Doctors are coming online and getting more open to this community. At this point the problem is two-fold. First, there is a segment of our community that thinks this should happen (modification of their genitals in all the different variations) without need to obtain therapist letters. Those who think this way are doing themselves, and our community, a great disservice. All that attitude does is drives away legitimate physicians who may be open to helping us. Second, getting physicians on-board with these ideas. At one time MtF and FtM were taboo, and now they are generally accepted by the medical community. The same can happen for MtE, and it is for the very first time mentioned in the DSM. Unfortunately it is mentioned as "Needing more study..." but it's in there. That's a bit of progress.

I think what would be helpful for those of us that want to get these surgeries in a legitimate place is to first self-identify ourselves as Male to Eunuch (MtE) and then seek out a therapist that works with transgendered patients. It doesn't matter that you don't think you're transgendered, it's how the medical community is identifying folks like us (the actual diagnosis is: Gender Dysphoria - not otherwise specified). It's happening, but is moving at a glacial pace. If you're wanting to be successful, the acronym BIID or directly the phrase, "Body Integrity Identity Disorder" needs to disappear from your vocabulary until after you've succeeded in obtaining your surgery. If you insist this is what is going on with you, you'll not cross the finish line.

The therapy sessions are easier than you think. The transgender therapist are very open minded so long as you maintain your professional view of the relationship you establish with them. I would advise finding one that is not a traditional MtF or FtM themselves. Sadly, I've found those tend to "eat their own" as far as MtE individuals go. So you'll be seeking an open minded therapist for these sessions. Be direct with the therapist. Explain what it is you seek, how long you've felt this way, etc. They will be honest with you and you need to do the same for them. It might be difficult at first, but you will understand that they are listening and learning what it is you desire and need so they can best help you.

Once you have the first therapist letter in hand, and amazingly that might be all you need, you'll then be in a better position to approach urologists and transgender surgeons about what it is you seek. It will show them you're serious and not wasting their time, and that there is a medically recognized path for them to perform your surgery legitimately.

Good luck!

--LT

Losethem (imported) wrote: Mon Feb 23, 2015 8:39 pm Doctors are coming online and getting more open to this community. At this point the problem is two-fold. First, there is a segment of our community that thinks this should happen (modification of their genitals in all the different variations) without need to obtain therapist letters. Those who think this way are doing themselves, and our community, a great disservice. All that attitude does is drives away legitimate physicians who may be open to helping us. Second, getting physicians on-board with these ideas. At one time MtF and FtM were taboo, and now they are generally accepted by the medical community. The same can happen for MtE, and it is for the very first time mentioned in the DSM. Unfortunately it is mentioned as "Needing more study..." but it's in there. That's a bit of progress.

I think what would be helpful for those of us that want to get these surgeries in a legitimate place is to first self-identify ourselves as Male to Eunuch (MtE) and then seek out a therapist that works with transgendered patients. It doesn't matter that you don't think you're transgendered, it's how the medical community is identifying folks like us (the actual diagnosis is: Gender Dysphoria - not otherwise specified). It's happening, but is moving at a glacial pace. If you're wanting to be successful, the acronym BIID or directly the phrase, "Body Integrity Identity Disorder" needs to disappear from your vocabulary until after you've succeeded in obtaining your surgery. If you insist this is what is going on with you, you'll not cross the finish line.

The therapy sessions are easier than you think. The transgender therapist are very open minded so long as you maintain your professional view of the relationship you establish with them. I would advise finding one that is not a traditional MtF or FtM themselves. Sadly, I've found those tend to "eat their own" as far as MtE individuals go. So you'll be seeking an open minded therapist for these sessions. Be direct with the therapist. Explain what it is you seek, how long you've felt this way, etc. They will be honest with you and you need to do the same for them. It might be difficult at first, but you will understand that they are listening and learning what it is you desire and need so they can best help you.

