How I talked to the doctor about the orchiectomy

I realized I never talked about the initial conversation with my urologist about the orchiectomy.  He had been treating me for orchalgia (chronic testicle pain) and had done a nerve block to see if that would stop the pain.  The night of the nerve block I was saying crap that hurts but the next day was fine.  While it worked for a few weeks, the pain came back.  About a week or so after the nerve block I had my appointment with the therapist where she recommended the orchiectomy along with HRT.  She was going to recommend me to a surgeon here in town who will do the orchi with a therapists letter but I mentioned I wanted to approach my doctor first.  At the previous appointment he had said something about having to do a removal of part of the testicle if the pain persisted.  I made the comment that, at my age, I wasn't that worried about it which is when he said, "Yes but your wife still wants a husband, not a sister."  I was laughing so hard I was about to fall off the table and my wife was giggling.  So I decided to use that as my opening at the next appointment.  I asked if he remembered the remark and he said he did so I launched into my explanation of being trans and that my wife has long had a "sister" so to speak.  I told him the recommendation from my therapist for the orchiectomy and that she was going to refer me to another surgeon but I wanted to speak to him first.  We talked about it a little more and he agreed, with a letter from my therapist to do the surgery.  One thing we did talk about was insurance.  He said he would write it up as high cancer risk in the right side and a chronic epididymitis, a chronic inflamation that sometimes has no known cause on the left side, both of which were true.  Antibiotics would clear mine up for a week or two but then the pain was right back.  But writing it up this way for the insurance company and not mentioning transgender would allow insurance to pay for it.  And they did.  Out of a several thousand dollar bill for surgery, a surgical theater and recovery, I think I paid less than $100.  Not a bad price considering a local doctor charges something like $5000 and doesn't take insurance!

The day of the surgery, we got there about 8:30, I was in for surgery 10:30, woke up in recovery around noon and leaving around 1.  I was hungry and not hurting so we stopped and got something to eat.  To go of course since I really wasn't up to going in for a sit down meal but we did sit at the table at home and eat with no problem.  Although I did sit down gingerly.  But I sat and ate before I went and laid down.  One thing that apparently comes with castration is leakage from the incision. You'll be wearing a maxipad for more than a week.  I really NEVER thought I would hear my wife ask me if I had check my maxi-pad and if there was too much blood, had I changed it?

New Appointment

I have a new appointment with another endocrinologist for evaluation for HRT.  This doctor literally wrote the book.  I mean he literally co-wrote the book Endocrine Therapy for Transsexual Persons.  Hopefully he won't be as conservative as the previous doctor.  A friend of mine who is a nurse and a former patient of that doctor said she's cutting back getting ready to retire and cherry picking easy to manage patients.

On another note, I will be getting rid of testosterone for good.  My appointment with my urologist the other day, he has decided my orchalgia (pain in the left testicle) plus the extremely high cancer risk for my right testicle warrants an orchiectomy.  He does also have a letter from my therapist recommending the orchi.  I also told him at the appointment I had been in touch with a surgeon's office regarding future possibility of GRS.  I explained they recommended a horizontal incision and he thought for a few seconds then said he could understand  that to save the centerline.  The other thing I told him was the doctors office recommended he call them and he surprised me by agreeing.  He gave me his e-mail address to forward what the doctors office sent me.  I said after my first visit with him I really wasn't impressed but I did go back for a second visit and I'm glad I did.  I've been more and more impressed with him and his concern each visit.

Urologist Update

Well, I had the talk with my urologist yesterday and he seemed quite knowledgeable regarding transgender.  Makes me wonder if he has trans patients.  He asked some pertinent questions, who was my endo, had I thought about any surgeons yet, etc.  I told him who my endo is and told him I was thinking about McGinn in Pennsylvania or Marci Bowers in California.  So the final result of the appointment is, with a letter from my therapist, he will do the orchiectomy.  Plus since he's treating me for orchalgia (pain) on the left side and because of the 10X greater risk for cancer right side due to undescended testicle that has reascended, he will use these as the diagnosis for removal so Medicare and my insurance will pay for it.

When he was asking me the questions he was sitting sort of behind me at the computer.  My wife said as we were driving home he seemed impressed that I was answering the questions quickly and knew what I was talking about.  I kind of laughed and asked her how many friends we've had that transitioned.  I said she could have answered his questions instead of me.

Urologist Appointment Monday - Orchiectomy?

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.