WPATH Standards of Care, version 8

[JesusA (imported)]

The World Professional Association for Transgender Health has just embarked on a project to write the next version of its Standards of Care. Version 7 (published in 2012) had the first mention of anything beyond the standard gender binary (pigeonholes for “male” and “female” with no recognition of anything else). Eunuch got a brief mention in the appendix as a possible gender identity.

The biennial WPATH conference that just concluded in Amsterdam had several entire sessions on genders outside the binary. Non-binary gender was also mentioned in papers scattered across several additional sessions. It was a frequent topic of hallway discussions. (I was pleased that our paper on voluntary eunuchs at the 2009 WPATH conference in Oslo was mentioned as the first paper on non-binary ever presented at WPATH.)

At the session devoted to beginning the process to rewrite the SOC, Eli Coleman, the editor for the new version, pointed at me and announced that I was expected to provide input on eunuchs for the revision. Now is our opportunity to help devise the standards of care that will be most helpful.

What needs to be in the SOC? For those who have read version 7 (available as a FREE PDF on-line in 13 languages at http://www.wpath.org/site_page.cfm?pk_a ... bpage=4655. (They will happily sell you a print version, if you prefer that to the free PDF.) What needs to be added, and where, in the standards? What needs to be removed or revised, and how.

For example, should a short period (no more than 6 months) of hormone blockers be required as a “test run” before any surgery? How much emphasis should be placed on fertility issues in counseling? What should any counselor make certain that a potential eunuch knows and understands? (E.g., what does “informed consent” mean before castration?)

Some information that would help me to write a proposal for WPATH would be

1) For those already castrated: at what age were you castrated AND, in retrospect, if you could do it over, at what age would you have preferred to be castrated?

2) For those not castrated, but who wish to become a eunuch: what age are you now and at what age would you have preferred to be castrated?

3) Did you ever think that you were Male-to-Female before you discovered Eunuch as a gender identity? What age were you when you first discovered “eunuch”?

4) Did you ever attempt any self surgery? At what age?

Any additional information about your personal path toward becoming a eunuch would be helpful. Any suggestions that you are willing to make will help to strengthen the SOC.

You can either comment below or send me an email with your thoughts at:

JAzevado-at-gmail-dot-com

[Losethem (imported)]

Hi Jesus,

Really? A test run of hormone blockers? Hell AND no! That pigeon holes people like me into doing something we're entirely uncomfortable with. My intention wasn't to end my masculinity, it was to end the discomfort living in this body that I was on the verge of killing because the genitals on it made me so uncomfortable... By the way, I no longer feel that way now that I've made it to my goal. Hormone blockers might be a reasonable thing for men who are desiring some state of asexuality as a result of their transition, but for the vast majority of men who have had their testicles removed, at least in my experience, this would be an incredibly unproductive thing to require us to do. A complete waste of time and incredibly frustrating.

For men in my position, there is absolutely no way to perform a 1-year real life test of any sort. How on Earth do you real life test what it's going to be like to be a nullo (or eunuch) with testosterone replacement? The answer is, you can't. So that leaves us with the psych letter and that interview process. That's about the best that can be done.

Fertility quizzing, perhaps if desire of children comes out in the therapy process. At that point those options would need to be explored with the person, but in my case I knew I wasn't suited to be a parent. I'm happily childless. I only like those that visit then go home and scream in their parents house.

After two decades of knowing what I needed, being given unnecessary hoops to jump through would have made me more despondent. By the time I went through with getting castrated, I think I pretty well had my mind set on giving informed consent. I would have consented to complete emasculation at the time I was castrated if a surgeon would have done so. I only did that much at the time because it was as far as I felt I could safely go then (back in 2005). Once a door opened to me for complete nullification, I took the opportunity and walked through it with the legitimate surgeon for the rest. Best. Decision. Ever.

Answers to your questions:

1. I was castrated at 35, and had my penis and remaining genital tissues external to the body removed at 44. I think 30-35 was right for me and castration, and I would have consented to have my genitals completely removed then in a legitimate setting.

2. N/A

3. Yes, I thought I was an MtF at a very young age, because back in the late 70's and early 80's, in the era before the internet, that's all a young boy of 10-13 could find where men had their genitals removed. But that never felt completely right... Enter the Internet around 1994-95, and I found out I wasn't alone and that what I actually was is a variation of Male-to-Eunuch (MtE), a guy who wished to remain a guy but wanted to have his external genitalia removed.

