Orchiectomy before vaginoplasty?

46
u/needSRS
Mon Aug 31 11:25:13 2020 UTC
*
(48 comments)

Hi,

I plan on getting a vaginoplasty in Thailand (I really like Suporn's technique) but can't afford what I want right now and probably won't for a few years, but my medical insurance covers the orchidectomy procedure and I'm wondering if it's worth it to do it now (I only need to wait 4-6 months after the appointment). I can't take the tucking pain anymore and I'm tired of having to use lots of E2 to shut down the T production by my gonads, so I kind of think it is worth it, but I'm worried that the generated scar tissue will worsen the vaginoplasty surgery or healing. Does someone has done this? Did it go well?

I would go for a "testicle removal only" (no removal of the scrotal tissue, only an incision in its middle) orchidectomy.

Thank you

all 48 comments



7
u/DrDanamarie
Mon Aug 31 12:19:54 2020 UTC
(1 child)

Shouldn’t be a problem but would contact GCS surgeon for his opinion and let Urologist know for GCS of course. Electrolysis may be little slower from what I understand if needs to be done.

3
OP
Mon Aug 31 12:57:13 2020 UTC
(0 children)

I just sent an email to the GCS surgeon, the urologist already knows

18
u/TanookiPhoenix
Mon Aug 31 12:03:19 2020 UTC
(13 children)

This is the route that I took. I think you're looking for a 'bilateral orchiectomy'(what I had) that retains the tissue for future SRS. I think 'inguinal orchiectomy' is the one you want to avoid. Basically just tell your healthcare provider that you want to retain the extra tissue and you should have no problems.

The relief of being able to stop Spironolactone alone was worth it. That stuff leaves you terribly dehydrated and makes you change your dietary habits to avoid all potassium.

6
Mon Aug 31 14:50:28 2020 UTC
(4 children)

You got it backwards. Inguinal is the one you want if you want srs in the future because the other method (called simple or scrotal) leaves scar tissue on the scrotum.

0
OP
Mon Aug 31 15:47:53 2020 UTC
(3 children)

My urologist told me that the inguinal one creates more scar tissue on the inside of the scrotum and is therefore less suitable

3
Mon Aug 31 22:24:09 2020 UTC
(0 children)

Yeah whatever scar tissue is added from an orchi I believe gets cut around during SRS. Mine turned out okay and my SRS was back im 2018☺

0
Mon Aug 31 15:54:13 2020 UTC
(1 child)

Yeah I think any type of orchiectomy before srs is a bad idea. But to know for sure you'd need to ask dr Suporn or whichever surgeon you choose. Plus tucking isn't supposed to hurt. Do you know why that's happening?

2
OP
Mon Aug 31 17:28:19 2020 UTC
(0 children)

Because you're not supposed to tuck at least 12h a day and it creates long-term irritation, etc

It's so uncomfortable it ends up being painful

7
Mon Aug 31 15:10:15 2020 UTC
(0 children)

Bilateral means 'on both sides,' i.e. both testicles. All methods of trans orchiectomy are bilateral.

6
OP
Mon Aug 31 12:54:59 2020 UTC
(6 children)

I stopped blockers a while ago but being on "high" dose E2 monotherapy and the tucking problem piss me off, it's a daily burden and I'm really tired of it...

9
Mon Aug 31 13:21:39 2020 UTC
(5 children)

Just fyi, an inguinal orchiectomy is the thing you want. The above poster is misinformed.

An inguinal orchiectomy doesn't touch the tissue on the scrotum - that's what you want! The alternative is to go through the scrotum, which could create scarring in the tissue that's used later for SRS. If you get an inguinal orchiectomy, you're in the clear for any version of SRS.

The internet at large is also misinformed about tissue atrophy - all of the actual surgeons I asked about this said that it wasn't at all an issue. One said that they'd had patients ten years out from an orchi and had no problems.

