Seeing Dr Arnkoff next week

[dvdbll (imported)]

I'm thinking about you this morning, and expecting that all went well. Since your appointment was at 7:00 am, I assume you already left your testicles behind in Dr. Arnkoff's office and are relaxing in your hotel now as a newly-minted eunuch. Congrats and I look forward to hearing all about it!!

[monkey50 (imported)]

Yes indeed! Great experience, doing very well. Going to post yesterday's note while I write up the first "post" experience...

1 day before orchiectomy

Flew into Detroit airport, rented a car, and found a local hotel near Arnkoff’s new office. The airport is not super busy (I guess these things are relative) and renting a car for a few days is fairly cheap. I will spend the night, go meet Dr. A in the morning at 7 a.m. and spend the day and next night here resting and icing myself.

Dr. Arnkoff is very matter-of-fact but likes to be in touch, and is very open to communication and responsive to questions. I have little bouts of nervousness but after I called him today felt a bit better. Went to a few little local shops near the hotel just to walk around. Bought some snacks and supplies for the hotel room so I don’t have to do that tomorrow. It’s been good to stay busy today with that, and I’ve done a lot of work while traveling and even in the hotel room to keep my mind active. Dr Arnkoff asked me to bring three pairs of pull-up depends (I picked up the men’s depends but went back and got the ones made for women instead) and to be sure I had neosporin on hand. So, all set with that.

Planning to watch a movie and get a hot shower tonight, have my things organized for the 15 minute drive over. Incredible amount of (nervous) planning for what I think will be very straightforward…

[monkey50 (imported)]

The orchiectomy!

Well, it’s about two hours post castration and I wanted to capture as much detail as I can here.

Slept reasonably well but got up wildly early, partly due to a time zone difference though obviously nervous. Showered (which is important, because I can’t do that for 24 hours) and picked up my go bag for a foggy/dark drive over to his office. Had been instructed to not drink or eat anything after midnight. I took 0.25mg of Xanax as I arrived at his (new) office, which was part of a medical complex. It’s a big and modern glass building, very nice and easy to get to from the interstate.

Dr A was waiting for me in his car in the parking lot and after introductions we headed inside. I had to wait in the waiting room while they set up. I was touched by his effort to make me feel at home — he went and found the remote control so he could turn on the waiting room TV. Watched a few used car dealers commercials.

His nurse came out and gave me paperwork to fill out — medical history (pretty simple), surgical history (none), an informed consent document that emphasizes all the surgical risks (bleeding, swelling, hematoma, and thrombosis are the ones I remember, but none of it was a surprise). Aftercare two page sheet which basically says put neosporin on the wound a few times a day, wear snug/form-fitting underwear or jock strap, etc, etc. More details about icing the groin for the first few days, strenuous activity, etc. A little section on the risks of elimination of testosterone, including infertility, bone density issues, and red blood cells/iron problems. Dr. A came out and reviewed the history, risks, and consent and spent plenty of time discussing with me. He’s very gentle in this conversation and nice, and I think receptive to conversation or questions but doesn’t press about gender identity or anything like that, which I appreciate. Zero judgement on anything.

I’m on testosterone injections now, and plan to continue that for a while, but am looking forward to some experimenting with very low dosing, just enough to keep general health up but eliminate erections and what not. I like the idea of being able to adjust the dose depending on interest in sexual activity and so on. Anyway, we didn’t talk long about those issues since I’m on TRT and being on testosterone will take care of those common sides (of course infertility is absolute).

I asked a few questions about scrotectomy (which I plan as a next step, but wanted to get the information while I had him), which I’ll post about here later.

He asked me if I had ever injected anything into my testicles. I said no (if you read in my history you’ll note I considered that but opted against it). He explained that some of his patients have done that and that it just makes his job harder. He also said very often you can see exactly on the testicle where the injection(s) happen, they are usually very localized and result in a small nodule right where the needle was. I suppose that depends on the injection routine and what you’re injecting, but I would add my two cents to what the veterans here have said many times: don’t do that. Save your money and go see Dr A, or a sympathetic urologist. Call/email around, I think more doctors will work with you in 2015 than ever before, though Dr A still seems by far the most visible.

He said to just call him anytime if there were future questions or if I needed a letter indicating I had genital surgery. I don’t plan to ever transition gender, but I think I will collect the letter at some point just to have it as a resource, and as an option. (?)

I gave him a cashier’s check for 3k. There aren’t any other fees for the procedure. I spent about $300 on the flight, $250 all in for the hotel for two nights, and a surprising $74 to rent a car for two days (but I guess this is Detroit, right?). Some other odds and ends for snacks in the hotel room.

He gave me a prescription for an antibiotic along with an explanation, and some hydrocodone. I haven’t had great experience with hydrocodone before, so he made it clear to take it with food on your stomach.

