I had an elective surgical castration, AMA

So you are keeping your penis, but without testicles? Or do you plan to eventually remove that as well?

I'm sorry you're getting downvoted. I really want people to feel safe to ask whatever questions they like without fear of offending me.

I plan to keep my penis. It doesn't give me any dysphoria and there's some things I like about it. I like that I can stand up to pee. I like to use it to top my lovers. I like that I can use it to make money. Most of my dysphoria comes from things that are public facing like my face. I figure anyone who sees my penis is already into me anyway, and I don't really feel like being a little different is a reflection of my womanhood.

I've heard some people seek a penectomy or a vainoplasty without a cavity, but those operations are both pretty rare and I don't actually know any surgeons offering them for gender dysphoria. The new wpath standards are being published soon though, and they are likely to have more focus on transgender people who don't fit the binary, so maybe options like that will become more common.

Thanks, I didn't mean offense by asking the question. Honestly curious.

If you like to top, how can you get hard without the testosterone from your testicles? Or am I misunderstanding the physiology?

Impotence is certainly a possible side effect of an orchiectomy, particularly for men, male eunuchs and some nonbinary people. I was made aware of that risk, but since I was able to maintain erections while taking cyproterone my doctors doubted that would happen.

When the penis becomes erect, it's because it's full of blood, not testosterone. As long as you're able to get aroused, there's a possibility that you can have an erection. In trans women, the hormone that helps the body feel sexual arousal is the oestrogen we take, so the method of arousal is often similar to other women (take your time to warm us up. Make it good) but when we become aroused, some of us are able to get an erection just fine.

All that said, erectile dysfunction is a problem for some trans women. Many trans women are okay with this because they can reach orgasm without an erection (and they may welcome it because an erection can be a source of dysphoria), but trans women who wish to top will sometimes have trouble with condoms, so doctors will often prescribe viagra and cialis to trans women in order to make condoms easier to use. I keep cialis and viagra around but I don't use it very often, mostly just for work.

Hi! Thanks for all the insight on this topic. I'm transfemme-nb, pre-hrt and that's one of my worries, losing the ability to top. Have you ever looked into a hollow strap on? Do you think it could work? I find the motion of thrusting/grinding is very arousing but I don't really care whether or not I do it with flesh or fake flesh.

I haven't used a sheath before but I've used a regular strap on. It's definitely something that takes practice but it's an option for some ppl.

Not OP, but I'll offer my experience as someone who has been on HRT, but has not yet had surgery (although I do have an orchi consult in a couple weeks).

Whether or not a trans woman can get erections is highly variable, based on lots of different factors. But HRT can make it more difficult, which is what happened in my case (I can if I really want to, but it takes quite a bit of effort and isn't what it used to be.) However, I personally don't care: if my penis fell off tomorrow, I wouldn't miss it (although it's kind of important for GCS surgery.) With that said, I can and do have orgasms most of the time. Sometimes they're elusive, but I also don't have to get off to enjoy sex -- if I come, great, if not, there's none of that physical frustration that used to be there if it didn't happen. I don't need an erection at all to thoroughly enjoy a sexual encounter, whether alone or with someone else.

To answer your question more directly: Right now I can still top, if I put a lot of effort into it, but HRT alone has made it much more of a challenge. However, I don't need to do that to enjoy sex with someone. And believe it or not, sex is a hundred times better and more enjoyable for me now than it ever was before! (And to answer a related question, little or nothing comes out anymore. At best it's a couple drops of clear fluid and that's it.)

Thank you so much for contributing your experience. Trans women's bodies experience arousal in such a myriad of ways and I'm really happy that other transfeminine people are sharing their stories here too.

I like that I can use it to make money.

I'm not judging but are you a prostitute or am I missing something?

I'm a professional dominatrix, but a lot of trans women see their genitals as an economic opportunity and use them to pay for the tens of thousands of dollars in medical costs we often have. As far as full service sex work goes, you could say I don't have the balls for it.

( ͡° ͜ʖ ͡°) 

Does the operation change your hormone prescription? For example, would you now take less of it since you no longer have to combat testosterone? Do they require you to be on hormone replacement therapy to have the operation? What is the recovery like?

