A few days a go, I had a lenghty telephone conversation with Helsinki. He was on the eve of his trip to the US and surgery by Dr. Kimmel. Helsinki is wanting castration due to TG issues.

I would ask that those of you who care about such things, say a few prayers for his (her) recovery. While he didn't tell me the exact date, I'd hazard a guess that as of the very moment of this posting, he is in recovery from both a bilateral orchiectomy and a scrotum removal.

I'm hoping to hear from him by telephone when he is back in his hotel room. If I do hear from him about his experience, I'll try to post it here.

let us know what you can and when

Many thanks to Kangan for his deep concern, good wishes and helpful advise.

In December, I had bilateral orchiectomy and scrotum removal with Dr Kimmel. Here is an account of how things went:

Day -1

I arrived in Philadelphia and checked into the hotel. I also went shopping for the items I would need in the coming days.

Day 0

I had a light breakfast. I returned to my room to have a shower with antibacterial soap and to shave the genital area as Kimmel had instructed. I took a taxi to Dr Kimmel’s office. On arrival, I was greeted by Joe, who introduced me to Dr Kimmel. Dr Kimmel introduced himself to me and then said he would talk for a while to relax me. He told me about himself and his days in the Navy, where he received a letter from President Eisenhower thanking him for training urology techs. He also told me about the history of the Kimmel surname.

When he felt that he had relaxed me, he asked me why I wanted the operation and what hormones I had been taking until now. (I am transgendered and I had been taking cyproterone acetate (52mg/day) and ethinyl estradiol (35ug/day) for six months, stopping two weeks before the operation). He gave me a consent form to sign, which I did.

He then took me to his operating room and asked me to remove clothes below the waist and then to lie on the table. He examined me, and then said that he was going to another room to change his clothes.

While he was out of the room, I looked around the room while lying on my back. I began to feel worried. There was a tray of instruments on the tray beside the operating table, but several nonsterile items (e.g. bottles, a box of gloves, a packet of gauze) had been placed beside them. So the instruments, even if they had been sterilised, were no longer sterile. I also wondered about the sterilisation technique. From what I understood, the instruments were sterilised by soaking in glutaraldehyde. This technique is inferior to the pressurised steam technique, and ought only to be used on items which would be damaged by heat.

Dr Kimmel entered the room. He was wearing scrubs, but did not have a sterile gown over them. He took a pair of gloves from the box and put them on. Normally a surgeon would use sterile gloves, which he would take from a sterile packet and put on without touching the outside. Also, as Dr Kimmel worked without an assistant being present during the surgery, he had to touch many non-sterile items in between working on the surgical field. He did not wear a mask during the operation, which was unfortunate given his tendency to drool. Thankfully, he did not drool into the surgical field!

He told me to roll onto my side so that he could give me an intramuscular injection of gentamicin into the buttock. I then rolled onto my back again. He applied drapes, and cleaned the surgical field with povidone iodine. He gave me several injections of lidocaine into the scrotum. He made his first incision and started to cut the scrotum away. Every now and then he would give me further injections of lidocaine. It seemed that he was a little too generous with the lidocaine.

Later on my lips and tongue began to feel numb. I felt faint and my ears were ringing. I also began to feel disoriented, and when I tried to speak the words did not come easily. Finally, I managed to tell Dr Kimmel that I was suffering from lidocaine toxicity. I asked him not to give me any more lidocaine except when I asked for it. As the operation went on, I would ask for a few more injections of lidocaine when the signs of toxicity had worn off.

When my mind was clear again, I looked down at the surgical field and saw that bleeding was not being controlled very well. I realised that I must have been bleeding for some time. I looked at my fingernails and saw they were white. I checked my wrists for a radial pulse and could not find one. I told Dr Kimmel that I had lost a lot of blood and asked him to make more effort to control the bleeding. He seemed to ignore my request. I repeated my request a few times. Finally I nearly shouted “DR KIMMEL. STOP THIS BLEEDING NOW”. He then applied a ground electrode to my thigh (he should have done this before he started operating), and started to perform electrocautery. He brought the bleeding under control, but I was already feeling the signs of hypovolemia. As I lay on the table, I felt a strange calm, as if I had no alternative but to accept whatever fate was in store for me. Nevertheless, I did not want to go into shock if I could avoid it. For the remainder of the operation, I would tell Kimmel to stop operating briefly whenever it seemed as though shock was imminent. I believe that I only survived because as a young person, my body was more able than others to compensate for blood loss.

After he had finished removing the scrotum, Dr Kimmel removed the testes. The left side was done without problems. On the right side, I felt extreme pain. When he used electrocautery, I felt the worst pain of my life and my right foot twitched uncontrollably. I looked forward and saw that he was cutting not through the spermatic cord, but 2 millimeters below the upper border of the testis.

Nothing remarkable happened during wound closure. Although I was unhappy with the sutures later on, nothing seemed wrong at the time. Dr Kimmel did not insert a wound drain.

