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What degree of feminization may I expect with orchiectomy and how soon

Dr. Reed,

Am contemplating having an orchiectomy in Miami at the Reed Centre.  How soon may I expect feminizing changes?  Beverly

Dear Beverly,

Before you have an orchiectomy, you should consider estrogens and perhaps spironolactone (a testosterone blocker).  The onset of changes, taken from WPATH version 7 is posted below.

Table 1b: Effects and Expected Time Course of Feminizing Hormones

Maximum Effect Body fat redistribution 3-6 months 2-5 years Decreased muscle mass/ strength 3-6 months 1-2 years Softening of skin/decreased oiliness 3-6 months unknown Decreased libido 1-3 months 1-2 years Decreased spontaneous erections 1-3 months 3-6 months Male sexual dysfunction variable variable Breast growth 3-6 months 2-3 years Decreased testicular volume 3-6 months 2-3 years Decreased sperm production variable variable Thinning and slowed growth of body and facial hair 6-12 months > 3 years Male pattern baldness

Adapted with permission from Hembree et al. (2009). Copyright 2009, The Endocrine Society. b Estimates represent published and unpublished clinical observations. c Significantly dependent on amount of exercise. d Complete removal of male facial and body hair requires electrolysis, laser treatment, or both. The degree and rate of physical effects depends in part on the dose, route of administration, and medications used, which are selected in accordance with a patient’s specific medical goals (e.g.,  changes in gender role expression, plans for sex reassignment) and medical risk profile.

All other factors being equal, there is no evidence to suggest that any medically approved type or method of administering hormones is more effective than any other in producing the desired physical changes.

Beverly, if you have already maxed out with appropriate estrogen dosage, an orchiectomy may be considered to decrease estrogens (typically by 1/3rd), stop spironolactone, and reduce genital bulging.

Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
1-3050-865-2000

 

Orchiectomy Example 2: Another patient status post orchiectomy and scrotal removal, unsure if she was ever capable of going all the way. P.S. she now wishes to have complete MTF and loss of scrotum poses no problem whatsoever.  Hoping to post followup photos in a few months.

Photo post-op orchiectomy and removal of scrotum  as requested by patient

 

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