Does the operation change your hormone prescription?

I was taking transdermal oestrogen (patches), cyproterone acetate, and finasteride. On the day of my surgery, I stopped taking finasteride and cyproterone, my testosterone blockers, but kept taking my oestrogen. One month post surgery I had a blood test that indicated average female range testosterone levels and low female range oestrogen, so I may be switching from transdermal to injection oestrogen, but that's likely not related to my surgery.

Do they require you to be on hormone replacement therapy to have the operation?

Currently to qualify for an orchiectomy you need to have been on hormones for one year. I was at the Canadian professional association for transgender health conference last year, and there was a push from some medical professionals to lighten that requirement so that male eunuchs and nonbinary people wishing for an orchiectomy can get one too. There's some ethical and medical concerns (people who have neither oestrogen nor testosterone can have medical issues) but I think that given that people are seeking this operation out from unlicensed surgeons it would be nice to see the requirements loosened.

What is the recovery like?

Following the operation I was kept in recovery for about two hours where I was given IV pain killers. I left the hospital in a wheelchair and when I got home I took a couple of tramadol and stayed on the couch. The second day I stopped taking my pain killers and the second evening I was able to poop (constipation is a side effect of surgery and pain killers). On the third day I was able to go to the grocery store, but I mostly took it easy for the first 7 days. I was able to return to work after 10 days, and after about two weeks my stitches started to dissolve and I was able to have sex again.

Mostly the recovery felt like I had been kicked in the balls felt hard, and that pain lasted about 3 days.

Well, on the upside, you won't have to worry about that "getting kicked in the balls" pain ever again.

Haha. As a side note, it's not a good idea to tell your psychological screening doctors jokes like this. One of my friends told her doctor that she "wanted somewhere to keep change" and was almost denied surgery as a result.

If you are not planning on removing your penis why did you decide to remove the testicles? Why didn’t you just keep everything?

I was taking finasteride and cyproterone to block the testosterone in my system. Both drugs are very harsh on your liver and made me lethargic, they also have mental health side effects. I wanted to stop taking those meds so that's why I got the orchiectomy.

Very ignorant and personal question here, but I’ve always wondered (trans or otherwise) what happens when you reach the point of climax? You can’t physically release, is there still a sensation of it or does the feeling continue beyond the point where you’d normally be “done”?

Great question! This is actually the sort of thing I talk about in my Making Love to a Trans Woman work.

So, before my orchiectomy I was taking chemical castration drugs and when I had an orgasm it was mostly dry, except for a few drops of clear fluid, and mostly underwhelming. There was a definite orgasm, but it wasn't very powerful.

Since I stopped taking those medications, when I orgasm I produce quite a bit of clear, slightly milky fluid and my orgasms feel more powerful.

The way trans women with penises experience sexual pleasure is often different from the way cis men do. We often produce a lot of fluid before orgasm, when we're aroused, and some of us have multiple orgasms.

I personally definitely experience release and an extremely short refractory period, so I can easily have multiple orgasms in a single sexual encounter. I would say my orgasms aren't as powerful as pre-hormones, but they're more powerful and satisfying post orchiectomy compared to when l was taking testosterone blockers.

From someone considering the same, what options were you offered in terms of surgical techniques? Why did you choose what you did?

Also, do they remove part of the scrotum or does it just kinda shrink on its own or...?

From someone considering the same, what options were you offered in terms of surgical techniques?

They only offered me a simple orchiectomy with an incision in the scrotum. Some surgeons will do an approach through the abdomen so you don't have a scar in your scrotum, but mine didn't offer that.

Why did you choose what you did?

It was the only option I was offered. I also don't want sex reassignment surgery but I wanted to stop taking my t-blockers, that's why I got the orchi

Also, do they remove part of the scrotum or does it just kinda shrink on its own or...?

Must surgeons like to keep the scrotum as in tact as possible in case the patient later wants a vainoplasty. They use the scrotum skin to form the labia in that surgery, so keeping it in tact and stretching it regularly is recommended. I don't want sex reassignment surgery and I'd like my scrotum to be as small as possible, so I'm not stretching it on purpose. If you don't stretch it, it'll mostly shrink up but there will always be a bit of slightly loose skin and a pad of fat there.

