General Information
What is gender-affirming orchiectomy?
Also known as “simple orchiectomy.”
Removal of both testicles and spermatic cords.
Can be done through a vertical incision in the middle of the scrotum.
Allows the patient to come off the spironolactone and can often lower the necessary estrogen dose.
Can be done prior to or concurrently with vaginoplasty/vulvaplasty.
Letters of Support
As per the guidelines set forth by the World Professional Association for Transgender Health (WPATH) in the Standards of Care (SOC) version 8, you will require 1-2 letters of support prior to your gender affirmation orchiectomy.
WPATH's SOC 8 serves as a comprehensive resource for healthcare professionals, ensuring that transgender and gender nonconforming individuals receive competent and compassionate care. In line with these guidelines, your readiness for gender affirmation surgery is typically assessed through the evaluation of referral letters from qualified mental health professionals as well as your hormone provider (if necessary). These letters should come from professionals who are knowledgeable about gender identity and experienced in providing mental health support to transgender individuals.
Surgery cannot be scheduled until all letters have been received and meet the requirements outlined in this document. Letters that do not follow the format below will be returned for completion. Please show this document to the provider(s) writing your referral.
*** Many insurances require only one letter of support for orchiectomy, some require 2. Check with your insurance carrier. ***
RECOMMENDED CONTENT FOR MENTAL HEALTH LETTERS:
1. Description of the provider’s qualifications as well as the duration of their relationship with the patient. Include types of evaluation and therapy to date.
2. The patient’s general identifying characteristics.
3. Results of a psychosocial assessment, including all psychiatric diagnoses and accompanying psychiatric medications.
4. An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting the patient’s request for surgery. Criteria include:
Confirmation of the patient's persistent gender dysphoria diagnosis.
Documentation of the patient’s capacity to provide informed consent.
If significant mental health concerns are present, they must be well-controlled.
5. Assessment of the patient’s understanding of the potential benefits and risks of gender-affirming surgery.
6. Evaluation of the patient’s overall mental health and ability to cope with the surgery and recovery process.
FOR HORMONE PROVIDERS:
1. Description of the provider’s qualifications as well as their duration of their relationship with the patient.
2. Duration and dosage of current hormone medications.
3. Confirmation that the patient has been on hormones for at least 6 months.
OTHER HELPFUL TIPS FOR LETTER WRITERS:
Each letter needs to specifically state the type of surgery that the patient is requesting (ie: vaginoplasty or orchiectomy).
Letters must be dated within 12 months of surgery date.
The letter must be signed. Insurance companies will not accept electronic signatures.
Each provider needs to submit a separate letter. One letter signed by multiple providers will only count as one letter.
Send your letters via MyChart so they can be uploaded into your chart.
Post-Operative Instructions
***DISCLAIMER***
The below instructions are provided to Dr Alford’s patients. If you are undergoing a procedure with a different surgeon, please follow the discharge instructions that were given to you at discharge.
Wound Care
You may shower the day after surgery. Do not scrub the incision.
No baths or submersion in water for 2 weeks after surgery.
There may be some bleeding from the suture line. Apply gentle pressure until it stops.
The sutures will dissolve and fall out over the next 2-3 weeks.
Medications
Tylenol or ibuprofen are fine to take for pain.
You will not be prescribed narcotics/opioids after this procedure.
A cold pack will help with discomfort and swelling.
Tight underwear and scrotal elevation will help with swelling.
Activity
No heavy lifting or strenuous activity/exercise for 2 weeks after surgery.
No straddle activities (riding bike, riding motorcycle) for 2 weeks after surgery.
As soon as you feel well enough, you may go back to work. This is typically about 48 hours after surgery (ie: if you have surgery on Monday, you can go back to work on Wednesday).
Please let the office know if you need a work excuse letter.
Post-Operative Follow-up
See your surgeon approximately 6 weeks after surgery to make sure things are healing up well and that all the sutures have fallen out.
Follow up with your hormone provider after surgery so that they can adjust your medications, if necessary.