IU West Hospital
Bilateral Orchiectomy MTF for Transgender Women – An Interview with Dr. Gallagher
A bilateral orchiectomy is a great option for transgender women. This is an outpatient surgical procedure that involves the removal of testicles. Some refer to this as castration. The purpose of this procedure to reduce testosterone production. Today’s post is based on an interview with Dr. Gallagher about her philosophy, style and approach to this procedure.
What are good reasons for a transgender woman to have a bilateral orchiectomy?
According to Dr. Gallagher, A trans woman may choose to have an bilateral orchiectomy MTF when she is not yet ready to undergo bottom surgery- be it for financial, medical reasons or that she is not yet ready to do the involved postop care a vaginoplasty involves (dilation, douching). Vaginoplasty is of course not right for every trans woman and she may only choose to undergo a castration.
Once a transgender woman has her testicles removed, she will not require a testosterone blocker (eg. spironolactone ) and her estradiol doses requirement will drop.
If the patient does not plan to undergo vaginoplasty in the future the scrotal skin can be removed at the same time to help improve the contour.
A before and after photo of the removal of testicles by Dr. Gallagher:
How long does this procedure take, and what is the typical recovery time?
For surgery with Dr. Gallagher, this procedure involves a local anesthetic and sedation. It is completed in 30 minutes and a patient will need a ride home afterwards. Most patients experience some soreness for a day or two but return to normal activities within a few days.
What are the benefits and/or disadvantages to having a bilateral orchiectomy MTF if a transwoman plans to have vaginoplasty in the future?
Most women who have a vaginoplasty by the penile inversion technique will require the scrotal skin to be used to help make a deeper vagina. After the testes are removed, there may be some shrinkage of the scrotal skin over time. When considering the benefits of removing testicles, Dr. Gallagher believes it “still safe for a patient to undergo orchiectomy,” if the ultimate goal is vaginoplasty.
What, if anything, is helpful for transwomen to know about having an orchiectomy?
Compared to vaginoplasty this is a much simpler and faster procedure. For a patient without benefits it can be a much more affordable way to help surgically relieve her gender dysphoria. In patient’s who have difficulty with hormone levels/ testosterone blockade it can be extremely helpful.
Is there anything else you would like to share about this procedure?
It is done via a short two inch incision, leaving a scar that is hidden in the midline of the scrotum. Skin glue is applied to seal the incision, and a patient can shower the next day. Pain is usually minimal.
Are erections the same after an orchiectomy MTF as before?
Because the goal of this procedure is to reduce testosterone, an bilateral orchiectomy will have the similar impact on erections as an anti androgen will. Erections are more difficult to achieve with a drop in testosterone.
Is a letter of referral necessary for this procedure?
APA: Proposed Diagnostic Criteria for Gender Dysphoria (in Adolescents or Adults)
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2 or more of the following indicators: [2, 3, 4]
1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]
2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) 
3. a strong desire for the primary and/or secondary sex characteristics of the other gender
4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)
B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability
With a disorder of sex development 
Without a disorder of sex development
See also: [15, 16, 19]
Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).
Note: Three changes have been made since the initial website launch in February 2010: the name of the diagnosis, the addition of the B criterion, and the addition of a specifier. Definitions and criterion under A remain unchanged.
APA: Proposed Diagnostic Criteria for Gender Dysphoria in Children
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least 6* of the following indicators (including A1): [2, 3, 4]
1. a strong desire to be of the other gender or an insistence that he or she is the other gender (or some alternative gender different from one’s assigned gender) 
2. in boys, a strong preference for cross-dressing or simulating female attire; in girls, a strong
preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing 
3. a strong preference for cross-gender roles in make-believe or fantasy play 
4. a strong preference for the toys, games, or activities typical of the other gender 
5. a strong preference for playmates of the other gender 
6. in boys, a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; in girls, a strong rejection of typically feminine toys, games, and activities 
7. a strong dislike of one’s sexual anatomy 
- a strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender 
B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability.
With a disorder of sex development 
Without a disorder of sex development]
See also [13, 15, 19]