Removal of part of the scrotum is a scrotectomy, which some doctors offer but mine did not. Depending on how things look in a year, I may get that operation done. Who knows.

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Most of the pain was immediately after the surgery. I told the nurse it was a 7, but my pain threshold is pretty high. When I said 7 they have me an IV pain killer. By the second day I had stopped taking my pain killers.

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Yeah I'm really happy with the results.

Always wondered, is it like the dentist where they let you take them home after being removed? Or are there laws that prevent that?

Also, have you noticed any shrinkage in the penis? Since you top I assume that's a concern? Or is shrinkage just a myth?

Hope this goes big! More trans allies!

Always wondered, is it like the dentist where they let you take them home after being removed? Or are there laws that prevent that?

They don't let you take them home. I've heard some people say its because of laws but I don't know why. I have heard some people seek an orchiectomy from an unlicensed surgeon in order to be able to keep them, including one of my friends who wishes to preserve them, so it's unfortunate that they don'tgive people that option. As it stands now, they're sent to a pathology lab for examination then incinerated.

Also, have you noticed any shrinkage in the penis? Since you top I assume that's a concern? Or is shrinkage just a myth?

Shrinkage happens, but it's a result of atrophy due to testosterone blockers. In most cisgender men, your penis gets erections as you sleep and that prevents it from atrophy. Trans women need to exercise our penis by getting erections a couple times a week if we wish to maintain our size. If your penis atrophies, it may complicate sex reassignment surgery and make your erections painful. For some of us, being able to give ourselves erections a couple times a week can be a chore, and I know for me it's sometimes been difficult, but it's part of your overall health so you try to do it anyway.

I understand that 'healthy' tissue that's been removed has to go to a pathology lab and be checked over in case of a previously undetected condition. Mind you, the surgeon who told me this may well have been lying, since he was already weirded out enough about fixing a trans man before I asked about keeping the offending bits in a jar...

No, it's true. I worked for a pathology lab and most tissue removed ends up there for testing. It's standard procedure. We'd get a lot of angry calls from patients who didn't know why they were getting a pathology bill for their placenta or cyst. Testicles would be no different. It's simply ensuring there's no cancer present.

I mean honestly though, even if you found cancer, what would you do? "Welp, that's fortunate that we removed those bad boys I guess."

So is your voice pitch any higher since losing your nuts?

No. Unfortunately once your voice masculinizes as a result of testosterone, you either need to get voice feminization surgery or train your voice to make it higher.

I saw a speech language pathologist for a few months last year and I'm slowly changing my voice using the techniques and exercises she taught me. People in British Columbia, Canada wishing to feminize their voices can access a voice therapy program administered by speech language pathologists by contacting the Transgender Health Information Program and inquiring about the Changing Keys program. The program is free to anyone who qualifies and is covered by BC medical.

Hiya, saw your post in /r/traa the other day! Anyway, I was talking with some friends about this the other week, and one of my friends, who is a little more versed in trans matters than me, said that orchiectomy can cause trouble with vaginoplasty in SRS, namely in that it can limit depth. I've already got my own share of concerns with depth because of my size, which has gone down since I started HRT just about 8 months ago, so I immediately dropped the idea.

My question is this: In your discussions with your doctors have they said anything about how it might influence depth with SRS? Would orchiectomy have a negative effect on depth any more than HRT alone would?

It's really important to talk to your doctor about this, but yeah, my surgeon said that it might affect my prospects for SRS in the future. Some surgeons have been known to not see people who have had an orchi, and some will take a skin graft from your thigh if there isn't enough scrotal skin for the operation.

My surgeon told me that I could do exercises to keep my scrotum loose, much in the same way that you can also do exercises to prevent penis atrophy (but not as fun, uwu).

There's also the issue of scar tissue at your operation site, but my surgeon made the incision on the raphe line, where the srs surgeon cuts anyway, and kept the incision less than 2 centimetres long to make the scar as small as possible.

