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Orgasm after orchiectomy

Dr. Reed,  Will an orchiectomy affect my ability to have orgasm.  Am 27 year old transgendered woman who has not had below the waist surgery.  Lisette

Dear Lisette,  We have done about 4000 transsexual orchiectomy (ies), many in associate with vaginoplasty and all patients who have been followed except 2 report they are still orgasmic.  One was an inveterate smoker and then other a diabetic in poor control.  2/3rds of our patients are sexually active.  Natal women have 1/10th the testosterone level of men, but do have enhanced testosterone receptor sites.

Hypoactive sexual desire disorder (HSDD) is reported in one-third of transsexual women. This prevalence is not substantially different from controls, despite markedly lower (free) testosterone levels, which argues against a major role of testosterone in this specific group.  Our fee for affordable orchiectomy is 2,500 which includes local anesthesia, IV sedation, use of the facility, surgery and my aftercare.

As reported in Eur J Endocrinol. 2008 Mar;158(3):393-9. doi: 10.1530/EJE-07-0511.

Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels.

Abstract

OBJECTIVE:

An unknown proportion of transsexual women (defined as post-operative male-to-female transsexuals on oestrogen replacement) experience hypoactive sexual desire disorder (HSDD). It has been suggested that the absence of ovarian androgen production together with oestrogen treatment-related increase in sex hormone-binding globulin (SHBG) levels could be leading to HSDD, due to low levels of biologically available testosterone. This study wishes to document the HSDD prevalence among transsexual women and the possible association to androgen levels.

DESIGN:

Cross-sectional study.

METHODS:

Transsexual women (n=62) and a control group of ovulating women (n=30) participated in this study. Questionnaires measuring sexual desire (sexual desire inventory) and relationship and sexual satisfaction (Maudsley Marital Questionnaire) were completed. Serum levels of total testosterone, LH and SHBG were measured in blood samples obtained at random in transsexual women and in the early follicular phase in ovulating women.

RESULTS:

The transsexual group had lower levels of total and calculated free testosterone (both P<0.001) than the ovulating women. HSDD was reported in 34% of the transsexual and 23% of the ovulating women (P=0.30). Both groups reported similar levels of sexual desire (P=0.97). For transsexual women, no significant correlation was found between sexual desire and total (P=0.64) or free testosterone (P=0.82). In ovulating women, these correlations were significant (P=0.006, resp. P=0.003).

CONCLUSIONS:

HSDD is reported in one-third of transsexual women. This prevalence is not substantially different from controls, despite markedly lower (free) testosterone levels, which argues against a major role of testosterone in this specific group.

Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
1-305-865-2000

 

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