I recently decided to begin working towards obtaining a bilateral orchiectomy, one of the many surgeries available to transgender women. This refers to the permanent removal of both testes, while leaving the penis intact. It’s also known as an orchi (rhymes with “Yorkie”), castration, or in animals, neutering. In short, it’s the polite term for having your balls cut out.
One of the first questions I’m often asked about this, particularly by people who value their testes, is “dear god why!?” For most ball-owners, it seems that few things provoke a more visceral reaction than the prospect of losing them. But this is a valid question – it’s worth exploring what exactly this surgery does, the role it plays in transitioning, and why I’ve decided that this is right for me.
How HRT works
This will be a significant milestone for me: the first surgery I’ll be having as part of my transition. And while that is a big step, I tend to think of it as simply being an extension of hormone replacement therapy, which is the only medical procedure I’ve had so far. HRT for trans women generally includes supplemental estrogen, as well as anti-androgen drugs to suppress testosterone. These anti-androgens are designed to shut down the production of testosterone, block its action at receptors, or prevent it from being converted into more potent forms. This clears the way for estrogen to produce physical feminization more effectively.
However, anti-androgens do have side effects. One common drug causes frequent urination, and can theoretically result in dangerously high potassium levels, although this almost never happens. Others have been associated with a small risk of liver toxicity. Overall, there’s little data available on the effects of using them for several decades.
Removing the testes eliminates the main source of testosterone – but as long as I still have them, I’ll need to monitor my testosterone to make sure it’s being adequately suppressed by anti-androgens. Furthermore, if I ever went off HRT for any reason, its feminizing effects would largely be reversed as my body began to produce normal male levels of testosterone again. My breasts would shrink away, my body hair would grow back thicker and darker, my skin would become rougher and more oily, my hairline would recede and male-pattern baldness could set in, my sex drive would become uncomfortably active again, my face would lose much of its feminine aspects, my facial hair would start to spread, my body would return to a more masculine shape, and all of these effects of testosterone would continue to accumulate as I aged.
What an orchi would change
An orchi can largely prevent this from ever happening. After having my testes removed, my testosterone levels would fall to within a normal female range – possibly even lower, due to the absence of any testosterone production from ovaries. This effect would be permanent, so there would no longer be any need for anti-androgens, and no risk of physical regression or re-masculinization due to uncontrolled testosterone.
At that point, the only HRT regimen I’d need would consist of estrogen and possibly progesterone. This would also permit me to lower my dose of estrogen, which reduces the risk of potentially life-threatening blood clots. If I ever did have to stop HRT, the regression of feminine features would be minimal, similar to that experienced by cis women during menopause. Practically speaking, an orchi would effectively lock in the feminizing effects of HRT.
Still, lacking any testes or ovaries would leave me dependent on supplemental sex hormones for the rest of my life, in order to avoid symptoms such as bone loss. At this point, I’m pretty comfortable with that degree of commitment. I’ve been on HRT for almost a year now, and even if I didn’t get an orchi, I would still need to keep taking it indefinitely in order to continue transitioning. By now, I’ve become accustomed to this as a part of my life.
I don’t intend to go back, so realistically, this isn’t a choice between needing medication or not. Rather, it’s a choice between needing more medication or less. And crucially, it means choosing between remaining in a limbo state of perpetually staving off masculinization, or making these changes more permanent and resilient.
Why not vaginoplasty?
Some people have asked why I wouldn’t instead choose to have a vaginoplasty, commonly known as sex reassignment surgery, or SRS. During SRS, the penile and scrotal tissue are used to create a vulva and a vagina. When people say “the surgery”, this is the one they’re talking about.
It’s usually easy for people to understand why a trans woman would want a vagina – they can recognize that, as women, we want this to be a part of our bodies. So it can sometimes be puzzling to them when we don’t, especially given that an orchi doesn’t do anything to align my genitals with normative female standards, and even takes them further away from normative male standards. Quite simply, I’ve taken the benefits and risks into account, and I’m not ready to have SRS at this time. While I’m certainly curious about what it would be like to have a vagina, it’s not something I have a particularly strong need for.
I’m comfortable with the way my genitals currently function, and SRS would alter that significantly, with a potential risk of losing sensation and the ability to orgasm. There are also a number of serious complications that can occur, and revision surgeries are often necessary. If SRS were perfect, I’d be much more willing to have it done. But as is, I personally don’t consider it worth the risk of compromising what I have now. This is just my own evaluation of my options – something that each person has to decide for themselves.
On the other hand, an orchi is a much simpler surgery in almost every way. It doesn’t involve repurposing the genitals to change their function or create a whole new organ – there’s no delicate crafting involved. Instead, it’s the relatively straightforward removal of two small bits of tissue that are just hanging out there, waiting to be excised. SRS is a highly specialized operation, uncommon enough that the surgeons who make a career of it are very well-known to trans women. These specialists are scattered around the world: getting SRS with your surgeon of choice can mean traveling across the country, or to the other side of the planet. And because it’s such a unique form of reconstructive surgery, it can cost $10-20,000, usually out-of-pocket.
