Orchiectomy also known as Orchiectomy or orchie is a surgical procedure in which involves the removal of one or both testicles. The penis and the scrotum are however left intact. The removal of both testicles is called bilateral orchiectomy and it is the surgical form of castration. There are three main types of orchiectomy: simple, subcapsular, and inguinal.
Pros of orchiectomy
If properly done, you are hormonally post-operative. And as I am sure most of the girls must have heard, Hormone Replacement Therapy works better when one is post-op. Let us face it: not every girl begins the transition with the same resources. If we agree that the goal of transition is to allow you to function in society as a member of the desired gender, there definitely is a case for orchiectomy.
The primary reason to opt for an Orchiectomy is financial. SRS in India can cost anywhere from 1 Lakh Rupees to 10 Lakhs. A lot of girls, especially those who begin to live full time early do not have ready access to so much disposable asset. One can obtain an orchiectomy for as little as 10,000 Rupees. And it is much more readily available. Any MBBS worth their salt can do it. Whether you can get them to do it is another matter. If you have GID certification from a Psychiatrist/Psychologist, I see no reason why you will not find an emphatic enough doctor.
Post-op Hormone dosage
The second strongest reason to opt for an orchiectomy is the difference it creates in Hormone Replacement Therapy. As I said, hormonally you are post-op. With the primary source of Testosterone removed (some produced in the adrenal glands), your endocrinologist does not need to prescribe Androgen Blockers. Most common androgen blockers were not actually developed for this application and have not been tested and marketed for this use. What we are doing is off-label prescription. Thus they have significant “side effects” which is actually the drug’s intended main effect. For example, spironolactone is the most commonly used androgen blocker but it is marketed as a “potassium-sparing diuretic. A diuretic is an agent that induces urination. Elimination of fluids will decrease the blood pressure and it can do so dangerously. You are at risk of dehydration and so should drink a lot of fluids. Also, human urine is not only Water and Sodium Chloride but also has Potassium and Calcium ions. Thus spironolactone is a kind of diuretic that preferentially eliminates Calcium and retains Potassium. Spironolactone consumed for extended periods of time at high dosage can cause hyperkalemia. All these unnecessary risks can be eliminated with orchiectomy before we begin HRT.
Less Testosterone blokers
Then there is the proper dosage of Estrogen required for proper feminization. Testosterone and Estrogen tend to work in opposing directions and hence part of the externally administered estrogen gets neutralized by Testosterone when you are post-op. Estrogen is not some magic potion we can consume and transform ourselves like sorcery. Its function is complicated. It also works as a growth hormone. High levels have been correlated with Breast Cancer along with other symptoms/conditions. And don’t be under the false impression that it breast cancer does not affect us girls or that a mastectomy will cure it. Make no mistakes girls: Brest Cancer is a killer. With orchiectomy, we can administer smaller, safer dosage of estrogen.
But the strongest reason I would say, the one that made me opt for orchiectomy was that it demonstrated a definite commitment on my part. I do not know how it was for other girls but I was not sure that I am a girl inside. In fact, there used to be a time when I was cocksure that I am a guy. So naturally I had doubts; doubts about my own motive for transition; doubts about how well my transition would turn out; doubts about what if one day I did not want to be a woman anymore. So, getting an orchiectomy was my way of laying those doubts to rest. I was crossing the metaphorical Rubicon. It was me taking control of my body and my destiny instead of my body dictating my destiny.
Cons of orchiectomy
The main disadvantage of having an Orchiectomy are surgical considerations when you go for SRS. Over time, the tissue down there shrink, both the sac and the phallus. With Penile Inversion Vaginoplasty being the most commonly carried out procedure for SRS, this is a problem. The skin on the phallus and the sec are utilized to craft/shape/build the female anatomy and if you have had orchiectomy a long time back, there is a chance that your surgeon may not be able to achieve the desired dimensions. This happened with me and I had made my peace with going through a Sigmoid Colon Vaginoplasty. It is more expensive, more invasive and much more risky. But talking to many doctors I learned that it is not my only option. One doctor suggested I use Penile Inversion and Skin Graft from a donor site. Another recommended a method called Singapore Flap. So, these problem is not unsurmountable.