1
OP
Mon Aug 31 15:49:16 2020 UTC
(4 children)

My urologist told me that the inguinal one creates more scar tissue on the inside of the scrotum and is therefore less suitable

1
Mon Aug 31 17:53:32 2020 UTC
(3 children)

I'd recommend asking an srs surgeon - I've asked 3, all recommended I get an inguinal orchi.

2
OP
Mon Aug 31 20:47:07 2020 UTC
(2 children)

I'm definitely asking Suporn, who did you ask?

3
Mon Aug 31 21:25:03 2020 UTC
*
(1 child)

Suporn has that information in his intro packet, which you can find on his website.

I asked Bluebond-Langner and her urologist, who are both present at my consultation (I have an srs date with her next year!), Dr. Peter Raphael in Texas (he did my orchi), and Wittenberg.

2
OP
Fri Nov 6 19:14:09 2020 UTC
(0 children)

Suporn actually adviced me to go for the "normal" orchiectomy (one incision in the middle)

4
u/[deleted]
Mon Aug 31 23:32:42 2020 UTC
(2 children)

I had the procedure you describe (orchiectomy without a scrotectomy, via a small incision in the middle, and about 1.5y later on I had SRS).

The orchi scar was tiny, after 6 months even a doctor would have a hard time finding it. I could not feel any "scar tissue" inside. It was a very precise, clean procedure. I give credit to my surgeon here; he performs a lot of testicular cancer procedures, and this was one of my best surgeries, in terms of scar size, and healing time. There was no impact on my SRS from scarring.

The main concern I heard was, if you had an orchi a long time prior to SRS, your scrotal skin might shrink, and this would leave you with insufficient material, possibly necessitating a skin graft. My SRS surgeon asked me to do stretching exercises on the skin, and I ended up having enough for the surgery.

It's best to check with the SRS surgeon of your choice prior to planning the orchi.

1
OP
Fri Nov 6 19:12:38 2020 UTC
(0 children)

Thanks for your answer!

1
Sun Mar 27 10:13:24 2022 UTC
(0 children)

Sorry if that's too personal to ask but what kind of exercises did you do to avoid shrinkage?

3
u/jamihershey
Mon Aug 31 14:36:47 2020 UTC
(3 children)

Had orchiectomy two years before my SRS and no issues with tissue or skin everything was perfect

1
OP
Mon Aug 31 17:24:16 2020 UTC
(0 children)

Ok, thanks!

1
Sun Mar 27 10:11:32 2022 UTC
(1 child)

Did you do the inguinal method or the simple one?

2
Wed Apr 6 00:47:44 2022 UTC
(0 children)

Simple

u/[deleted]
Mon Aug 31 19:31:08 2020 UTC
(1 child)

[deleted]

1
OP
Mon Aug 31 20:46:30 2020 UTC
(0 children)

Thank you, and good luck <3

2
u/[deleted]
Mon Aug 31 21:38:58 2020 UTC
(1 child)

my understanding is that the incision point, the raphe, wouldn't have been used anyway, it's discarded for a vaginoplasty.

i did a simple (not inguinal) bilateral orchi in Jan and am in the very very early stages of scheduling GCS. i'm not too worried about depth or anything, they can always grab tissue from the peritoneum too. Dr. Grotas at Sinai told me i'd have no issues scheduling a future GCS.

1
OP
Fri Nov 6 19:13:13 2020 UTC
(0 children)

Ok, thanks!

2
u/Mirlostinusa
Wed Sep 2 15:56:12 2020 UTC
(1 child)

Had bilateral orchi few years back with Reed in Miami, best surgery related decision ever. Even went out to eat later that afternoon. Now, I can't find a scar and no evidence in scrotum skin, plenty there for future use if I decide. Nothing shrank, shriveled , etc. As long as I keep my E dose up there, my energy and attitude are great!

1
OP
Fri Nov 6 19:08:13 2020 UTC
(0 children)

Thanks for your answer!