4. Self-surgery... If defined as using a cutter, then yes. It's how I got castrated. Now that legitimate routes are available, I encourage my yet to be eunuch brothers to see a surgeon. I also did a meatotomy on myself, but I don't consider that much of a self-surgery or self-harm, that was more to enjoy playing with urethral sounds and get bigger ones down the urethra. The castration at Age 35, the meatotomy at 37, penectomy and the rest 44.

My biggest suggestion... as MtE is added, do not insist that we all need to do a chemical castration trial first. MtE is not cookie cutter, and in my and many other MtE's cases, it wouldn't be productive and would likely have upset our partners, if we have one. This is because the goal is not to become asexual, it's to be more comfortable in our physical bodies. We enjoy sexual contact. MtE is not always done to become asexual (definitely not in my case), and that's the only reason a chemical castration trial would be of any use. For those who wish to become asexual as a result of losing their testicles, then perhaps this would be o.k. to do. Those who do not wish that, please don't, we'll just get more despondent.

At the end of this, if they grew back, I'd be seeking to have them removed again. I absolutely love being a nullo... and I no longer wish to do any sort of self harm.

--LT

[gandalf (imported)]

HI. Here are my nswers.

1 67. I would have preferred to have them removed when I had my vasectomy at around 35. I think, no believe, I would have been much happier. Of course, being married put a crimp in that thought process and desire.

2. N/A

3, Yes. As early as 4 years. It never really left me adn I can remember standing in front of a mirror and hiding my genitals between my legs and thinking it would be wonderful to be smooth like that, nothing dangling between my legs.

4. No.

My ultimate path to castratin was extreme pain in my testicles that no medicine would astop. My second urologist was wise enough to accommodate me in the removal of them witha proviso. If my health provider covered testosterone replacement. I was fortunate it did so he consented to do the surgery. I am cutting down on the amount of testosterone I am using now. 20.25 mg every other day. I feel great and am not gaining weight unless i forget to watch what I eat and how much..

Line Losethem, if they grewe back I would want them removed again. I would not mind losing my penis now but at 78, I doubt i can get that done.

[dvdbll (imported)]

1) I was castrated at 49, and in retrospect would have preferred to have been castrated at a young age, maybe in my 20s. My only hesitation thinking back is that, if I had found the right mate, I would have liked to have had children. I found a doctor to castrate me as I was about to turn 50 because I completely ruled out the possibility.

2) N/A

3) No, never on Male-to-Female. I found eunuch as a gender identity in my teen years. I first learned about a vasectomy and then about castration.

4) Yes, many times since my mid-30s because castration seemed so out of reach.

Hope this helps. Let me know if you want more information.

[JesusA (imported)]

A test run of hormone blockers? Hell AND no! That pigeon holes people like me into doing something we're entirely uncomfortable with. My intention wasn't to end my masculinity, it was to end the discomfort living in this body that I was on the verge of killing because the genitals on it made me so uncomfortable...

That's exactly the response that I expected from you (and from many others as well). The question, though, is a critical one if we are to get "eunuch" into the Standards of Care, Version 8 so as to get proper care (and even insurance coverage!). Experiences with the Version 7 are such that WPATH will emphasize INFORMED CONSENT in the next version. We need to have a very clear statement of what it would look like for those wanting to be castrated.

It turns out that, despite counseling, there have been many Male-to-Female who get to the other end and have regrets because their Sexual Reassignment Surgery included castration and they can no longer produce children. It was, of course, included as a topic in the counseling, but it didn't penetrate. We need to be very clear on the issue in any statement we want included.

I hope that you, and others, will be able to come up with steps toward an effective statement on exactly HOW a counselor can be certain that you know what you want and that you will have no, or are at least very unlikely to have, regrets after surgery. For those who are MtE, a trial run could be a central part. For those with xenomelia/BIID, it wouldn't work. We need a SINGLE standard, however, that works for everyone.

Any thoughts?????

[zeebster (imported)]

Well I guess I'm going to be something of a fly in the ointment on this one.

1. 62. I started thinking about ways to either cut down or eliminate my libido in my late twenties. I was quite surprised to learn that medical castrations were performed as part of the treatment of prostate cancer. So it was possible for a human male to be castrated in a safe environment not like my friends farm animals. That was in my early thirties and given the chance, I'm pretty certain I would have opted for the procedure at that point.

2. N/A

3. Never really considered MtF although I was curious what it might be like to be female. I was probably about 10 when I ran across references to "Eunuch" in some of the books I read, mostly having something to do with harem guards, but I never thought it actually happened.

