Trans Things: Orchiectomy? I hardly know me!
A personal account regarding post-op recovery
CONTENT WARNING
This article contains discussions of the medical system, surgery and pain. Reader discretion is advised.
IMPORTANT TO KNOW
An orchiectomy is the removal of the testes through a surgical incision made in the scrotal sack. The procedure takes minutes, the recovery takes about a month. This procedure leaves the remaining genital material intact for follow-up surgical interventions. Here’s a link to more info from Mayo Clinic, for the curious.
Part 1: What are we doing here?
From the lead up to my orchiectomy, I was constantly doing research to better understand what I was about to do. This was wise, and I did learn many things about the procedure itself, and even pulled together a few expectations which held their accuracy right up until I was knocked out and under the knife. However, during that period of neurotic fact finding, I discovered that there's very little information online about what happens AFTER you get home post-op.
This is specific to orchiectomies, as there are many people who go into detail about vaginoplasty recovery (which is very perfect and good). Among my peer group I am the only person who has ever experienced this surgery, so this account is meant to help those who are on the fence or might even be unaware of orchiectomy as an option for their transitional healthcare.
Why an Orchiectomy and not Vaginoplasty?
A great question!
The answer is a mix of several things, some of which are personal, but the most important of which are rooted in my material conditions. Let’s talk about two things:
The affordability and availability around trans medications in the age of collapse.
The terrible bureaucracy surrounding gender affirming surgery in Canada and Alberta.
Point one: the economy made me cut my balls off
There have been multiple shortages in the supply of anti-androgen medications in the region I live, which has led to much stress. Testosterone is a far more tenacious hormonal agent then estrogen so the effects of being without it are measured and felt much more rapidly after missing even a handful of doses. As well, the cost of anti-androgen medications is something that I was finding fairly unfeasible to pay for even if I could find the pills. An orchiectomy in many ways was a cost-cutting measure for me. The horror of trans-economics manifests in many interesting ways, and this is one of them.
Point two: Everyone hates trans people
Regarding bureaucratic weaponry, the wait times and general treatment of trans people by the medical system had proven to be unbearable for me. The wait time for procedures considered to be under the gender affirming umbrella stretch into the multi-year mark. This is bad enough, but even after clearing the hurdles to access, the instructions on how to advance the administrative process between me and the surgical systems in Montreal were inscrutable.
Anyone who has managed to set foot in a certain Albertan psychiatrists office in this province will understand the bewildering experience that I am referring to. There's no telling how many people have been halted from their transition due to the actions of one single man. Phone calls to dead numbers, offices full of people who haven’t heard of my referral;. It all pushed me to walk into my endocrinologist office and request a referral for an orchiectomy.
The wait time for an orchiectomy procedure is an order of magnitude shorter than for vaginoplasty. I did not require multiple psychiatrists to weigh in and scrutinize my transness to access this surgery. In a turnaround of roughly 6 months from start to finish, I went from walking into my doctor's office to laying in bed and recovering from surgery.
I will not be focusing on what happened during this period, though I will say that the smoothness of the proceedings lay in stark contrast to the barrier presented by the gender affirming network. The postoperative experience, on the other hand, is a bit of a mystery that needs more ink spilled on its behalf.
Part 2: Post-Op Experience
What follows is a textual recounting of my orchiectomy post-operative experience. This is entirely centered on my experience, and cannot account for the foibles and cruelties of biology, the medical system, or other the existential paraphernalia which accompany something like recovery. Read and incorporate this knowledge with that grain of salt firmly in hand.
On Pain
Firstly, this is not a surgery without cost with regards to physical pain. Most information online, as well as the doctors I had spoken with pre-op described the situation after surgery to be one of discomfort. This was not true for me, as it was one of the more painful experiences I’ve ever had. My track record includes dislocations of several different joints, various painful illnesses and the removal of all the finger-nails on my right hand through brute force. The pain was no cakewalk, and you need to be aware of that.
