Orchiectomy Part 2

[graphic content warning]

Recently I performed self-orchiectomy according to the procedure which i have discussed here. Prior to operation I had practised surgical techniques for some months using silicone pads and was relatively confident in my ability. During the operation I had friends on standby in case of emergency and to provide emotional support.

I will not discuss the procedure in great length, which is well documented in this video (graphic, be warned). I would however like to talk about some of the difficulties I encountered…

• The most stressful part of the procedure was the injection of the anaesthetic. This was the only point at which I experienced pain, and I am slightly scared of needles. I felt my blood pressure drop (probably due to shock response), and had to lie down for a few minutes and drink some water. I was relatively calm for the rest of the procedure.

• I had a large quantity of fascia (connective tissue) and struggled to reach the spermatic cord/vascular bundle. They make it look so easy in the videos! I succeeded in the end but it took a while, over thirty minutes for each testicle.

• Ligation was the most technically demanding aspect of the procedure. It is vital to get as much spermatic cord/vascular bundle clearance as possible to make this part easier.

• Thermocautery is a godsend. It works quite well, comparable to electrocautery, and is much more affordable.

Why I did it

Of course I would have preferred professional treatment. To do this I would have had to get an appointment at a gender identity clinic (GIC) through the NHS (national health service in the UK). The current webpage for GIC’s states the following statistics:

At this rate, the current wait times for a first appointment are >5 years. You need at least two appointments to get a gender dysphoria diagnosis, let alone get booked in for a medical procedure.

The private healthcare provision is minimal, still has long waiting lists and is prohibitively expensive.

The ideal option is to go to Thailand and have the procedure done there, where is both affordable (~200$), professionally done and works on an informed consent model that does not require some other prior diagnosis.

In short, I did this procedure because the trans healthcare provision in the UK is horrific and dehumanising. The procedure went successfully and I am glad that I did it.

More shenanigans with the NHS

A few hours after the procedure I went to an NHS hospital in order to have the procedure on my medical record and to ensure that I was safe.

After a long wait time I was seen by a junior doctor who removed my compressive bandages to look at the wound (if there is a wound present, standard textbook procedure is to inspect it). He then reapplied a small plaster and said he would redress the wound later, which he never ended up doing. Thus my wound was exposed unnecessarily and the lack of compression increased scrotal swelling.

I was offered antibiotics, about which I was hesitant knowing risk of side effects. The junior doctor insisted I take them just as a precaution. I was given cefuroxime and metronidazole intravenously. I had an adverse reaction to the latter, causing my eyes to redden and be in excruciating pain over the next few hours. Of course we could not have predicted this, but it was undoubtedly the most painful part of this whole story.

I had blood tests taken, which all came back as normal (very slightly elevated WCC which is to be expected):

White cell count, norm 4.5-11.0, elevated indicates stress response
            WCC: 12.1

            C-Reactive Protein, norm <1.0, elevated indicates infection/inflammation
            CRP: <0.4

            Haemoglobin, norm 138-172 male 121-151 female, low indicates blood loss
            Hb: 134

            Lactate, norm <2, elevated indicates hypoxia or cell death
            Lactate: 2

            estimated glomerular filtration rate, norm >60, kidney function
            eGFR >90

            creatinine, norm 62-115 male 53-97 female, kidney function
            Cr 70

            Antibody screen, blood: negative
            ABO RhD, blood: B negative

After waiting another hour I was transported to a different hospital which had a urology team. After another hour or so I got to see a second year trainee urologist, who had seen the procedure once as an assistant. It turned out that I knew more about it than she did. She removed my plaster to inspect the wound, and replaced it with another plaster, again aggravating the area.

I asked for an ice-pack to reduce swelling and apparently they didn’t have one in the hospital (???). Had to get a friend to pick one up for me from a supermarket.

I was told I would be seen by a psychiatrist, but ended up seeing a mental health nurse who could barely speak English and was useless in all regards. I insisted that I be discharged and finally at around 3am I left the hospital, in more pain than I had arrived with.

The silver lining is that I got complimented on my courage and suturing technique by the doctors. The other silver lining is my discharge papers - the procedure is now on my medical record, and I now have a legal document that marks my gender as female.

Healing

I experienced some pain along my spermatic cords (indicated in black below), probably because of them being pulled during the procedure.

There was some bruising in one or two parts of the scrotum after surgery, although it was barely noticeable. Walking around was slightly uncomfortable. Ibuprofen was used for pain relief and ciprofloxacin 500mg twice daily as antibiotic prophylaxis. Pain worsened in the first ~5 days following surgery, after which it improved rapidly and I could walk comfortably by the 10 day mark.

The stitches fell apart ~30 days after the procedure. Healing is now complete and I am extremely pleased with the final result! There is no visible surgery scar, as if my scrotum had never been touched in the first place, which is a better result than much of what I have seen of “professionally-done” surgeries.

Thanks for reading :)