Hoping for a GID diagnosis

[Caith721 (imported)]

Thanks, MrT.

My vasectomy was performed about 17 years ago and at that time, they still made a 1/2-to-3/4 inch incision on either side of the scrotum, using two or three sutures to close each incision. I drove home afterwards, in a car with a manual transmission and never had any swelling or pain and no complications whatsoever. Instead of only suturing and ligating the vas deferens on each side, they also suture and ligate the artery and vein in the exact same manner. The single median raphe incision should only be 3/4 to 1 1/4 inch, not much worse than my vasectomy. I think the worst trauma inflicted will be from pulling the cords down as far as possible, typically resulting in swelling and inflammation at the remaining stump of each cord. Here's a good description (http://www.urologymatch.com/Orchiectomy.htm) of the procedure, scroll down to the bottom of the page. Page 429 of Glenn's Urologic Surgery (http://books.google.com/books?id=GahMza ... es&f=false) describes the procedure in even more medical terms, with excellent illustrations.

Hell, if I was a trained surgeon, I'd probably do this myself. (Please don't flame me for this one, folks. I said if, and I'm not, so I won't.)

Dr. Christine McGinn performs simple orchiectomy in a hospital with a general anesthetic, driving the cost up to almost $5K. Using a less risky spinal block is performed strictly for the comfort of the patient, and not for any other legitimate medical reason. Hospital expense and general anesthesia are completely unnecessary expenses for simple orchiectomies. Radical and/or inguinal orchiectomy is a totally different matter, especially when dissection of the lymph nodes is required for pathology.

[mrt (imported)]

I'm not a doctor either but I've been a pretty informed patient and I've got my been there and done that card. *Which ok - I admit it not worth much but here goes.

Spinals come with serious baggage. These are "supposed" to be safe but. Messing with that area with needles is (My opinion) asking for trouble. Surgeons also have to deal with a patient thats awake and some don't / won't deal with that when they are trying to work. If your interested in being awake so you can watch this probably raises a red flag for the surgeon. ie they think "Is this person cracked?" Plus like it or not awake you might suddenly find the process not so hot and who wants a patient spewing while they are cutting?

I personally don't have a good feeling for non inguinal orchiectomy. This is an amputation and leaving cords of any significant length to dangle and or try to attach to whatever is a open invite to future pain issues. Phantom pains being a second part of this but I won't go into that. Doing an inguinal has the highest rate of post op - pain free experience. And of course doing an inguinal is not a "quickie"

Glad your not going to start talking about doing your own surgery. That is a topic I still have a raw nerve on since my friend DonFL took that route and ended up dying. I just looked at Dr Bowers site and she still offers Orchiectomy if you have a note from your GP and a therapist (If I follow it) so there really is no need to do any do it yourself surgery.

[Caith721 (imported)]

Since I'm not full-time or living the real-life-experience (RLE), Dr. Bowers would not qualify me as a pre-op TS. She's recently stopped performing simple orchiectomies unless the person is on track for full GRS/SRS. Something I've mentioned to both my psychiatrist and psychotherapist in the last two weeks is that I would not have scheduled appointments with them to discuss this procedure, unless my mind was already made up. This is not a decision I took lightly, in any way.

I sincerely appreciate your "been there, done that" card. Your thread describing chronic orchalgia before and phantom pain afterward caught my attention long ago, when I was first lurking here at the EA.

More modern urology and surgery texts recommend injecting a small amount of long-lasting (several days) anesthetic into the cords before cutting, precisely to minimize the likelihood of phantom pain in the remaining stump in the days following the surgery. Unfortunately, the brain learns things we least expect, pain being one of them. Even when the pathway to the source of the pain is eliminated, the brain continues to expect the pain, and we experience these phantom pains. Anesthetizing the cord itself blocks this pathway before the cut and the resulting pain response. Using a long-lasting anesthetic prevents the brain from learning and expecting the pain.

My regular urologist was quite the talker when performing my vasectomy all those years ago. Knowing the same factors you described, I mostly responded with "yeah" and "nope" and not much more. Urologists are trained by their older mentors to ask a lot of questions before starting surgery, much like the experienced carpenters' and/or plumbers' advice "measure twice, cut once."

