I see my urologist on Monday for the first time since my therapist recommended HRT. One thing she also recommended was an orchiectomy (castration) so that, due to my age, I don't have to take anti-androgens like spirolactone or finasteride along with estrogen and, maybe, progesterone. She said she could refer me, with a letter, to a surgeon here in town who does orchis for trans people. I told her what I would do first is talk to my urologist, since he has been treating me for orchalgia (testicular pain) and my insurance should cover it as an ongoing problem. Plus I have a 10X risk of testicular cancer on one side and medical protocol calls for it to be removed. If he's reluctant, then my therapist can refer me to the other surgeon.
My main thought is how to open the conversation with him. When he did the nerve block back in December he mentioned removal if it didn't work. I said something then about me not not being bothered removal and he said, "Yes, but your wife still wants a husband, not a sister." Of course both of us burst into laughter and he was looking at my wife and I like we were crazy. So I may start out with mentioning his joke, then moving into talking about seeing a gender therapist and go from there about HRT. Wish me luck.
Good Luck.
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Susan