To break things down a bit, I did not have any pain at the incision site which was unexpected. In contrast I had a considerable level of pain up at the base of my genitals and further up into my abdomen. I learned later that this pain originated from the severed tubes which connected the testes to the rest of my body. After your testicles are removed, the remaining tubular tissue tend to pull back up into the lower abdomen, leading to a pain that resides deeper inside than you would think. It felt like a dull, burning ache and it involved swelling in the area around the base of my genital zone. I suppose what you need to know is that this is a fairly normal thing to experience.
Disclaimer: I am not a doctor. If you receive medical advice counter to the information I have provided here from your own physician, follow it.
During my initial recovery period, I was given confusing information online about pain management. As well, information from my doctor made it seem like medication that would reduce swelling would cause bleeding, so I stuck to the Tramacet I had been given. This was the wrong idea, and I eventually had this information corrected by a triage nurse after an ER visit. Advil and other non-steroidal anti-inflammatory drugs (NSAIDS) like naproxen were key to my pain management. As well, compression underwear is unpleasant to wear but helped in keeping the swelling down and making sure I didn’t get jostled incidentally. Wearing a bandage over the incision site helps with this as well. I used a simple bandaid in my case.
There was, and even now several months after my surgery, some not insignificant post-surgical pain. It has consistently become less of an issue with time and as of writing this I barely every experience more than a few little jolts a couple times a week. It mostly takes the form of aches in my lower abdomen, or in my phantom left testicle (yes you read that correctly, my darling). This might be a factor of my specific biology or it might be a common experience in my experience. I am willing to accept a level of low-grade pain for the benefits I’m experiencing, but you must be able to integrate that kind of risk into your life before considering this procedure.
A final note: Doctors will not be able to give you an accurate assessment of what the pain will be like, or really predict the nature and speed of your recovery. It took me about a month before I started to feel a bit normal. If you have never had surgery before, most of this will feel scary; it certainly did for me! Despite these hurdles things turned out okay, but be prepared with ice packs, relevant medications, and tempered expectations.
On Emotions
You are going to feel many, many things during this period. I will walk you through a bit of what I felt, and maybe that will make your inevitable feelings a little easier to deal with.
Surgery of this kind only takes a day, and does not have any hospitalization associated with it’s recovery. You will be sent home a few hours after your surgery, assuming you are able to urinate. That part was humiliating, because I am an anxious pisser and it took far too much time and pain to do that particular deed. I am unsure if humiliation is avoidable regarding a surgery like this, so try and take comfort in the universality of the experience.
The night I went home I had to take an hour drive back from High River on a bumpy road. I was extremely cold, crying and shivering. Without my partner or in your case anybody who can help you through this surgery it would have been far worse. The greatest antidote to pain in this case will be to rely on your loved ones.
I felt extreme anxiety about my surgical wound, recovery, swelling, and postoperative aesthetics. I have fairly extensive training for management of my anxiety, and my partner was a damn rock for me in the time. I had my partner take a look at my surgical area a few times, and my trust in their reassurance was an important tool for helping break what I imagine would be common cycles of anxiety.
On Aesthetics
No one ever talks about how you will look post-op. There is a shadowy gap in the record of experience for post-op aesthetics and what they could mean. I’m going to do my best to describe the visuals of my experience. This portion may be graphic or unbearable for some, but I will do my best to provide a neutral and easy to read account.
My surgeon gave me three sutures and a thick cap of surgical glue overtop the incision site. I must stress that it is important to use a bandage to hold this cap down as it can get caught on things such as your underwear and cause significant distress.
The surgical cap will be red or pinkish in hue at certain points in its structure; this is an antibacterial agent meant to keep you safe so don't worry about it too much. Do not try to remove this cap, as it will flake off on its own. Because of the sutures, the surgical glue was often enmeshed in the threads, so attempting to peel it away could have easily resulted in a busted stitch. It was basically never worth messing with this cap, so take my word, bandage it up, and leave it alone.
Your new scrotal setup should be relatively deflated but still squishy. There wasn't anything hard or textured present in the area post surgery, and there still isn't. It isn’t an entirely empty flap of skin, but especially directly post surgery there was essentially a curtain of loose hanging skin that was kind of unmanageable. It just got into every damn thing, there’s no other way to say it. In my case, even though it seemed very oversized this skin tightened up over time to the point where it doesn’t bother me anymore.