Did you go through insurance or private pay? Either way, did you find a lot of docs were available, or was this a harder procedure to find?

I ask because my wife is shopping for an orchi as soon as her 12 months are up (OMG Spiro and peeing!), and I'm FTM and remember shopping for my bottom surgery to find meta's were not as popular as phallo's so it was hard to find a surgeon. I'm hoping Orchi's are a bit easier to find a surgeon for.

This is a good question. I live in Canada so my orchiectomy was paid for by the government. Although it's an elective surgery, it's considered medically necessary when a trans patient requests it, so it's covered by BC medical.

I didn't need to search for a doctor. In British Columbia, the Provincial Health Services Authority runs a program called the Transgender Health Information Program. Your physician puts in a request with them to start the process of getting an orchiectomy, then they arrange all the screening and find you a surgeon.

In Vancouver, Dr Ryan Paterson does most orchiectomies and he did mine. He was doing at least two others on the same day, so I got to hang out with two other trans girls as we all waited to get our balls chopped off. That man really knows how to line 'em up.

If you don't mind me asking, did you have any regrets at any point after the surgery, or was it a total improvement for your life?

I wasn't really excited for this surgery beforehand, so having regrets was a big fear for me. Usually when trans women talk about this surgery online, they're elated, and I wondered whether my indifference was a red flag. It actually delayed this surgery for me by about 5 months because each time they called me with a time slot, I told them I wasn't ready yet.

After my surgery, I tried really hard to see if I could feel regret, and one night I think I might have felt a really quick flash of it, when I tried really hard to feel it, but it went away almost immediately.

My sex drive has improved, my energy levels have improved, I've started to lose weight again and I really like the way my genitals look in the mirror (I swear my penis is bigger) so I feel absolutely no regrets, even when I try.

I should note that I made my decision to be childfree about 10 years ago and I was briefly part of the childfree by choice community, so infertility isn't really that big of a deal for me, in fact it was kind of a selling feature. I had a lot more worry about how it might affect my ability to work in the adult entertainment industry, as my niche is starting to get interest from mainstream studios. While it's a barrier if I wish to work with some studios, it's not necessarily a deal breaker.

Did the doctors tell you that getting your orchy will net you less flesh for GRS later? That's my fear that getting my orchy done will make my vagina shallow later.. is this a legit fear?

BTW I'm happy for you congrats!

They said it's a possibility that it might cause complications if I decide to get srs, but a lot of doctors can use a skin graft from your thigh if there isn't enough skin for your surgery.

When they do an orchi on a trans girl, they try to make as small of an incision as possible. I've also heard that the scrotum skin can be exercised by stretching it a few times a week, I'm not sure how effective that is though.

Did you have to get off anti-androgens long before the orchiectomy or could you just stop with them right before the surgery?

My doctor let me choose when I stop taking my anti androgens. She recommended I stop cyproterone as soon as possible, but keep taking finasteride. I stopped both the day of my surgery because I wanted to be on as few medications as possible.

After your orchi, you experience a surge in testosterone as your adrenal glands attempt to compensate for your lost testicles, but once your body realizes it's getting a sex hormone from your estrogen, your testosterone levels should go down to the female range. About a week after my orchi I experienced the testosterone surge and I felt like a horny teenager, but it levelled off quickly.

hi! fellow trans girl here, congratulations on cutting your balls off!

were you planning on having kids, and did you bank your sperm? that’s one of my main qualms for getting an orchiectomy as soon as possible, or even starting hrt.

I wasn't planning on having kids. I actually had this talk with my doctor years ago when I started HRT. She knew I didn't want kids though because we had that discussion years earlier when I had inquired about a vasectomy.

God bless Canada! Good for you to have the courage to do what you think is right, also. Are you holding a whip in your twitter profile picture?

Asking for a friend..

Yeah, I think I'm holding a riding crop in that photo.

Two questions..

-After the surgery is there a sensation of a "phantom limb"?

-how do doctors approach this type of operation VS somebody who has body integrity disorder? Like someone who goes to the doctor says "I don't want this leg anymore" because to my knowledge they are usually just prescribed some sort of drug. Is there some sort of mental exam?

