Abstract: PD25-06
Sources of Funding: None

Introduction

For M to F transgender women, bilateral orchiectomy provides significant medical benefit: if allows many patients to use a lower dose of estrogen (used for feminization). Estrogen at the high doses that transgender women require has significant cardiovascular risks. Bilateral orchiectomy also allows immediate and complete discontinuation of Spironolactone, a potent diuretic also commonly used for feminization. _x000D_ In general, patients not ready for vaginoplasty benefit from early bilateral orchiectomy._x000D_ A technique specific for transgender patients which anticipates future vaginoplasty surgery by preserving collateral tissues to be used later with vaginoplasty, and which can be done via a minimally invasive approach, has not been described.

Methods

We describe a trans-scrotal technique for bilateral orchiectomy via a single midline scrotal incision that excises the cord at the level of the external inguinal ring. In our experience, is fast/efficient, and is associated with very low post-operative pain and morbidity. Furthermore, this technique spares a little described adipose tissue pedicle that is superficial to the spermatic cord, and which we use to support the neo-labia majora at time of subsequent MtoF vaginoplasty surgery. _x000D_ Outcomes for a consecutive series (single surgeon) of 40 MtoF transgender women are described, including specific post-operative wound care instructions and complications.

Results

All patients were discharged home on same day of surgery. Mean operative time was 27 minutes. No significant complications occurred in this series. A total of 3 small (<2 cm) hematomas occurred. No wound infections or wound dehiscence occurred. Post op pain was minimal, and over half of the patients in this series managed post-op pain with NSAIDS only within the first 5 days, and thereafter required no analgesics.

Conclusions

Bilateral orchiectomy for transgender women has significant medical benefit and can be done with minimal morbidity, on an outpatient basis. Given the latter, bilateral orchiectomy should be offered to transgender patients that meet WPATH Standards of Care Guidelines criteria. The technique we describe anticipates future vaginoplasty surgery, spared adipose tissue needed for vaginoplasty, and minimizes risk to scrotal skin that will be later used for vaginoplasty.

Funding

None