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?

HRT Approved

I had an appointment yesterday, May 20, with a second endocrinologist.  Earlier this year, I was turned down by another doctor who gave me a bunch of BS reasons she wouldn't approve it.  I came home that day and was laying on the bed with a pillow over my head screaming and crying.  After that, I just laid and stared at the wall for three or four hours.  It was a very dark time for a week or two.  That changed yesterday.  I had a 2:30 appointment and was called back exactly at 2:30!  Yeah, I know.  Amazing, right?  The nurse took my vitals and very shortly, a younger doctor came in.  She told me she worked with the doctor I was seeing and she wanted to get some background.  She was looking through my file, mentioned the letter from my therapist also recommended an orchiectomy.  I told her it was already done on 4/26.  So she did some evaluation of my health, then went and talked to the main endocrinologist.  I told my wife I wasn't happy she didn't mention blood tests and didn't have a good feeling.  My wife simply said a prayer.  So the older doctor comes in with the one who had evaluated me.  He sits and talks for a couple of moments and says he sees no reason I shouldn't start HRT.  When I was turned down by the other doctor, I started crying in her office and when he said he was approving me, I started crying again although for a totally different reason.  We also talked about my therapist and he seems to have a very high opinion of her plus we talked about Southern Comfort Conference which he went to last year.  So anyway I had to go down stairs to the clinic for them to draw blood to check baseline hormone levels, check kidney and liver functions.  If everything comes back ok, he will send a prescription for estrogen to my pharmacy, probably the middle of next week.  I have had both kidney and liver function tests in the last six months so I know they will be ok.  So next week, God willing, I will be on a starting low dose HRT.  I see the endo again in four months and we will up the dosage.  Look out world!

Two Week Orchiectomy Update - Hot Flashes Are A Bitch!

Yes, the hot flashes have started and OMG!  I had one just before the start of church Sunday and one of my friends was laughing at me when she realized why I was fanning myself with the bulletin.  Anyway, I had my two week checkup yesterday and the doctor says I'm doing fine.  I have been so impressed with him.  He actually called and talked to Dr. Christine McGinn who is a GRS surgeon regarding how to do the incision.  He must have talked with her a while or done a lot of research because he talked about how the surgery is done.  Not many doctors would have done that for a patient.  I told him that I appreciated the fact he has treated me with dignity and respect, something transgender people don't always get.

Five Day Update On Orchiectomy

Five days and still almost no pain.   This evening I've had just a slight ache in the abdomen but no more than a 1.  Still a little watery leakage showing in the pad and I have to admit one thing I never thought I would hear my wife ask me is, "Have you checked your maxi pad and changed it?"  I don't know what the timing is but I'm pretty sure I had a testosterone crash on Friday.  I felt like a vampire had bit me in the neck sucking every bit of energy from my body and last night had a major hot flash.  I haven't noticed any emotional changes yet but I'm sure there will be because there are side effects with castration just like with anything else.

Orchiectomy Done

As of about 11AM yesterday morning, my body is only be producing about 5% of the testosterone it was producing.  The only testosterone being produced in my body is by my adrenal glands.  Testicles have gone bye-bye.  As in orchiectomy.  As in castration.  As in medical waste to go in the incinerator.  Surprisingly very little pain and what there is would be no more than a 3 on a 1-10 scale.

Update: 48 hours in and still no pain.  After thinking about what I said, I don't even think yesterday's was even a 3.  It was  really more like a discomfort than pain.

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.

Therapy Results

Well, I had my first appointment with my therapist yesterday.  I have to say I'm still in shock!  Before I go any further, let me note that I've known and been good friends with my therapist for 15 years.   So we didn't need to do any of the "get to know you" sessions most therapists require.  Basically what she pointed out is this.  My entire life, I have put other people's needs in front of my own.  When I was a child and a teenager,  my parents both worked so I did a lot of the housework and such.  That way my mother could spend as much time as possible with my disabled brother.  When my wife and I were married, I tried to bury my transgender side (didn't work) putting her needs ahead of my own.  The same when our son was born, I put their needs ahead of my own as it should have been.  When he went to college, my wife went back as the person I took care of.  When she had surgery and ended up paralyzed, I took care of her after she spent a month in the hospital learning to walk again.  When my mother developed dementia, instead of putting her in a nursing home, I became the caregiver for her and my brother for eight years and they lived at home until they passed away within a couple of months of each other.  So my therapist said it's time I put my needs to the forefront.  She pointed out also, much of our health does depend on our happiness and "you're not happy!"  So what are we doing?  She is referring me to an endocrinologist and will write my letter to begin HRT!!!!  She also mentioned since at my age we're not planning on starting another family and so that I don't have to take androgen blockers she will also write a letter to a surgeon here for an orchiectomy.(If you don't know what that is, look it up.)  I told a friend who transitioned years ago all of this last night.  Her response was she knew it all the years she's known me, she just wondered how long I could grit my teeth. LOL

The most amazing thing is my wife.  When we sat down and talked last night and I told her the results from the session, she was fine.  I know for a fact that she has some issues that she won't talk about with me but I'm insisting on her seeing someone to talk to.  Since we belong to a very LGBT friendly church (our pastor is L) my wife is going to sit down with her and talk.