Questions on becoming a nullo in the US as a foreigner

[T van Keel (imported)]

Hello!

Some of you might already know me and my goal to become a nullo. I’m 43 yo and the best fitting label for me is non-binary transgender. Therefore I would like to have my male parts down there completely removed, to be smooth there. First signs of wanting my penis and balls completely removed could be seen before puberty. So this is something that developed over decades and today I am absolutely sure I want to be a nullo, the sooner, the better.

To achieve this, I started as my Plan A five years ago counselling with therapists in my local area. Unfortunately, all therapists I tried are very hesitant to write a letter of recommendation, although they know about MTE and non-binary. The thing is, I’m obviously the first patient in Germany who is wanting this kind of treatment, so there’s no experience how to handle this. “Normal” transgender like MTF or FTM can get their gender reassignment quite easily here, but everything outside the binary is still extremely difficult.

Interestingly there are doctors available in Germany who are well experienced in grs-surgery and who are willing to perform the nullification, but they need a letter, and that’s the problem to get this damned letter.

That makes me think about Plan B. In the US it seems to be much easier to obtain the needed letters and find a qualified surgeon. Due to this I start thinking if a trip to the US could solve my problem, even if I would prefer to get the surgery done without much travelling.

My first questions are these:

Would it be possible to get the necessary letters and other needed paperwork as a foreigner? How could it be done without travelling to the US?

Which surgeons are really recommendable for the nullo surgery?

I will continue with my Plan A, but after this long time of failure it would be good to have an second option.

Thanks for your helpful answers!

TvK

[TopManFL (imported)]

Hey TvK,

You are correct that most US urologist and surgeons would require two therapist letters.

I know that XXYGuy26 was able to get one letter via sessions with a therapist online. His surgeon required that at least one letter be from a local therapist that he visited in person.

Perhaps he can offer you a bit more advice.

[Losethem (imported)]

Much would depend on how much time you're willing to spend in the US in pursuit of your goal. My therapist was located relatively near two good surgeons willing to help. You'd need a hire car and time, as he needs to send the letter to the surgeon himself. The surgeons require that because many people are so desperate they would write a fake letter on their own and hand deliver it, so it has to be delivered by the therapist.

The other issue is after you get the letter, you need to get on the surgery schedule with the surgeon. That may take up to a year. So perhaps it's two extended trips to the US to get this done. I do not see a scenario where you would get the letters, then proceed immediately to surgery in a reasonable amount of time for someone who is traveling.

As long as you're willing to pay cash for the surgeries, I do not see a problem with the surgeons I'm thinking of performing your nullification.

[T van Keel (imported)]

Thanks for your replies so far. Indeed it was XXYGuy26's story that made me think if a trip to your country could be an option for me.

Spending 3 or possibly 4 weeks may be possible. I already feared that some kind of online counseling will not work to get the letters. If I need two different trips for the letters and later the surgery, it would mean that I need two years for that, as my yearly vacation wouldn't allow more than one extended travel per year. Also it would rise the total cost significantly.

Payment directly to the surgeon would be possible. Even here in Germany it is quite likely that I would have to pay by myself, as nullification is currently not covered by public health insurance (in opposite to MtF and FtM surgery).

Just another thing that might help me to reach my goal here in Germany:

Are there any numbers on how much nullifications were performed by qualified surgeons during the past years?

What diagnosis and/or ICD codes have been used?

Is there any current reference for treatment to refer to?

The thing is, if I could get the needed documents here by my local therapists, it would be possible to schedule the surgery with just approximately 4 weeks of waiting time. Somehow a crazy situation....

[Dekeldoh (imported)]

Thanks for your replies so far. Indeed it was XXYGuy26's story that made me think if a trip to your country could be an option for me.

Spending 3 or possibly 4 weeks may be possible. I already feared that some kind of online counseling will not work to get the letters. If I need two different trips for the letters and later the surgery, it would mean that I need two years for that, as my yearly vacation wouldn't allow more than one extended travel per year. Also it would rise the total cost significantly.

Payment directly to the surgeon would be possible. Even here in Germany it is quite likely that I would have to pay by myself, as nullification is currently not covered by public health insurance (in opposite to MtF and FtM surgery).

Just another thing that might help me to reach my goal here in Germany:

Are there any numbers on how much nullifications were performed by qualified surgeons during the past years?

What diagnosis and/or ICD codes have been used?

Is there any current reference for treatment to refer to?

The thing is, if I could get the needed documents here by my local therapists, it would be possible to schedule the surgery with just approximately 4 weeks of waiting time. Somehow a crazy situation....

Hi! Did you think about flying to the US for the letters and then having the surgery done locally? Your message implies that won't work, but I wanted to make sure. Just another idea.

My urologist's office cited "gender identity disorder of adulthood" for my orchiectomy. I don't see an ICD code right now, but I think it was F64.9. Even for nullification I figure they'd just use one of the F64 ones. As for concrete numbers on nullifications, that sounds hard. The best I could think to do is point at some surgeons who have done them and say "well, they must have done some." This article (https://broadly.vice.com/en_us/article/ ... heir-penis) quotes Dr. Curtis Crane on the subject, and Dr. Peter Davis openly advertises the service on his website (https://www.davisplasticsurgery.com/gen ... ation.html). But I don't know any published academia content that focuses solely on nullification. There's lots related to MtE and some mention it—a search for "male-to-eunuch" on Google Scholar will bring those up. Maybe you can bring a sticky note with some of those DOIs. And WPATH should qualify as a "reference for treatment."

[T van Keel (imported)]

Hi! Did you think about flying to the US for the letters and then having the surgery done locally? Your message implies that won't work, but I wanted to make sure. Just another idea.

Well, I also had this idea already. To be honest, I currently don't know if it would work. I have to do some research on that. The surgeons won't probably make problems, but I think my health insurance wouldn't accept a letter from some foreign country, even if it follows WPATH standards.

One other question, how much would I have to pay for a letter approximately?

[Dekeldoh (imported)]

Well, I also had this idea already. To be honest, I currently don't know if it would work. I have to do some research on that. The surgeons won't probably make problems, but I think my health insurance wouldn't accept a letter from some foreign country, even if it follows WPATH standards.

One other question, how much would I have to pay for a letter approximately?

I have seen fees ranging from $80 to $250 per visit. Some practitioners specifically offer clinical evaluations to get a letter in one longer session; that's easier to accomplish when it's just a second letter. Honestly, I think price, time needed to write a letter, and willingness to write a letter at all are completely up in the air. It depends on who you see.