There is also the matter of scars. As far as I know, there are two places an incision can be made for a bi-lateral orchiectomy: one of the median raphie of the scrotum (the line down the middle) or on the lower the abdomen, a little above the hip bone. If it is the second kind of incision, this discussion is moot. If the surgeon doing the Orchiectomy is not good at what he does, the incision is going to leave bad scars and render the area unsuitable for a Vaginoplasty. But the incision on the abdomen is more invasive and I would recommend you go for the incision on the scrotum. If there be scars, we can use other methods.
Bone Density issues & weight gain
There are a couple of things you need to know if you are going to have orchiectomy and not go on Hormone Replacement Therapy. Anecdotal evidence suggest (some hijdas) that you will gain weight if you do not go on HRT for a long time. I have rationalized this to the absence of Testosterone slowing down your metabolism. Probably the decrease in muscle mass is also a factor. It takes calories to maintain muscles. The much more clear and present danger is that of osteoporosis. Sex hormones are required to maintain healthy bone density and in their absence bones become porous. You will become much more prone to fractures or bone deformities.
My Own Experience
There were some post-operative bleeding and seepage of plasma so I had to wear a sanitary pad for a few weeks. I remember thinking I better savor this experience because it’s a part of a cis girl’s life and I am unlikely to go through it even after I transition successfully. The first change I observed was heat flushes, like the ones described as one of the symptoms of menopause. Your body suddenly feels very warm and you break out in sweat. And just like that , it is gone. We are talking 30 seconds, maybe a minute. It was not a major inconvenience and I did not keep count of how often I was having it. After a while, it went away.
I lost a bunch of weight, mostly muscle mass; quite a bit of fat too I suppose. I’ve had severe hair fall problem since my teenage years and that went away. I even regained some of the lost hair. Facial features changed too. My looks became a little softer and probably for the first time in my life I began to like something about the way I looked. But we are talking about very subtle and gradual changes here. I did feel some changes in the breast but there was not a lot of development. To my great delight and disappointment, I could easily hide the girls with a slightly thicker shirt or layers.
If one asks if I am happy with the results of HRT I obtained, then, obviously no. And there are girls out there who make me green with jealousy. But compared to most girls I know, I think I got above average results on HRT. I fill out a B cup comfortably and my bones are not overtly masculine and so I get to look like I have wider hips. I like to think I got these results because I got the orchiectomy before it was too late and my body was irreparably masculinized. You see, the body keeps growing/changing until death. Some masculine features of the anatomy are developed as late as the 30s or 40s. So, the longer you have androgen in your system, the more your body becomes “manly”. Not having to overcome the native Testosterone enabled the administered estrogen to work properly.
I am of mixed ethnicity with mongoloid blood. So I never had much body hair. I did have some on the limbs and a little on the abdomen. The proper hair on the pubis and underarms. I saw changes in the hair coarseness, distribution pattern changed. The hair on the abdomen disappeared. The ones on the limb became finer and grew short. The ones on the pubis too became finer and shorter too and they tended to stay straighter. The ones on the underarm almost disappeared and now it’s nothing but villus hair. But I have to warn you that changes in body hair pattern took a long time.
There was some subtle difference in a facial hair but here again, we are talking very subtle changes. As men age, they find that they need to shave more and more of their face. The area decreased for me post-orchiectomy. And I also think Laser Hair Removal worked better because of the procedure. To be fair/objective, I was already on HRT when I was going for laser so we cannot say which factor caused it or if both were factors.
Over the long term, the scrotal sac shrank and so did the phallus. I gained sub-cutaneous fat and gradually the phallus sank a bit in it. Thus I never experienced any packing and tucking issues. All I had to do was get a reasonably tight panty and I was ready to go with any outfit. Obviously, I am talking about being fully clad not walking on the beach in a Bikini.
DISCLAIMER: I am not a doctor. This article is from my personal experience and journey, and should never be treated as a advise from a professional. I do not recommend or expect this article to be a substitute of a proper medical practitioner or guidance. I strongly suggest everyone to seek professional medical and psychiatric opinion from a doctor, before opting for any treatment.