4. Didn't ever try "self surgery".

I did spend quite a bit of time trying to figure out ways to restrict my ability to masturbate including a several year run with serious chastity devices and a willing partner. I seemed to be much calmer and less irritable with not having the ability to masturbate at will but I knew it wasn't the answer because the urges were still there and although I'd given up on women after a nasty divorce and subsequent issues with the fairer sex, I was indulging in increasingly hazardous auto erotic activities. By that time, the Internet had become available and it was made known that Thailand was a place you could get MtF surgeries including the orchiectomy with no questions asked.

The I went on a run one day (I'm a retired Paramedic) where we found a male college student dead in his room from suffocation. He'd gotten himself into a hog tie position usine self bondage techniques, with a noose around his neck. Now anyone who's played with bondage stuff will know that after a period of time, those muscles will start to contract and there's nothing you can do to stop them outside of a release. I'm not sure how he figured on getting out but he didn't make it. That was enough for me, I started trying to find out the specifics and costs of getting overseas. It was always more money than I could lay my hands on, I didn't have a prayer of getting the two letters since at that point you could get them for MtF but what man in his right mind would want to be castrated to become a MtE?

Finding Dr. Arnkoff was a godsend for me and I started saving money immediately. It had become possible to obtain the anti-Androgen drugs in the US and I picked the generic Androcur. I felt it was important for me to have a trial run of the symptoms and for me, it was a good choice. I first contacted Dr. Arnkoff after being on the med for six months and I wanted to know how to get things done. I had the procedure five months later so I was on meds for eleven months total. I really liked the change in myself and the only real issue was the breast development after I went to the max dosage at six months in, strangely enough I was never able to get my Testosterone levels down to castrate level with the single med. After the orchie, it didn't take long for the symptoms to get more pronounced, the night sweats were awful.

Now four years out, I'm extremely glad that I did it but outside of the trial run, I'm not sure I'd have done it right then even though I'd wanted to get it done for quite a few years. So while I know you asked that a SINGLE reason come out of the discussion but I don't really think that's possible. I believe that those suffering from different medical issue like testicular pain should have an open and direct shot at getting some help. Those who feel identity disorders are a different proposition. I've seen to many fellow humans make decisions that they later regretted and always felt sorry for those who'd gone through all the MtF stuff including the surgeries and then felt like they'd made a mistake. I don't see a way around that other than a time period spent with a counselor, they've thought about things or felt certain ways for quite awhile, waiting a few more months should not be that big of an issue.

[ZeuterMe (imported)]

1) For those already castrated: at what age were you castrated AND, in retrospect, if you could do it over, at what age would you have preferred to be castrated?

Can't help you with this, sorry.

2) For those not castrated, but who wish to become a eunuch: what age are you now and at what age would you have preferred to be castrated?

I am in my early thirties. The first time I wanted to be castrated, I was about sixteen, and had strongly mixed feelings - I was also afraid that I wanted it. This came out of a misunderstanding in my biology class during high school leading to some internet research.

3) Did you ever think that you were Male-to-Female before you discovered Eunuch as a gender identity? What age were you when you first discovered “eunuch”?

I never seriously thought about it, though in hindsight, I had some minor gender-noncomforming tendencies before entering school. During high school, I flirted with the idea of male-to-hermaphrodite, though - that was when I was reinventing transhumanism, and I was extremely pleased to find out that there were other freaks out there like me who enjoyed the thought of that kind of weird shit.

4) Did you ever attempt any self surgery? At what age?

No. I'm well aware that I am not capable of guaranteeing my own safety, and my standards for doing anything in regards to body modification is "The right thing, for the right reason, in the right way." While it's certainly a high standard, self-surgery doesn't get anywhere close to meeting it. (I'd also like to add "…at the right time" to that list, but if I need to see four specialists before local doctors will do anything surgical, as my urologist requested, and they're backed up, that's not even anywhere close to realistic, either.)

I have no interest in doing a trial of chemical castration. My hormone levels are already FUBAR; I'd probably spontaneously feminize. I have active interest in NOT doing it. What I might be willing to do is to spend a while using hormone blockers and supplements to dial in a hormone level I like, though - I must echo those before me who said they have no interest in becomin

g sexless. If the emphasis is on informed consent, then let us make informed consent to hormone replacement of whatever form we want, with the option to fall back to natural levels if it doesn't work for the patient.

It turns out that, despite counseling, there have been many Male-to-Female who get to the other end and have regrets because their Sexual Reassignment Surgery

included castration and they can no longer produce children. It was, of course, included as a topic in the counseling, but it didn't penetrate. We need to be very clear on the issue in any statement we want included.This will be less of an issue, going forward. Why? New 3D Printed Ovaries Allow Infertile Mice to Give Birth (http://singularityhub.com/2016/04/10/th ... y-in-mice/) and Lab-Grown Testicles Could One Day Help Injured Soldiers Have Kids (http://motherboard.vice.com/read/lab-gr ... -have-kids) There's a lot of work being done to fix being fixed, thanks to DARPA. My answer to possible regrets is the fact that in about ten years, a sex change will be reversible.