-After the surgery is there a sensation of a "phantom limb"?

I never experienced this.

-how do doctors approach this type of operation VS somebody who has body integrity disorder?

Doctors have guidebooks to help with these requests. In Canada we follow the World Professional Association for Transgender Health standards (wpath). They lay out how to field these sort of requests as well as the standards of care for transgender patients in an array of situations. In British Columbia, caregivers can also call the Transgender Health Information Program for assistance with these kinds of requests.

Body integrity disorder, to my understanding, has different standards of care so those sorts or requests are probably treated with something like therapy. If I had failed my psychological screening, they likely would have had me go through some kind of therapy as well to see if that helped. From talking with folks in the trans community, they often worry about things like dissociative disorder or obsessive compulsive disorder during screening, but I'm not a doctor or a psychologist, I just answer the questions honestly and hope for the best diagnosis and treatment.

Is there some sort of mental exam?

Yes. I had to be screened by two doctors who specialize in transgender health. Some people get a screening by a psychologist instead, but I didn't get one.

Why is this commonly done? Strictly hormone related or are there other reasons as well?

Some trans people get it done as a stepping stone to an eventual vainoplasty. Some get it done because they're afraid of bottom surgery or they can't get srs for medical or financial reasons. Some people have dysphoria from their testicles but not their penis. I personally got it done because I didn't want to take testosterone blockers anymore.

Cancer is another reason for orchiectomy, though that is usually for just one testicle.

Some people will get a bilateral orchiectomy for tumours that are sensitive to testosterone, like prostate cancer or breast cancer.

Did you never have dysphoria about your penis or is it something you've worked to come to terms with and how? I'm trans and bottom dysphoria is what is worst for me but bottom surgery may not be an option for me so I just want to know if its possible to get over dysphoria to an extent?

I have never had dysphoria about my penis, at least not as long as I've been out to myself as trans. When I started my transition, coming to terms with the fact that I'll likely never pass was a big hurdle for me to start my transition, so maybe my comfort level with my penis is tied to overcoming that.

If you have bottom dysphora though, an orchi may alleviate some of it. Many post orchi trans girls start to enjoy muffing, and the back of the scrotum becomes an erogenous zone on some of us after our orchi. About 3 weeks after my orchi, I had another trans girl show me how post-orchi girls sometimes like to be touched there, and it felt amazing.

[Serious] Why is it that when someone goes to their doctor and asks to surgically remove a healthy arm, they are labeled as not mentally stable and sent in for help, but when someone wishes to remove healthy testicles/penis it’s seen as normal and not labeled as a mental problem? I feel like this should be pushed more, either all or nothing, not some body parts being “normal” to remove and some not

So, I'm not a doctor but i can tell you what i know as a trans woman. People who ask for a limb removed usually have body integrity disorder which has a very different treatment type. Similarly, many people who go to their doctor about transitioning are screened for other disorders that might make them think they're trans, and some of them get treated for things like obsessive compulsive disorder or dissociate disorder.

Many parts of being trans are treated similarly to a mental health issue. It's called gender dysphoria in the DSM or transsexualism in the IDC. The treatment laid out depends on the patient, but might include hormones or surgery. A lot of trans people don't end up being treated with those, but as doctors and professionals understand more about transgender health, and as acceptance grows, outcomes for people who have surgeries or take hormones become more positive, even for people who are visibly trans.

Me again, because... curious. I have a MTF trans friend so I suppose I could ask her.

Did you have them place testicular implants or is that not a thing?

I never wanted implants but a friend who had her orchi around the same time as me asked if they were an option and her surgeon said they don't offer them to trans women. I don't think I'd want them anyway because I don't really like the look of testicles anyway. Trans girls usually have smaller testicles than cis men too, so they might look out of place.

Does the nutsack become smaller or do you now have a flab of skin hanging there?

Edit: And another question out if curiosity. I've had a (luckily benign) tumor removed from my right testicle some years ago and they actually cut my lower abdomen above my penis to extract the testicle, instead of cutting into the nutsack.

Was this the case for you as well? I believe for me it was due to tumor potentially being cancerous but I'm not sure.