Once you have the first therapist letter in hand, and amazingly that might be all you need, you'll then be in a better position to approach urologists and transgender surgeons about what it is you seek. It will show them you're serious and not wasting their time, and that there is a medically recognized path for them to perform your surgery legitimately.

Good luck!

--LT

Succinctly stated. Thank you. For the most part what we have been advocating here, at WPATH, and elsewhere for years. I would have some qualms about your statement re: BIID. It may be a bit more flammable, but is getting a very great deal of attention the past couple of years. This is, of course, one of my areas of significant interest.

I definitely support most of what you said.

The first thing I'd add though is we should get actual therapy first because frankly we really might need therapy. Any thoughts of self-harm, even if meant to be transformative into a more congruent body or gender, is technically a mental disease. I've seen people on this forum who seem to want castration because they are struggling with being gay. I'm among those who have sought it because hyper-sexuality has dominated and distracted my life. Some have trouble aligning their religious beliefs with their carnal desires. Others that post here just seem to be outright mentally ill. For all these cases, it is best to acknowledge that therapy may divert an unhealthy obsession with amputating your genitals. It is also quite appropriate for doctors to insist on such therapy as well.

Regarding declaring oneself as MtE, I agree that in medical community you get best help if they can categorize you. However, I would caution that you need your story to also "ring true" with the therapists and doctors. For me, it is a lot better to seek therapy for my hypersexuality and related paraphilias. Those conditions also can medically be categorized with castration as a viable option. I know I wouldn't be convincing if I tried to say "I really feel sexless and would be more comfortable with my body being eunuch", versus saying "my life is a disaster and I need my libido reduced to get it back on course".

But for those that indeed simply have a desire for eunuchness, definitely try to get categorized as MtE and educate your doctors and therapists on this now defined category.

My intent with this thread is to show that it is indeed possible to achieve what those who are seriously wanting to be castrated/penectomized/nullified want to achieve. What I've been finding in my personal experience as I've looked into going further is that doctors/surgeons will pay more attention to those people who have gone through the therapy process, which ultimately as we get better recognized, is what is going to be required to have legitimate surgeries to achieve our goals.

I've been directly told by both a surgeon and a therapist that if a person presents saying "I have BIID" they will likely come away disappointed. The main reason being that BIID isn't getting surgical help but Transgenderism is. Simply put it's the goal, not the label, you should be worried about. They could call me a purple and green spotted rhino for all I care so long as I was able to achieve my ultimate goal. While BIID is being recognized similar to MtE in the DSM V (the new DSM), it's treated much differently than Gender Dysphoria by surgeons. That's why I said if you're serious about this, then get BIID out of your vocabulary - it's presently a dead end road.

I think a person going through the therapy process and stating they are MtE and their desire is to be rid of part or all of their external genitalia is going to get them much closer to their goal. They get the therapist letter in hand more doors will open than the random phone calls I've seen discussed in Eunuch Archive forums until now.

--LT

Once you get this far to EA, generally you have come to realize that 'labels' really don't work and we start to resist them as defining us. Personally, I am so complex I could not begin to label myself! However, @Losethem is right, for the 'system' we need some clear categorization that medicine can identify as an illness/dis-order or the Hippocratic oath kicks in.

I have seen a councilor since I attempted to castrate myself and it was not nearly so bad as I imagined. I am very glad that I did and it has helped me a great deal.

This self identity is crucial for medical acceptance or we will forever be left with trying to find ways to 'fix' ourselves which remains open to risk, infection and possibly death.

To add to this discussion, here is a comment from a distinguished and well-known psychiatrist who works closely with the trans* community:

The Gender Dysphoria diagnosis and WPATH Standards of Care, version 7 apply to genderqueer and other non-binary folks. Insurance companies can deny claims for all kinds of reasons, but if there is an appeal, one can cite the DSM 5 Gender Dysphoria diagnosis, which is inclusive of the gender spectrum, and WPATH SOC 7, which makes clear that surgery can be medically necessary for non-binary people. I have had a number of non-binary people have surgery covered by insurance. In the letter, I focus on the gender dysphoria, which could benefit from the surgery.