After he had finished operating, Dr Kimmel told me to stay on the table until he told me to get up. While I was on the table, Joe came to clean the surgical site and my legs. He put dressings and a scrotal supporter on me, while congratulating me. I felt the worries disappearing from my mind, to be replaced by a wonderful sense of freedom from gender dysphoria. Dr Kimmel and Joe asked me to move into a sitting position on the table, and then allowed be to sit in a chair with my feet up. Dr Kimmel brought me a bag full of items: sterile gauze, pills, etc. and gave me instructions for post-operative care. Joe called a taxi for me and stayed with me while I waited.

After arriving at the hotel, I got some ice and then went to bed.

Days 1 and 2

I spent two days with an icebag between my legs. I didn’t do much except change dressings and read books. I ordered meals by room service. Dr Kimmel telephoned on both days. During these calls, Dr Kimmel showed signs of cognitive impairment. He asked whether the next day would be Christmas day. During both calls, and on days 4, 5 and 6, he asked me whether my wife was staying in the hotel with me, or whether she had to leave on business. Given that I was staying on my own, I am only attracted to males and I am single, this was an impossibility! Each time, I explained that I had travelled alone. Whenever I asked a question, he would give me an answer that was not relevant to my question, but was instead a verbatim repeat of something he had said in previous conversation.

Day 3

By now, the wound was starting to look worrying. The remaining scrotum was very swollen, and it was clear that some sutures were too tight and others too loose. The drainage from the wound had become offensive in smell. Where the sutures were too tight the skin was pulled into lumps.

I saw Dr Kimmel for a follow-up appointment on this day. I took a taxi to his office. Once there, he told me that the wound looked good and would cause me no problems. I explained my concerns. He said that the lumps produced by the tight sutures were actually pedunculated growths, that I could not possibly have an infection because I had received a gentamicin injection and was taking ciprofloxacin pills, and that the swelling had occurred because my testicles were the size of kidneys. I challenged him on the last statement, and the conversation became heated. Every question I asked thereafter was met with the reply, “I know my testicles from my kidneys,” even though I was not asking about the size of my testicles.

We also talked about hormone protocols, and he gave me an account of male and female endocrinology. In this account, he substituted several incorrect words with complete fluency. For example, he said that the adrenal glands produce finasteride, and that luteinising hormone is the enzyme that converts testosterone to dihydrotestosterone.

Days 4 and 5

The wound continued to produce offensive discharge. I also began to feel as though I was getting weaker rather than stronger. I thought of various causes for this: perhaps I was bored or depressed, perhaps I was adjusting to the absence of hormones, etc. The real reason would soon become obvious. Also the pain was becoming harder to control. I was taking tylenol and ibuprofen as frequently as the instructions allowed, but the pain would break through between pills.

Day 6

I took the flight home. During the flight I became very unwell. The joints in my hands became so stiff and painful that I could not manipulate the back-of-seat table or open the containers of the in-flight meal. I drank lots of water during the flight but hardly needed to urinate. I felt restless and slightly confused. During a moment of confusion, I took my wallet out of my pocket and could not remember what it was. Thankfully, I became lucid again before I lost my money.

I felt a sharp pain between my legs. I went to the rest room to investigate. I found that two of the previously tight sutures had fallen out, allowing the wound to open and releasing plenty of pus. I attempted to clean the area with sterile gauze, before returning to my seat.

During the remainder of the flight, I began to feel less unwell. I had narrowly escaped sepsis. I would find out just how narrowly the next day.

Days 7, 8 and 9

Back home, I go to the ER, saying that I thought I had a wound infection. They took a swab from the wound, which grew Staph. My pulse was 155. My white cell count was 28 and my CRP was 120. My body had fought hard and was only just winning. I spent three days in hospital on IV antibiotics. After leaving, I had to spend a further two weeks on oral antibiotics. The wound was now gaping, but the doctors were not interested in this because controlling the infection was the most pressing priority.

After the three days on antibiotics, I could not believe how well I felt. I only realised then how unwell I had been before. The wound also improved dramatically in appearance in the three days, and the drainage had become less offensive. I wonder how many patients who have undergone this operation, who experience prolonged fatigue and slow wound healing actually have infections.

Day 14

I saw my family doctor, who called another doctor to assist. There was debate between the doctors – did the sutures need to come out, or would this make things worse? Was surgical closure needed urgently to ensure a good cosmetic result? They arranged for me to see a urologist later that day.

The urologist said that taking the sutures out would cause the wound to open completely, and that they should remain in place for the time being. He asked, “Is Dr Kimmel a urologist?” adding that the technique of wound closure was “unusual” and “not one that I would use myself”.

Days 15-24

I carried on taking my antibiotics. The wound still drained, although the quantity reduced from five sheets of gauze being saturated after three hours (on day 9), to the same number being stained after twelve hours (by day 21). Where the sutures were tight, the skin died and dropped off by day 21. This left a gaping main wound running the length of the scrotum, as well as several smaller wounds that intersected with the main wound, giving the appearance of a broken window. Now that all the tight sutures had fallen out, only the loose sutures were left.

