Bilateral testicle removal or Orchiectomy can be an important surgical procedure offered to the MTF as either a final or interval step in the gender transition process.
Very occasionally, removal of the scrotal skin is also requested although this step eliminates an excellent source of potential vaginal skin for later vaginoplasty and should be considered carefully prior to proceeding. The so-called ‘Ken doll’ look should be considered a final step in the gender transition process.
Much more common, the Bilateral Orchiectomy is performed by opening the scrotal skin along the midline raphe, the vertical scar seen in all males running along the front of the scrotal sac. A short, 4 cm incision is created with dissection carried down to the inguinal ring where dissolvable sutures are used to ligate the spermatic cord. This effectively renders the biological male sterile with markedly reduced testosterone levels, It can be useful in those seeking to reduce their costly and or/potentially risky use of high-dose estrogen while speeding the visual effects of transition as it relates to the feminizing loss of testosterone.
The procedure is performed entirely as an outpatient, normally in the San Mateo Surgical Center or in combination with any of Dr. Beck’s procedures. Recovery can be painful for some as the cramping associated with tying off each spermatic cord can be uncomfortable, especially within the first 48 hours following orchiectomy. Ice (to reduce swelling), pain killers and antibiotics (to reduce the risk of infection) are the mainstays of postoperative care. Most patients can resume near full activity within one week of orchiectomy. A stay of no more than 5 – 6 days in the Bay Area is normally recommended. The procedure can be combined with Tracheal Shave (Dr. Bowers)or Breast Augmentation (Dr. Beck).
The WPATH Standards of Care require one letter of recommendation from a licensed mental health professional rather than two for GRS. Orchiectomy can be performed for males wishing to remain males but again, a psychiatric evaluation and documentation would be required. These requirements are not set as hurdles and obstacles but rather, as assurances that a final decision is made carefully and with full knowledge regarding the permanency and outcome of any decision to proceed.