Anyway, they took me down the hall! The room was very doctor’s office-ish, but outfitted with a special table that seemed to me to be more dentist’s office chair than I expected. Had a little pull-out shelf for your feet. I was expecting stirrups like the gynecologist uses, but you just lay flat and he obviously can get to everything he needs that way. There were a few trays of gleaming medical instruments and plastic packaged items, but I didn’t linger there. Most of the instruments looked like scissors or hemostats, an inordinate number of them actually. I don’t have a fetish around this and didn’t care to focus my attention on that. Also a big positionable surgical light, again a lot like the dentist.

The nurse (I’m not going to mention her name because I didn’t ask her if I could talk about her on the web) was wonderful. She had a very kind presence and was a comfort throughout. Can’t say enough good things about her. She had me undress (you can leave your shirt and socks on!) and wrap the paper drape around me.

The Xanax is not doing a whole lot for me at this point, very jittery. I could have taken more but I didn’t want to be wasted for the short drive back.

I laid down on the table when she directed, and the paper drape was taken away. I guess that’s for some feeling of propriety. She used betadine (the brown stuff) basically from my waist to just above my knees. I went in completely hairless (decided to shave the thighs yesterday, too) so I’m not sure how they handle that if you’re bushy, it never got brought up in the prep. In my mind that’s a basic courtesy, and little/no hair is my preference anyway, so. Betadine everywhere, all over the penis, underside of penis, and folds around the scrotum, and perineum but nothing on the back of the legs or in my crack (which is probably the germiest place isn’t it?). She had a bunch of surgical cloths, and draped one across my abdomen, one on each thigh, and one across the thighs. Finally, she neatly folded my penis upward (pointed it at my head… have to say here that I’m not very long and I wondered if they would have to tape me up, but seemed to work fine) and tucked it there under another cloth, leaving just my rapidly shriveling scrotum in a neat little window…

[Continued in Part Two]

[monkey50 (imported)]

The orchiectomy! [Part Two]

Dr. Arnkoff came in again and fiddled with his iPhone a bit to play some music. Here’s a little idea of him… very self-assured in a positive Doctor kind of way. He’s older but seems in good health, with a thick frame (though not heavy/fat). More like a naturally strong guy. If I had to guess he’s in his mid-60s, close-cropped gray hair. He sort of pleasantly hums to himself while he’s going from place to place, and had a playlist that included Ben Folds and similar. Relaxing, and he would sort of hum along or comment every now and then that he liked that song. Friendly but professional, wearing surgical scrubs and sneakers.

Then it’s time for the first injection. He explains that it’s just like the dentist’s office, and honestly the whole experience was very much like that: the dentist. Except not as bad. There’s a deep inescapable quality to the dentist with a bunch of tools and scraping in your mouth, but stuff on your genitals you can sort of mentally separate from. I mentioned to Dr A and the nurse that I didn’t want to be rude but I planned to distract myself with some iPad browsing while they worked, and in general the less I knew about what was going on down there, the better. They were cool with that. Laying flat you can kind of prop the ipad on your chest and it’s a nice shield so you don’t see the shiny instruments coming and going…

The nurse gave me a little spray of something topical (she said “aloe numbing spray” but I suspect it isn’t the aloe that’s doing the numbing), which I appreciated. A few minutes later Dr A said I would feel a little pin prick when he injected and you definitely feel it, but honestly, that whole part lasts 4-5 seconds.

How’s the pain compare to other stuff? Stubbing your toe in the middle of the night is much worse. Imagine a paper cut on your balls in terms of pain. Nobody wants to experience that, right, but you’re not going to scream in agony over it. I’ve had a few genital piercings over the years and if the Prince Albert is a 4 out of 10 on the pain scale, my scrotal piercing (which is long gone) was maybe a 5 out of 10 with a big 8g needle, this is seriously a 1 or a 1.5. You can feel the medicine spreading from the injection, which is a warm/burning sensation, and then they leave you to bake in the room for 10 minutes. Even that warming part only lasts maybe 10 seconds before you can’t feel it. Good chance to read email, etc.

10 minutes later, they come back in, don their surgical masks, and he does… something… and then says “I guess the numbing worked.” He pulls the tray over and I busy myself with a demanding iPad application for a bit. I chose a silly kids’ game that required some arcade-like precision so I’d have to focus a little on timing. I didn’t set any new high scores today. By now we’re close to, hmm, 7:40 a.m.?