Day 25

I saw another urologist. The wound looked cleaner than before, with no signs of infection. He said that I could stop taking antibiotics. He also decided to remove the sutures as the only remaining sutures were loose and were therefore contributing little to wound closure. He noticed that some sutures were strangely positioned. For example, in order to exert tension on a wound, it is necessary for a suture to cross the wound. Yet some of the sutures had both ends on the same side of the wound. He commented that it was “an interesting way to do a bilateral orchiectomy”. He warned that the wound would take “forever” to heal and that surgical closure was not an option. Instead, I would have to wait for complete natural healing and then see if a plastic surgeon could improve the scar.

Later that day, when changing my gauze, I saw that the now unsutured wound had become a circle 2.5-3cm in diameter.

Day 26

The wound appeared to have shrunk slightly so that it no longer looked circular.

MORE TO FOLLOW

This is another horror story that should never happen. What you describe in the operating room is worse then what one would expect in a cutters motel room. If half of what you are saying it true which I do believe. Dr. Kimmel's incense should be pulled and sent out to the pasture. Jail would also be a good option for practicing medicine with out care to the patient.

I hope you do heal well and the scar heals well. The mental scar will be hard to heal. I feel so very very very sorry for you. Waiting so long to reach your goals and then be putting through hell like it is just not right.

I truly hope your recovery is fast if that is still possible. Do wish you the very best. You need some real big hugs from your friends in here

I am sorry to hear that you had such a difficult experience with your castration, but I am glad to hear that you have furthered your goals in getting it done.

I too visited Kimmel for my surgery, and while my story is not as concerning as yours, things certainly did not go perfectly, and I eventually developed an infection. Fortunately mine was localized and only required oral antibiotics taken at home to treat.

However, I have noticed that the stories seem to involve increasing amounts of a horror element as time progresses, and I am wondering if the time has come for Kimmel to retire.

It does not appear he is prepared at this time to do so voluntarily, so I am not sure what the options are when it comes to perhaps considering forcing him to retire. I am also not certain that the majority of members here would agree that any such action should be taken, given that Kimmel has helped many of them when no other doctor would and is generally the only option for the male-to-eunuch community.

I guess it comes down to weighing removing the only real help for the eunuch community as an option versus keeping him in business and potentially allowing him to cause further problems like these or even the death of his future patients.

Hope that you healing well, and once again congrats on achieving your goal of castration

Helsinki, If you want to talk... my yahoo messenger name is lilpup002

This indeed is very sad. I sure hope you heal well and quickly. Kimmel is the only hope the archive has. Without him we have nothing to promote and commnity in time will end. Many of us are content and happy as Eunuchs. Some are not.

Helsinki.

I'm sorry to hear about your experience. If you remember, you and I exchanged private messages indicating that I felt that too many people were going to ER due to Kimmel. I guess you're another example.

But I understand how the desire to be castrated, and the difficulty in finding qualified willing doctors, would have driven you to go to Kimmel despite your worries.

I'm glad however that you achieved your castration goal. Congratulations! Now that you are under proper medical care, I trust you'll be doing very well again.

For everyone else, we can no longer recommend Kimmel here on the board. He's risked too many good people's health.

SD

SplitDik (imported) wrote: Sun Jan 11, 2009 8:11 pm But I understand how the desire to be castrated, and the difficulty in finding qualified willing doctors, would have driven you to go to Kimmel despite your worries..

Spot on. In fact, when discussing my thoughts in a PM with another member a few weeks before surgery, I wrote:

Having thought about everything, I know that if forced to choose I would be happier with an ugly scar hidden by my underwear than with my gender issues unrelieved and my body and face continuing to masculinize. However, I really would prefer not to have to go to the ER!

Plix raises a good point:

plix (imported) wrote: Sun Jan 11, 2009 6:26 pm I am also not certain that the majority of members here would agree that any such action should be taken, given that Kimmel has helped many of them when no other doctor would and is generally the only option for the male-to-eunuch community.

Before my surgery, I would probably have been part of that majority.

Even now, caring for my wound causes me far less distress than my gender dysphoria used to. So I am better off than before. But what if I had been less lucky with lignocaine toxicity, hypovolemia and sepsis?

I am sorry this has happened, Helsinki. I had a good experience 8 months ago with Dr. Kimmel, and I recently recommended him to people. But now I have to change my mind about him.

If some of his recent patients want to start the procedures on Dr Kimmel that brought an end to Dr Spector I can attest to the nonsterile operating room.

As a community we have to come up with a safer alternative to Dr Kimmel. Weather it is a surgeon in another country. Or going the route of a local urologist and seeing a psychologist prior. That is very sad for me to say because if you know my story, do you think I could have been castrated going that route? Probably not.