Finding professional medical care for castration, whether chemical or surgical, is not easy. There may never be another licensed urologist, such as Murray Kimmel, who is willing to perform orchiectomies on demand. Hand him cash and he pulls out his scalpel….

The first concern of any competent physician faced with a patient asking for castration will, of course, be the sanity of the patient. This is as it must be with the ever-present threat of malpractice suits. The physician will need assurance that you clearly understand the consequences of castration and that you have no medical or psychiatric conditions that indicate against it.

This is why you will be referred first to a counselor – a psychologist or psychiatrist – for evaluation.

The Harry Benjamin Standards are in the midst of another major revision, which will happen over the next two years. One goal is to move away from a binary model of gender, allowing far more flexibility for people who only want or need hormones or orchiectomy or other types of surgery. There is already acknowledgment in the current Standards of Care that there should be flexibility for individual needs.

You will need to find an individual provider or clinic which implements the standards in a progressive way, recognizing that some individuals do not conform to the traditional paradigms of Male-to-Female or Female-to-Male. This includes various interpretations of the Real Life Experience, which is for some very different than living in the role of the other sex. Also, for an orchiectomy, a Real Life Experience is often not a requirement. Hormone therapy sometimes is, sometimes is not.

The SOC technically only requires psychological evaluation and 3 months of therapy (3 sessions) OR 3 months of real life experience (whatever that means for the individual in question) prior to hormone therapy. If orchiectomy is an alternative to hormone therapy, the same requirements apply. If orchiectomy is an option in and of itself, it might be indicated for some people to first try chemical castration, as it is reversible, before receiving support for irreversible surgery. It all depends on whether the person is interested in hormones, surgery, or both, and any potential medical contraindications. Treatment is highly individualized and should be negotiated with each and every client individually.

As Dr. Walter Bockting of the Center for Sexual Health of the medical school at the University of Minnesota writes, “In my view, it is not appropriate for the provider to make these decisions. These have to be the client's own decisions. My role as a provider is to make sure the client makes a fully informed decision, that I can get behind that decision, can support it, and do no harm.”

For those of you who live in the upper Midwest, the University of Minnesota is probably your best place to seek help. It is now probably the foremost center for gender questions in the United States, and it is one of the most client centered. You will need to convince a caring professional of your needs, but it is certainly one of the best possible choices you could make.

I will continue searching for professionals who are willing to help and will post further suggestions on this thread as I find them.

JesusA (imported) wrote: Tue Sep 01, 2009 10:29 am You will need to find an individual provider or clinic which implements the standards in a progressive way, recognizing that some individuals do not conform to the traditional paradigms of Male-to-Female or Female-to-Male. This includes various interpretations of the Real Life Experience, which is for some very different than living in the role of the other sex. Also, for an orchiectomy, a Real Life Experience is often not a requirement. Hormone therapy sometimes is, sometimes is not.

What you're proposing is great IF the man in question wishes to become asexual on a permanent and irreversible basis. However, that isn't the goal of many of us.

I still take issue with demanding chemical castration for individuals like me. I never wanted to be asexual (which chemical castration will do) but simply wanted to be a man who doesn't have testicles. I maintain that if you continue down this path where the only avenue to get physically castrated will be to do a chemical trial first, you're going to scare the bejesus out men like me. The prospect of having to become asexual to meet some sort of "standard of care" is frightening to me at best, and terrifying in general. If the idea is to do no harm, forcing a man like me to get chemically castrated is going to do more harm than good.

While I appreciate your efforts in general, it seems like this whole concept has gone completely over your head. If your goal is to put cutters out of business (I think that is good) you're just going to perpetuate that system of voluntary castration for men like me, because we will REFUSE to go on chemical castration.

I got castrated voluntarily and permanently by means of underground surgery. I am completely happy with my genital configuration now, and finally feel comfortable in my body for the first time ever. I would have preferred to get it done safely by a doctor - something that will continue to wait for men like me if your mode of voluntary castration gets accepted.

If I had been required to be chemically castrated first, I surely would have ended up dead by suicide. I was getting close. But apparently in the world you're navigating, there is no concept that chemical castration can actually be harmful.

My point to you is get your head out, there is a segment of this community to which what you're proposing is a scary prospect. We want medical system care, but not in the form you're pursuing, and if chemical castration becomes mandatory, you're going to find that we're still going to seek out cutters.

It's taken 50 years to get to this point of even having the discussion that gender isn't binary, don't put guys like me through another 50 years of waiting because you're not even discussing our type of M2E while this while the door is open. Of course, perhaps not having this affliction yourself, you're like all those practitioners who just don't get it.

Please, take the type of eunuch like me into consideration as you do this, you're making me, and perhaps us, feel like you've completely blown us off and ignored us.

Losethem,

Re-read carefully the paragraph that you've quoted. It opens the way for BIID as a valid reason for castration. It's a matter of working with a competent therapist who is ready to recognize it as a diagnosis. There are few professionals at that point yet, but the DSM-V, when published, should make it much easier.

While agree with Losethem in that what for some seems like should be a "cut and dry" procedure, without further hurddles. I also understand and applaud Jesus for "working within the system" to bring about real change.

Losethem, have you had your levels drawn lately?

chilli-

Maybe if I had insurance I could.

A group that the medical model would serve even less well than the body dysmorphic eunuchs would be those who understand castration as spiritual path. Men who seek castration as a spirtual path, and who see castration as part of the ritual. This grouop would likely find displeasure with the regimented routine and sterile atmosphere of the OR or surgical center. They might seek a "priest" or some other kind religous figure to perform the procedure. The procedure being a kind of rebirth as well as part of the persons gender identity. The medical/legal model definately has limitations.

chilli-

No one model will serve everyone. At the moment, perhaps we should concentrate efforts on making sure there is a path for even some, or hopefully the majority. While it may not be perfect, no solution is. Even if the proposed path is not what you seek, any path at this stage is preferable to the lack of a path that has existed up to this point. Once this path has been established, then we can turn our attention to creating other paths. Compromise is the way the world works. An all or nothing attitude benefits no one.

I fail to see why some people seem to put so much more importance on the hows and whys of the process to get castrated than then seem to care about just getting to the end result in an expedient manner. If you want A done and the SoC says you must do B first, you simply do B to get to your goal. If the B process is so distasteful that you refuse to do it, you will not get to A in their court. This doesn't mean that you can't get to A, you just have to use some other, alternate process.

BTW- Testosterone blood level tests are relatively inexpensive. My insurance gets billed $22 for mine so you might get a better deal as a cash customer.