies, the incisions are made on the scrotum, while for an inguinal orchiectomy, the incisions are made on the inaugural region, the lower abdomen. Not only that, but some surgeons may leave the spermatic cords in the scrotum. For me, I preferred the inguinal method. Making sure to have no scar tissue on my genitals for later surgeries was a priority. I wanted the spermatic tube gone as well; I did not want any remnants of my testicles in my body.
At the American Insulation of Plastic surgery, they offer inguinal orchiectomies with the removal of the spermatic cord. Since an orchiectomy is a common procedure, I did not feel the need to have multiple consultations with other surgeons. In hindsight, that may have been a mistake. I may have been able to get it cheaper at another facility.
For my appointment before surgery, I was given a packet of information for post-op care. Not only that, but I was told how to prepare and what to bring the day of. Before the surgery date, I submitted my blood work and my therapist note. The surgeon also confirmed that someone would drive me home and take care of me post-surgery.
The day of – My surgery time was in the latter part of the day; I had a regular day up until the point of my arrival. However, I was told not to drink or eat anything for 24 hours before surgery. I had to go in for surgery alone due to COVID regulations. I brought my wallet, phone, and headphones with me. My surgery time was later than expected, so bringing headphones to past the time was critical. I spoke with nurses and the surgeon before the anesthesiologist put me under. The surgery in total was 30 minutes to an hour. When waking up, I remember feeling horrible. I felt groggy and exhausted. I was wheeled to my mom’s car and taken home. I do not remember anything for the rest of the day.
The days postoperative – I had an appointment the next morning to make sure there were no problems the night of the surgery. For me, the pain was incredibly manageable the first and second day. I was able to stop taking my pain medications the second day. Overall I felt tired and not fully like myself. My whole body felt incredibly sensitive and fragile. The area of the incisions did feel sore; however, it was manageable.
I had two incisions on my lower abdomen that were covered with bandages. I was given a package of additional bandages, a post-surgery strap with padding, and compression stockings for my legs. I was told to keep all of those on for the first week. I went back to showering and parts of my routine on the third or fourth day. However, I was instructed not to submerge the incisions in water for 6 weeks.
Life went back to normal pretty quickly after surgery. My mom took care of me for the first and second day but went back to work after that. I was able to walk the day after and take care of myself to some extent. However, I still felt fatigued, sore, and nauseous for the first week. In total, the recovery for me was extremely manageable, especially with help.
The weeks and months postoperative – One week after surgery, I was able to take off my compression stockings and strap. One of the worst parts of recovery for me was the 2nd or 3rd week. In one quick surgery, my testosterone dropped from 241.6 ng/dL to 10 ng/dL. Your body needs time to get accustomed to your new hormone levels. I felt exhausted for almost the entirety of the 2nd and 3rd week. My motivation and drive both plummeted. These feelings passed by the 4th and 5th week; however, feeling exhausted from your new hormonal normal is part of the surgery.
I was able to restart my HRT a week after surgery with my doctor’s permission.
My experience fully healed – At this moment in time, 6 months after my orchiectomy, I feel the most mentally and emotionally stable I have ever felt. I can express myself with whatever clothes I see fit. However, I still do need to tuck if I am wearing extremely tight clothing. It is though, exceptionally easier now to tuck than it was before. In daily clothing like jeans and sweatpants, I feel no need to tuck.
Furthermore, I no longer have stress or anxiety relating to my testosterone levels. I have experienced drastic amounts of feminization since having my orchiectomy. Not everyone may experience the same amount of growth I did. Those who had testosterone levels in cis female ranges before their orchiectomy may experience little or no amounts of increased feminization.
My genital dysphoria has been partially alleviated now as well. I viewed having testicles as an incredibly masculine part of my body; having them removed has made me feel more in line with how I am truly supposed to feel. In my future, a vaginoplasty is going to be a necessary part of my transition. However, that may be years from happening. Taking smaller steps to have genitals that align with my identity made the most sense for me. In comparison, a vaginoplasty can cost anywhere from 20,000 – 75,000 USD. In contrast, my orchiectomy costs 3,500 USD. Not only that, but an orchiectomy seldom affects your ability to get a vaginoplasty down the line. Genital atrophy will increase post orchiectomy; for certain types of vaginoplasty that may be a problem. However, methods exist to combat genital atrophy.
In short, my orchiectomy was a critical part of my transition so far. I have no regrets about doing it and would recommend the surgery to anyone who is considering it. It has opened the door for me to new feminization as well as partially alleviating my genital dysphoria. I now have the freedom to wear clothing without having to worry. My orchiectomy was a fantastic stepping stone to a later vaginoplasty.