There are more and more therapists out there who are willing to listen and able to help. Willing surgeons are still difficult to find, but they do exist in locations scattered across North America. (Europe may be a bit more difficult.) It may even be possible to have insurance cover the cost of surgery.

I think most therapist who work with transgender people would understand an androgynous orientation rather than eunuch. I think they grasp the idea of gender on a spectrum and that you would just be better adjusted closer to the middle of the spectrum, sans testicles. I could be totally wrong too. Thoughts?

For those of you who wonder what a successful therapist letter looks like for a penectomy (and possibly a nullo or castration):

Therapist Letterhead and phone number

Date

Address and phone of surgeon

Dear Dr. (Surgeon),

This letter is to serve as documentation that (patient) whose date of birth is (DOB), has met the readiness criteria for penectomy surgical procedure. Mr. (patient) has requested a letter of support for his decision to pursue this surgery and he has completed appropriate authorization to release this information. I am a psychologist with an independent practice in the state of (STATE). My (STATE) physchologist license # is (NUMBER). I have specialized experience and training working with transgender, transsexual, and gender non-conforming individuals; and I am also a full member of the World Professional Association of Transgender Health (WPATH).

Mr. (patient) is a (age)-year old, White, Gay, Self-identified male-to-eunuch (MtE) gender non-conforming individual. Beginning in (Month-Year), I have seen Mr. (patient) on 3 occasions (i.e., 1 clinical assessment/readiness for surgery evaluation and 2 psychotherapy appointments). Based on the results of my clinical assessment, Mr. (patient)'s symptoms and experience are consistent with the following diagnosis: 302.6 Unspecified Gender Dysphoria as outlined in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition.

Beginning in his teenage years, Mr. (patient) reported experiencing male-to-eunuch gender dysphoria characterized by a pervasive and consistent discomfort with the presence of his penis and testicles. According to Mr. (patient), since that time he has experienced a consistent desire to have his external genitalia removed. In (YEAR), Mr. (patient) had completed a bilateral orchiectomy surgical procedure performed by an "underground cutter" to address gender dysphoria concerns. Mr. (patient) expressed satisfaction with the results of the orchiectomy procedure, and he is now seeking a penectomy from a board certified surgeon to aid his medical gender transition. Mr. (patient) would like to pursue this surgery with no intention of acquiring female physical sex characteristics, but only to have his external genitalia (i.e., penis) removed. Mr. (patient) shared that he intends to continue presenting as male; however, he no longer intends to regularly experience ejaculations nor stand to urinate. Mr. (patient) also intends to continue with his physician prescribed hormone replacement therapy that entails biweekly testosterone cypionate injections.

My clinical assessment indicates that there is no evidence of any symptoms of psychosis, current mood disorder, or disturbances in personality that would interfere with his ability to make an informed decision about undergoing the requested surgical procedure. At this time, there is no evidence of substance abuse and/or alcohol abuse. Additionally, clinical assessment results indicate little evidence of the following psychological conditions: Body Dysmorphic Disorder, castration paraphilia, and Obsessive-Compulsive Disorder. Further assessment may be warranted to rule-out xenomelia. Mr. (patient) has a strong support system that includes friends in his MtE community who have demostrated care and compassion. Mr. (patient)'s judgment appears to be sound and good, as he has the capacity to make an informed decision about this medical treatment.

I have no hesitation in recommending Mr. (patient) for the surgical procedure that he has requested; he has good knowledge of the procedure and he has the ability to follow any related Standards of Care for this surgery. If you need any additional information or have questions, please do not hesitate to contact me at (therapist phone #).

Sincerely,

(Therapist)

(State) Licensed Psycholgist (License #)

That's the golden ticket if you find a sympathetic surgeon wanting such a letter.

--LT

So you were able to schedule a penectomy with that letter?

With the help that is coming online I could, but it isn't cheap.