[Caith721 (imported)]

Well, I was hoping for a Christmas present from my psychiatrist/MD in the way of a phone call, but apparently Santa didn't get the urologist's information to her in time. I didn't receive a coupon for an all-expenses-paid week-long vacation to an SRS center, either.

[twaddler (imported)]

Well, I was hoping for a Christmas present from my psychiatrist/MD in the way of a phone call, but apparently Santa didn't get the urologist's information to her in time. I didn't receive a coupon for an all-expenses-paid week-long vacation to an SRS center, either.

Sorry to hear the SRS elves didn't plumb your chimney. Happy Xmas anyhow!

[Caith721 (imported)]

The wife was digging in my wallet for a stamp yesterday (another problem in itself) and felt obliged to open the folded pages from a yellow legal pad I keep in there. They contained the talking points I prepared for discussing with my psychiatrist/MD and psychotherapist/PhD re: my desire for orchiectomy. She of course completely misunderstood some of them, because she takes everything in the worst possible scenario, instead of attempting to understand the true meaning of the words.

She decided to tell me this over lunch yesterday, after she couldn't eat nearly as much as normal, and it was obvious something was bothering her. First, she admitted snooping, second, she was afraid I was seeking a divorce. I told her to read it again: "divorce is not a practical option". This was a directive to both doctors, to prevent either of them suggesting it.

She finally got past her shame and guilt for snooping, then got past her insecurity that I was seeking divorce. That's when she finally asked me about the orchiectomy. I explained what so many here have heard before: I'm sick and tired of wanting something that's not working in our relationship, and that is also diametrically opposed to my transgender nature. I don't want to continue buying and taking Androcur/Siterone (cyproterone acetate) when an orchiectomy is a more practical and permanent option.

I'm taking a few positives from our conversation yesterday. First, she now believes what I've been trying to tell her for years: I'm transgender, and I want my testicles gone. She doesn't understand or appreciate it, but she finally recognizes I'm not kidding or playing when I mention it. Second, she didn't fly off the handle or completely shut down while we were discussing it. That's a markedly different behavior for her, and it's a welcome sign. Finally, if she'll eventually sign a statement she's accepting of the orchiectomy, that will be the closing argument to go with my MD and PhD referral letters for the urologist. This will be difficult, because it goes against everything she feels, but she now appreciates this is about how *I* feel.

Thank you to everyone here for all of your support. I hope to post more good news as the new year progresses.

[Caith721 (imported)]

Fifth session with psychotherapist/Ph.D. this morning. Other things (flu, job, spouse) have been causing stress and we discussed those, but I brought up my stated desire for orchiectomy again. I said the only thing preventing me from setting a date with a surgeon was her referral letter. She re-iterated what I've said previously, that she's not one to play the gatekeeper role and will be happy to prepare the letter for me. I'll get that letter at our next session in two weeks, so this hurdle is about to fall.

I'll be scheduling with Dr. Reed in Miami because it's reasonably close, he performs orchiectomy in his office rather than a hospital, and Miami is beautiful in the Spring. Still don't know if I want to drive down there or take a plane. With the rising cost of gasoline, flying and then renting a car is almost as economical as driving.

[twaddler (imported)]

Fifth session with psychotherapist/Ph.D. this morning. Other things (flu, job, spouse) have been causing stress and we discussed those, but I brought up my stated desire for orchiectomy again. I said the only thing preventing me from setting a date with a surgeon was her referral letter. She re-iterated what I've said previously, that she's not one to play the gatekeeper role and will be happy to prepare the letter for me. I'll get that letter at our next session in two weeks, so this hurdle is about to fall.

I'll be scheduling with Dr. Reed in Miami because it's reasonably close, he performs orchiectomy in his office rather than a hospital, and Miami is beautiful in the Spring. Still don't know if I want to drive down there or take a plane. With the rising cost of gasoline, flying and then renting a car is almost as economical as driving.

Very exciting! Hurrah!

[Caith721 (imported)]

Thanks! It's really more of a symbolic accomplishment. After taking cyproterone and estrogen for over a year, and then performing several cycles of ethanol injections I'm fairly certain the damned things are inert. If they're not, they're awfully quiet and small. Still, once they're gone, they're gone FOR GOOD, and that's a literal achievement.

[feedback (imported)]

Hope you succeed, it's something I have wanted for years.