It’s worth noting that you can request to have the excess skin removed during the procedure. I did not choose this, so I don't know what it's like to undergo that part of the procedure. The remaining skin can be used for vaginoplasty in the future if you are able to attain it, and so it might be wise to keep it.
It's worth it to know about my experience with swelling because there was very little information about how swelling worked online or from personal accounts. Around two days after the initial surgery, stemming from the left side of my genitals, I had radical purple to black coloured swelling which inflated things I wish it hadn't. This swelling was not painful, but it was, in fact, alarming as hell.
I ended up going to the emergency room and speaking with a urologist there. Though it lasted for quite a while (maybe 2 weeks), it was never painful and went away without issue. If you experience swelling accompanied by any real pain throughout the swollen area, it's probably bad! If it's painless, then it might be similar to what happened to me. If any physician offers to pierce this area for you to reduce the swelling, run away from them and never come back.
Eventually the surgical glue did wear off. This revealed the incision site which had some painless pink areas and wept here and there with some fluid. I panicked and went to the doctor; I've never had a surgical incision before and it made me sick to look at it. My doctor took a look at it and even swabbed it with alcohol which in retrospect seems suspect. I can’t tell you if this is a wise thing to do to an incision site, so use your discretion.
Regardless, there was no pain, and from the moment my incision became exposed I started applying over the counter antibacterial ointment with a q-tip every evening after I showered and before I would put on a bandage. The lesson here is it’s better to go to the doctor than not.
Part 3: Post Recovery
After my recovery had completed (in all I’d say it took about 6 weeks), there are a few weird and wild things that I want to talk about. Bodies are strange, and mine is no different so take the information I am about to present to you as obscure lore more so than dogma.
On Aesthetics and Sense
First thing I'll mention is that I smelled entirely different post surgery. This is similar in character to the change in body odor that can happen when you first begin HRT, but it was unexpected and unmentioned anywhere. I am extremely sensitive to odor, and so I imagine it has a part in this equation. It’s not unpleasant, but it is worth mentioning that it drove me crazy for some time.
The second thing is that my outfits feel better to wear, but not perfectly so. Depending on how your body works, you will still likely need to wear doubled up pairs of underwear or compression gear if for instance you want to wear a swimsuit. However the fact that I am no longer in pain due to tucking, or experiencing any of the regular testicular difficulties of trying to wear clothing that makes me feel good is a huge plus. It's much easier to fold my legs closed now, and honestly sitting is a bit of a dream. Take that as you will.
On Sex
I can’t discuss my orchiectomy without discussing sex, so here we are.
I have no idea if this will happen for everyone, but my libido has basically erased itself post-op, which I'm fine with. Part of why I transitioned was to be more free from my sex drive and I welcome this change openly. Despite this decrease to libido, I have found that my orgasms are off the fucking charts with regards to quality. I don’t know why losing a bit of my anatomy has caused this, but it owns. As well, there's also basically no mess to clean up after.
In my case, my transitional sex life has been characterized by fairly extreme post-coital pain after an orgasm. This problem has greatly diminished along with the disposal of my testicles, which is good news. Obviously I can't guarantee that this will happen for anybody but it's one of the better unintended side effects of the procedure for me. Shrinkage and lack of genital elasticity is a general characteristic of an AMAB body sans testosterone, and so it is the case here. My erections are still painful if they go on too long, and frankly my hardware looks a bit imbalanced after several years of little to no testosterone. I don't care about this, but it's a simple fact of life and it might become part of yours if you choose this route. These elements of my experience have accelerated since my procedure which is to be expected when you have zero testosterone. Luckily I have had no loss of feeling in any parts of my genitals, and it all functions well or even better in the sensation department.
End
I hope that this first-hand account is of some value to people who are considering an orchiectomy period. It was an important procedure for me, and very much worth getting. If you have any questions after reading this, do not hesitate to DM me, and I will do my best to answer your questions.