Does the nutsack become smaller or do you now have a flab of skin hanging there?

The skin eventually shrinks if you allow it to, but many trans women want excess skin there so it can eventually be used in a vaginoplasty in the future, so many women stretch it to try and keep it loose. I am hoping mine shrinks up because I like the eunuch aesthetic.

Edit: And another question out if curiosity. I've had a (luckily benign) tumor removed from my right testicle some years ago and they actually cut my lower abdomen above my penis to extract the testicle, instead of cutting into the nutsack.

That's one way of performing the operation and I asked my surgeon if he would do an abdominal approach, but it's more complicated so he just does a scrotal approach.

I read this earlier but had no questions and I was laying in bed thinking about it and has to come back and find it because I actually thought of questions I'm pretty curious about that I guess I normally wouldn't have the opportunity to ask..

So you had your testes removed.. does that mean that they take the skin off too and just close it all off and you're left with just a penis? Do you still get erections? And do they happen the same way they did before or has it changed since you had your testes removed? I've only know one trans person personally but he is F2M. He was super cool with sharing everything because he wanted people to be more understanding and not feel shy. He's had his top surgery but I think that's as far as he is going.

So you had your testes removed.. does that mean that they take the skin off too and just close it all off and you're left with just a penis?

They leave the scrotum in place, and with time it will shrink up. They can remove the scrotum, that's called a scrotectomy and it's not normally offered to trans women. They like to have scrotum skin available in case you want sex reassignment surgery later, they use the scrotum to construct a vagina.

Do you still get erections? And do they happen the same way they did before or has it changed since you had your testes removed?

I still get erections. Before my orchiectomy I was taking chemical castration drugs which have a bit of an impact on your sex drive and mess with your erections. You don't get spontaneous erections as much anymore or erections at night time, so you need to make sure you get regular erections in order to prevent your penis from atrophying. Your Postx ex drive is more like a woman's, so you need to get warmed up for things to work right.

Post orchiectomy, since I stopped taking cyproterone and finasteride, my erections have been more frequent and my orgasms have felt more satisfying. Those medications seemed to have serious side effects for my mood and my libido, so I'm glad I'm off of them.

What are your thoughts about Jordan Peterson?

The free speech superhero who sued a college for saying mean things about him? He seems like a doofus tbh, but that's just my personal opinion.

Do you support the free speech restrictions in Ontario that he made a scene about? I always expected trans people to be uniformly in favor of them, but then the two close friends I have who are trans are strongly against those compelled speech laws. So I’m always curious to hear other perspectives from the community. Thanks for any insights!

There are no "compelled speech laws." The laws he was opposing were the recognition of human rights for transgender people. Human rights laws protect people from employment and housing discrimination, they don't say you can't be a dick (although if you get fired for being a dick, that's not a violation of your freedom of speech, that's the consequences of being a dick. That's why Wal-Mart greeters don't swear at people).

A lot of transgendered people have serious regrets after having life changing permanent sex surgery and become suicidal. Mostly because the idea of the surgery is much better then the reality of it and they don’t really get what they wanted out of it. How did yours turn out?

I'm super happy with the results. Post op depression is common with any operation, but I never experienced it.

As for gender conforming surgeries, the rate of regret after post operative depression is thought to be around 1%. People are more likely to have not gotten the operation earlier.

Why is it that you feel you are a woman even though you have a penis. Im being serious, is the logic behind that somehow confusing?

Do you not know that females dont have penises? Or s it that you dont believe that to be true?

I don't know. I fought it for a long time and I even got involved in transphobic hate groups, but I always had problems living inside my body, and as I started trying to change my body to be more comfortable, I felt more and more like I was living in my body. I didn't one day decide I was a trans woman, for me it was a really slow process that involved trying out progressively more feminine looks and identities. I went through a genderqueer phase for years, and even now I'm not the most binary of trans women. For me, it's just about finding a comfortable place.

How do you know you're not mentally ill?

Because I passed the psychological screening required for me to give informed consent on all my transition decisions. I am certified sane, at least sane enough for a doctor to be like, "she knows what she's doing, let her cut off her nuts."