An orchi is a relatively routine and commonplace procedure with a low risk of complications. It’s likely performed for more cis men than trans women, and there are many more surgeons in everyday hospitals who can do it safely and effectively – you don’t have to travel to Thailand to find someone who can give you the perfect orchi. It’s a minor operation using a small incision and local anesthetic, and many trans women report staying awake for the entire surgery. The recovery time is only a week or two. And given that it doesn’t require such detailed work, it can be obtained for as little as $2,500 in some areas.
Furthermore, this is not an either-or decision. Having an orchi still leaves open the choice to have SRS in the future – the testes are not a crucial component of vaginoplasty, and they’re discarded during the procedure. Some surgeons prefer not to perform SRS after an orchi, and others will charge more for it, but it is possible. And post-operative HRT regimens are essentially the same whether you’ve had an orchi or SRS. Right now, I’m not pursuing this, so an orchi will give me the hormone-related benefits without requiring me to have such a major operation.
My priorities in transitioning
I should emphasize that I personally find the whole-body changes induced by HRT to be much more important than obtaining a vagina. People tend to reduce all of transitioning to being solely about correcting your genitals, as if that’s the entirety of what a “sex change” is. And yes, for many trans women, having a vagina is a priority. But there’s still much more to this than rearranging small pieces of flesh that most people will never even see.
Over the past year, I’ve been amazed to discover that HRT changes almost everything. It’s changed the way my face looks, how my body is shaped, the way I move, my hair, my skin, and my physical strength. It’s also changed how I experience the world, my emotions, and even sex. My body and my mind feel so much more right for me, and this has improved my life in nearly every respect. It’s fixed whatever was missing for me, and for the first time, everything matters and I can actually find a reason to care about things. My life is worth living now. Without question, this has made me more complete as a person.
This isn’t like putting on makeup – this has fundamentally changed my physical presence in the world. I consider these changes to be integral to who I am now, and I don’t ever want to lose them. As I move forward in life, it’s very important to me to ensure that these effects will become a permanent part of myself – that’s my priority. An orchi will give me that certainty, and if I ever do feel the need to get a vagina, that option will be available as well.
Some people have wondered how an orchi would affect sexual functioning, and a few were apparently under the impression that erection and orgasm are impossible without testes. However, that’s not really how that works, for cis men or for trans women. I should note that HRT has already reduced my testosterone to the levels I would have after an orchi – essentially, I’ve already been “chemically castrated”.
Those levels will be the same both pre-op and post-op, and the sexual effects of this are likely to be similar as well. Every trans woman experiences sex differently, but for me, this already hasn’t compromised my ability to orgasm – if you really must know. And, well, let’s just say it’s not all about erections anymore.
Others have asked if I’ve banked sperm prior to this. I haven’t, and I don’t intend to. HRT has already made me practically infertile, and I would have to go off it for several months to have even a chance of regaining some fertility. In that time, most of the feminizing changes would be reversed, which is exactly what I want to avoid. If you had been in my shoes, and experienced all the differences between living with testosterone and replacing it with estrogen, trust me: you wouldn’t want to go back, ever.
I also don’t personally consider it very important to pass on my genes, and I never intended to have biological children anyway. I already have two wonderful stepkids, and they’re the best in the world – they’re all I need. For me, reproducing isn’t a big deal, and I really don’t mind if my gametes are forever erased from existence.
Some have questioned whether being hit or kicked in the area hurts as much after an orchi. I’ve asked other trans women who’ve had an orchi, and they report that being hit in the balls doesn’t hurt when you have no balls. Personally, I’m looking forward to having this glaring vulnerability fixed.
Most interestingly, some people have asked whether I’ll get to keep them after they’ve been removed. And some surgeons do let you take them home! I figure we’ll preserve them in a jar, display it on our bookshelves, and use it as a weird prop for videos. (Anyone who knows what chemicals and processes are necessary to do this, hit me up.)
Where we stand now
At this point, I’m highly certain that an orchi is right for me. I’ve been seriously considering it for several months, and during that time, I’ve only become more comfortable with the possibility. I’ve never particularly valued these organs, nor are they a necessary or important part of my self-concept. Beyond just a weighing of benefits and risks, I’ve reached a point where I’m happy to regard them as merely a temporary part of my body. I don’t feel I’ll regret permanently separating them from myself.
Nevertheless, I’ll still have plenty more time to think it over – there’s a lot of work to be done. I have to obtain the necessary referral letters, find a surgeon, and see if there’s any way my insurance could cover some or all of the costs. As I don’t yet know how this will turn out, I’ve made a goal of saving $4,000 to cover medical expenses, travel, time off work, and other incidentals. While this is a substantial amount, I’m aiming to have an orchi before the end of next year.
Those are the parameters. I’m making this happen, and I’ll continue to keep you all updated on how it goes. Wish me luck!