The nurse explained that previous patients had explained they could feel pulling and tugging but not pain, and (spoiler alert) she was exactly right. I did feel something liquid a minute or so after he started, which must have been blood running down into my crack, though it could have been something else. You do have this otherworldly sensation of what’s happening, without feeling anything specific. That’s hard to explain, but it’s not unpleasant and certainly doesn’t hurt. I never felt an incision or anything being cut, though I could hear the little scissors working pretty often. As he was working, he — again, just like the dentist — would sort of mumble something quietly to the nurse (on the other side of the table) with some Doctorly jargon and she apparently knew exactly what he was talking about, as she would move. He did let me know, “now that I have the right one out ,I need to refreeze it”, which I assume is more numbing. I didn’t suspect actual freezing.

As far as the sensations, you aren’t exactly being manhandled or your whole body moved, but I assume the way the spermatic cords are hooked into your body (or maybe it’s something with the nerves) when things are moved and handled you sort of feel it like a stretching sensation in the lower abdomen. Again, not painful, but like a shadow of the feeling of being kicked in the nuts. I am relatively sure I could feel the weight of the surgical clamp/hemostats at different points, as they were holding things. At one point, Dr. A said something to the nurse and she reached over and I could see by the position of her hand that she was holding something up for him. The iPad was blocking my view and at this point, sorry to have wimped out, but I really did NOT want to see what she holding. But it couldn’t have been skin or anything, had to be the testicle she was holding up in the air a few inches out of me? (Or maybe the handle of the hemostats.)

About 10 minutes into it, she looks over at me and says that one is already out!

The second one seemed to take longer, but I’m not sure when exactly it came out and when he started the process of sewing up the different layers. But she gave me the update and let me know that they were both out.

On the emotional front, at this point I did feel a powerful sense of happiness and euphoria. I wanted to hug both of them. I’m not a super sentimental person, but the deep joy I felt here was really interesting. Despite all the nervousness and questioning leading up to this moment, I knew it was the right decision. (Interesting side note: I suspect I’m feeling a bit of transference and have some vague sense of love and affection for my nurse. A little crazy, but I guess it’s a bit of an emotional overload and my brain doesn’t know where to send that emotion.)

Dr. A made a few comments here and there during the procedure, but mostly about some aftercare details.

[Continued in Part Three]

[monkey50 (imported)]

The orchiectomy! [Part Three]

Some of those aftercare details included:

The placement of the rubber drain, which is not sewn in. Take it out in 24 hours (just slide it out with your fingers in the shower, and give your scrotum a gentle milking to get out any good scrotum juice (my words) when you do that). If it falls out on its own, don’t worry about it.

Expect some swelling. Maybe the size of an orange, but that happens slowly. If it fills up with blood and gets big fast, call! But the nurse told me privately that she’s been there many years and that Dr A has been doing this longer than she’s been alive and they’ve never had a serious issue with that. Dr. A told me at one point to feel free to call/text and I can always send a picture so he can see what’s going on.

The ends of the spermatic cords will swell where he tied them off. He said that was the main blood supply for the testicles so they would swell so much it would feel like I still had testicles for quite a while but to rest assured my testicles were on the tray over beside him.

Wear the jock strap, even after the initial healing period. Probably won’t prevent swelling but I think the basic idea is that it will help with things getting knocked around.

Probably going to ooze quite a bit but don’t expect bleeding necessarily. More of a slow seep. Any incisions on the scrotum will tend to seep. (Hope you’ve had your breakfast already, sorry!)

So, then I could see the sutures going in (the suture thread must be like 10 feet long, because he would do something and then hands and needle and thread are up at the ceiling for the next pass). The sutures are dissolvable. If they dissolve early the incision can open up but that is definitely cause for calling Dr. A to get his advice — he said you don’t re-suture that or it’ll be an infection, but it probably will need to be seen by someone local to me. I plan to be careful and hope to keep myself together. Sounded like a hot tub was the biggest risk for dissolving early, or getting an infection, but I’m not super interested in making human soup anyway. Inexplicably went from totally shriveled/flaccid to soft/full but not erect. The last thing on my mind, be assured, but the various feelings of pressure I suppose prompted that.

At this point, maybe 20 minutes after he started the actual surgery he has me lean up to check it out. It’s not bad! Well, it’s a bit bloody and the rubber drain looks to me more like a garden hose. But not a horror movie or anything. Surprised that the incision is side to side and not up and down the middle line of the scrotum. I’m not sure why I thought that, I think it makes sense to be able to get testicles out of both sides, right? Also, I guess the wrinkles of the scrotum will hide the incision fairly well, but since I plan to get the scrotum removed later it probably doesn’t matter.

My nurse stays as Dr A steps out, and has me sit up on the side of the table to get my bearings. She brings me my jock strap and a pair of depends from my bag. Jock strap (brand new) goes on for close support with the diaper over top of them to catch the bleeding. No dressing or anything. (I’ve just peeked in the depends, and not having them is not an option — I haven’t soaked them exactly, but they’re bloody.)