1
u/HiddenStill
Mon Aug 31 12:42:14 2020 UTC
(4 children)

This is discussed on Suporn’s website.

If you’re really set on Suporn you must make sure an orchi is done properly or it will cause problems. If you did remove the scrotum Suporn would refuse surgery. It’s better not to do it.

Suporn is a special case among all surgeons.

1
OP
Mon Aug 31 12:56:38 2020 UTC
(3 children)

Do you have a link to this part of his website? I don't remember reading anything about orchiectomy without scrotum removal

2
Mon Aug 31 13:11:05 2020 UTC
(1 child)
1
OP
Mon Aug 31 13:18:54 2020 UTC
(0 children)

Thanks!

2
Mon Aug 31 13:12:34 2020 UTC
(0 children)

Type this into google


site:supornclinic.com orchiectomy

1
u/kafka123
Mon Aug 31 13:26:57 2020 UTC
(7 children)

Does anyone know of a surgeon who is willing to do the opposite: a testes preserving vaginoplasty?

I've heard stories of people who've discovered they're intersex late on in life and stuff like that, and I wouldn't want to transition only to find that ovaries were removed or something.

7
Mon Aug 31 14:35:32 2020 UTC
(3 children)

If you keep testes buried in the body it increases your risk of cancer. I’m not sure you’d find a surgeon who will do it.

2
OP
Mon Aug 31 17:25:24 2020 UTC
(2 children)

Do you have sources on this? I've heard it lots of times but never seen any source (I'm not saying you're lying, just want to read about it)

1
Tue Sep 1 00:18:17 2020 UTC
(1 child)
1
OP
Fri Nov 6 19:12:20 2020 UTC
(0 children)

Thanks a lot!

2
OP
Mon Aug 31 17:26:34 2020 UTC
(0 children)

I don't get the link between preserving the testes and discovering that ovaries were removed

1
Mon Aug 31 14:56:38 2020 UTC
(0 children)

I know Wittenberg does a penile preserving vaginoplasty and has a page on her website for non binary people. She would probably be a good person to talk to because if it can be done, she seems like the person most likely to be able to do it.

1
Mon Aug 31 18:57:35 2020 UTC
(0 children)

What do you mean by this? Even if you were intersex and had ovaries (that's pretty insanely rare though, even more so to have working ones), they wouldn't be in the scrotum or where SRS takes place.

u/[deleted]
Mon Aug 31 19:38:23 2020 UTC
(1 child)

[deleted]

2
OP
Mon Aug 31 20:46:09 2020 UTC
(0 children)

My urologist told me the same, that the inguinal is a mess and with worse healing and internal scarring... I do not plan on removing the scrotal sac but it still worries me a bit.

1
u/HiddenStill
Tue Sep 1 00:23:23 2020 UTC
(1 child)

I'm tired of having to use lots of E2 to shut down the T production by my gonads

If this is pills then injections will probably work a whole lot easier.

1
OP
Fri Nov 6 19:09:08 2020 UTC
(0 children)

I'm on gel and it's a mess, so the possibility to use less is something I really look for... (there are no injections available were I live)

-1
u/hrt_breaker
Mon Aug 31 12:35:24 2020 UTC
(3 children)

Waiting long between the two could cause scrotal atrophy, not so good for SRS.

I remember it being suggested to have prosthetic testes post orchi just to keep pressure on the tissue. But considering how often I was tucked, I'm not sure that would have made a difference in many people

1
OP
Mon Aug 31 12:55:46 2020 UTC
(2 children)

I'm litterally 24/7 tucked so don't know if that applies, but it's an interesting thing to consider

1
Mon Aug 31 13:24:14 2020 UTC
(1 child)

I still suggest a little tug occasionally, just in case

1
OP
Mon Aug 31 17:24:06 2020 UTC
(0 children)

I'll take it into account, thanks!