As for waiting periods, well... For example, if I decide I want to be a neutered twink, I'd like to look like a twink - with the waits some here have described, you'd end up looking like one of Tom of Finland's gay-and-gray types.

I have another (completely optional) question for the survey, if you've read this far and it amuses you to answer it - would you make any other changes to your body if the technology was there?

[Losethem (imported)]

I hope that you, and others, will be able to come up with steps toward an effective statement on exactly HOW a counselor can be certain that you know what you want and that you will have no, or are at least very unlikely to have, regrets after surgery. For those who are MtE, a trial run could be a central part. For those with xenomelia/BIID, it wouldn't work. We need a SINGLE standard, however, that works for everyone.

Any thoughts?????

You NEED a single standard that works for everyone, but everyone is different. There's that dreaded cookie cutter showing up again. The cookie cutter needs to be thrown away, as I can think of at least 7 variations of MtE, 4 of which would have chemical castration as a component and the other 3 are more common from my experience here. Finding a single, unified response for MtE is like trying to find a unicorn. It's not going to happen. The seven variations are:

Non-asexualization - wishes to remain with testosterone post-op, the most common variety of MtE (and where I am):

1. Penectomized

2. Castrated

3. Both (nullo)

Asexualized - Wishes to reduce libido/eliminate sex drive:

4. Penectomized

5. Castrated

6. Both (nullo)

7. Neither (wishes long-term chemical castration)

I'm not sure you can unify all that into one thing for a therapist or an MD to go, "Aha! A diagnosis..." This in many ways is going to be more complex than MtF or FtM. While some of those go for only top surgery, bottom surgery, or both, it's more clear-cut what they ultimately desire to present to the world. We MtE's are not so easy to define. Unless this single standard is a standard with subsets/variations, it's impossible to create just one.

--LT

[tugon (imported)]

I was castrated at 41 years of age. I wish it had been done in my early twenties.

I was not happy being a boy and thought about being a girl. The feelings started at a young age and I was still thinking about it until my early twenties. Once I learned about eunuchs and castration I knew I found my answers.

In my case I do not think hormone blockers would have been needed. I had already waited so long. As far as fertility as a gay man and now a gay eunuch I never considered having a child. Storing sperm was a non issue for me. Just get the T out of my life. As a therapist it would be interesting to determine if someone is happy with their birth gender or not. Once it is determined they are not comfortable determining rather M to F or M to E is the answer.

[T van Keel (imported)]

You NEED a single standard that works for everyone, but everyone is different. There's that dreaded cookie cutter showing up again. The cookie cutter needs to be thrown away, as I can think of at least 7 variations of MtE, 4 of which would have chemical castration as a component and the other 3 are more common from my experience here. Finding a single, unified response for MtE is like trying to find a unicorn. It's not going to happen. The seven variations are:

Non-asexualization - wishes to remain with testosterone post-op, the most common variety of MtE (and where I am):

1. Penectomized

2. Castrated

3. Both (nullo)

Asexualized - Wishes to reduce libido/eliminate sex drive:

4. Penectomized

5. Castrated

6. Both (nullo)

7. Neither (wishes long-term chemical castration)

I'm not sure you can unify all that into one thing for a therapist or an MD to go, "Aha! A diagnosis..." This in many ways is going to be more complex than MtF or FtM. While some of those go for only top surgery, bottom surgery, or both, it's more clear-cut what they ultimately desire to present to the world. We MtE's are not so easy to define. Unless this single standard is a standard with subsets/variations, it's impossible to create just one.

--LT

That's really a good point, LT.

MtF or FtM cases are mostly quite easy in regards what surgery is desired and what hormone treatment is applicable. There are only few varieties, but as you describe, MtE is not so easy. I don't know if it is possible to cover all the different types of MtE in one standard. But all these seven types NEED to be covered, if a proper treatment shall be possible.

TEST RUN. Obviously the doctors like to suggest chemical castration before surgical castration. On the other hand, the same doctors always will tell you that you will need HRT after castration to stay healthy. So, why a mandatory test run, if later a HRT is strongly recommended? I think a test run is only useful if it is wanted to live without HRT.

Chemical castration is not suitable to simulate the physical fact that testicles and/or penis are removed.

FERTILITY. This subject should be covered during counselation. It needs to be stressed that castration causes infertility. Maybe there are wannabees who haven't thought about this.