I got dressed and Dr A asked if I wanted to see my testicles! With a little euphoria and newfound confidence I was game, so he left them on the tray for me and I got a picture (see below)! They asked if I had any questions, the nurse went over the shower/drain/cleaning issues once more for me as she observed I was nervous on the first time she explained it all and thought I might need it all again. I did. Then I gingerly slipped on my pants, shoes, they made sure I had all my stuff, and Dr A walked me back to the exit where we had parked!

I had been very worried about how far my hotel was from his office (quick note: in a few months a new holiday inn express literally 0.5 mile from his office is opening and will be a great option), about a 15 minute drive on the interstate. Totally worried about that for nothing. I stopped at Starbucks for a celebration coffee and junk food and then popped into CVS to fill my prescriptions. Got back to the hotel and started writing.

And that’s it. I’m still numb but I am starting to feel a little sensation of dull pain in my groin. I’ve already started on both prescriptions to get ahead of or preempt whatever pain. I don’t imagine I’ll need the pain med after a day or two? Dr. A said I could switch to Tylenol if that was working, but the other common stuff (Advil, Aspirin) thinned the blood and I need to avoid that.

On the emotional front… I feel great. A little bit of excitement and euphoria as soon as they were out. I think your backstory is the important predictor of how you’ll feel after. My early advice (obviously this is very new territory for me) is to think about it carefully and not only approach this decision as if you want to be a eunuch or not, but rather to seek to understand your motivations. I never hated my testicles or hate being a man. I’m not severely depressed. I’m pretty happy with my role as a man in most facets of my life, and feel like as I’ve got a few gray hairs and happy marriage and family life that exploring seriously a gender transition is just not of real interest or possibility. I’m grateful that I can modify my genitals though, and think the scrotectomy later will bring me further satisfaction. No regrets! In fact, the sense of “hey, that wasn’t so bad, I did the right thing!” is truthful if your mind starts spinning toward “now let’s get rid of the scrotum!” or more as soon as it’s over, then you’re probably on the right track. Dr A asked if I wanted to remove my penis as well and, even though I really don’t think so, I said maybe! Tell me about it! (See Heinrich’s excellent posts for information on the penectomy with Dr A). More on that later.

Maybe a silly thing, but I’m looking forward to tossing out most of my old underwear and replacing with more ladies-cut style (I’ve found a nice brand of women’s panties in the style of a men’s classic brief, with a fly front, but without the extra room in the pouch).

I see my few earlier experiments with genital piercing as a little precursor to the castration. I suppose there is a sense of dissatisfaction with my genitals, but more like “hey this could be better! I should modify it. I’d like it to look more like a woman here.” After the first piercing I had a very, very palpable sense that “life is very short, this flesh is going to age and die” and I was very glad that I was making it into something I liked better. Why not take advantage of that? If we lived even a hundred years ago even this conversation would be unthinkable. Castration was an extension of that idea — again, not of self hatred at all or dissatisfaction with myself, but a sense that I could make myself better. Why not change my genitals to suit me? I have a family, I have access to hormones if I want them (and even female hormones if I want to see what that feels like), and I’m male, but I’m now a eunuch and plan to do a little more as things go forward. Feels great, and is a great secret about me!

Feels special!

Okay, here are a few pictures, all are NSFW and possibly unsettling! Warning.

Pre-orchiectomy, standing. Picture of penis and scrotum. http://imgur.com/Xkw0k49

Pre-orchiectomy, lying down. Picture of penis and scrotum. http://imgur.com/JYjtLnN

Post-orchiectomy, testicles lying on a tray. Warning! Gore. https://imgur.com/7JkgaAS

Post-orchiectomy, three hours after, standing view of penis and scrotum. Warning! Gore. https://imgur.com/yuT0mJU

[baldwin92 (imported)]

thanks so much for sharing.

[nvrgag44 (imported)]

Great detailed report! Thanks. I'm surprised you felt alert and energetic enough to write all that right after your surgery. Maybe it's the difference between local and general anesthetic. Look forward to reading further reports on how your healing progresses.

The pictures are awesome. Thanks for including them.

[unencumbered (imported)]

The orchiectomy!

..

she gave me the update and let me know that they were both out...

Congrats and welcome to our group! I wish you all the best! I hope that you heal quickly.

[theemptyone (imported)]

Great report, thanks for sharing. I think my experience was pretty much the same.

[micdavi24 (imported)]

Congratulations and welcome to the club. For myself, I have always wanted my scrotum removed as well and will get that done one of these days when I can afford to have it done. Ironically, I had never thought of modifying my penis till a while after my castration, but now I want to get it shortened, not totally removed, just cut back to where it will be about 40mm (1.5") long when fully erect. I had never considered this before, and so I was surprised when thew idea cam to me about 6 months post castration. You may also consider something like shortening or maybe even total removal as time goes by.

All the best and hope you heal quickly and easily.