First Time Poster - Aspiring Eunuch/Nullo - Help!

[WheelyFixed]

That’s good to hear. Some of this jargon is a bit contradictory. I’ll just tell them about me and they can decide to call me whatever they think I am.

One thing I’ve seen SOC8 I believe and other similar documents is that Eunuchs that are at risk of self mutilation, obtaining drugs illegally, back-alley surgery should be recommended pharma and/or surgical intervention. Does that mean that’s the threshold for intervention, or are they just saying don’t withhold it from people just because they’re willing to take risky actions.

Yeah, I’m not sure theirs is a pharmacological solution for my goals. Spironolactone and Cyproterone are used to treat many other conditions other than GD- so maybe a lower dose? There’s some drugs shown to reduce the gyno risk in studies but it’s not something to do for a long time.

You’re absolutely right the I have to take the initiative and of course I know that. I just have a lot of fear revealing this part of me. Does this count of coming out of the closet?

I think that is the easiest way to deal with the shrinks is to mostly let them make their own determinations unless you think they are going way off the track...

The SOC 8 recommendations in regards to the 'high risk' patients isn't that it's a threshold for care, but more on the order of 'harm reduction'... If a person has already made "DIY" efforts it is relatively safe to say they have shown determination and desire, so that part isn't really needed, and they want to see the person getting appropriate medical treatment, rather than having them continue the DIY efforts...

As I mentioned in the other post, there isn't a lot of research into trying to get 'partial' chemical castration, and I don't know of any current routines that reliably accomplish it. Our bodies seem very resistant to the idea, as removing just one ball doesn't accomplish much as the other just picks up the slack... So it seems very much to be an 'all or nothing' deal...

In terms of 'coming out' - Coming Out is not a requirement at all, you don't have to tell anyone other than maybe your doctors... I also highly suggest talking about it with romantic partners, but we have had members on EAv2 that didn't tell them (instead they staged 'accidents' to justify needing the removal) In terms of general life, there is absolutely no requirement to tell anyone... I feel that in 99.9% of my dealings with other people there is no more reason to tell them I'm a eunuch than there would be to tell them I was an intact straight male, as they have no 'need to know', and can just assume whatever they like... (I feel the same way about coming out as gay, fine if you want to, no need to...)

Obviously if you hang out in locker rooms it's likely folks will notice something's missing but I'm told by others that there is usually very little in the way of adverse reaction, (especially since we aren't supposed to notice such things...) and even if they ask you can always say it's something you'd rather not talk about...

I know that I'm not out to anyone but a very select few and most of my medical caregivers. I don't advertise and present as "normal male" and nobody needs to know any differently... I'm sure someday it will come out, and given my position as lead mod here, I can see it possibly becoming necessary, and I am not worried about it terribly, but don't feel a need to rush it either.

WheelyFixed

[fusion]

Going on with what Wheely said there is no need for eunuchs or nullos to come out to the general public. I mean bob down the road does not care that you missing a pair of testicles and has no reason to know.

For me my family, partner and close friends know I'm an eunuch but the general public and work mates don't know or know and don't care.

[Swim1650]

That’s good to hear. Some of this jargon is a bit contradictory. I’ll just tell them about me and they can decide to call me whatever they think I am.

One thing I’ve seen SOC8 I believe and other similar documents is that Eunuchs that are at risk of self mutilation, obtaining drugs illegally, back-alley surgery should be recommended pharma and/or surgical intervention. Does that mean that’s the threshold for intervention, or are they just saying don’t withhold it from people just because they’re willing to take risky actions.

Yeah, I’m not sure theirs is a pharmacological solution for my goals. Spironolactone and Cyproterone are used to treat many other conditions other than GD- so maybe a lower dose? There’s some drugs shown to reduce the gyno risk in studies but it’s not something to do for a long time.

You’re absolutely right the I have to take the initiative and of course I know that. I just have a lot of fear revealing this part of me. Does this count of coming out of the closet?

I think that is the easiest way to deal with the shrinks is to mostly let them make their own determinations unless you think they are going way off the track...

The SOC 8 recommendations in regards to the 'high risk' patients isn't that it's a threshold for care, but more on the order of 'harm reduction'... If a person has already made "DIY" efforts it is relatively safe to say they have shown determination and desire, so that part isn't really needed, and they want to see the person getting appropriate medical treatment, rather than having them continue the DIY efforts...

As I mentioned in the other post, there isn't a lot of research into trying to get 'partial' chemical castration, and I don't know of any current routines that reliably accomplish it. Our bodies seem very resistant to the idea, as removing just one ball doesn't accomplish much as the other just picks up the slack... So it seems very much to be an 'all or nothing' deal...

In terms of 'coming out' - Coming Out is not a requirement at all, you don't have to tell anyone other than maybe your doctors... I also highly suggest talking about it with romantic partners, but we have had members on EAv2 that didn't tell them (instead they staged 'accidents' to justify needing the removal) In terms of general life, there is absolutely no requirement to tell anyone... I feel that in 99.9% of my dealings with other people there is no more reason to tell them I'm a eunuch than there would be to tell them I was an intact straight male, as they have no 'need to know', and can just assume whatever they like... (I feel the same way about coming out as gay, fine if you want to, no need to...)

Obviously if you hang out in locker rooms it's likely folks will notice something's missing but I'm told by others that there is usually very little in the way of adverse reaction, (especially since we aren't supposed to notice such things...) and even if they ask you can always say it's something you'd rather not talk about...

I know that I'm not out to anyone but a very select few and most of my medical caregivers. I don't advertise and present as "normal male" and nobody needs to know any differently... I'm sure someday it will come out, and given my position as lead mod here, I can see it possibly becoming necessary, and I am not worried about it terribly, but don't feel a need to rush it either.

WheelyFixed

Thanks for the response. I appreciate the reassurance. Again, I just find the SOC8 Eunuch read very odd. I’m just trying to think about the ways a clinician might expect me demonstrate spending time living as my gender identity. It’s good to know sharing my desired outcome with others outside of the clinical setting is not expected.

I have considered a lot others reactions would be if strangers or friends or non-relevant healthcare providers found out and what my reaction would be. That provokes some anxiety. I’m not one to walk around naked in lock rooms but who knows, maybe I would be comfortable to do so without my male appendages. I would assume being a male presenting eunuch wouldn’t be that interesting to people, if they’d even really notice. But a nullo… I think that might draw attention.

If I currently had a partner, disappeared, and came back missing my manhood… I don’t think that would end well 9/10 cases. And especially knowing it was voluntary. Lying to a romantic partner about it being an “accident” is pretty inconceivable to me… that’s not a great basis for a relationship if you ask me.

[WheelyFixed]

It is important to remember that the SOCv8 was the first time there was any mention of eunuchs as a gender option, prior to that everything was purely binary swapping... I haven't read any versions prior to v7, and while there were a few places where it would be possible to sort of edge in, there was not any sort of clear middle option. I'm told that there was a great deal of opposition to the Eunuch Chapter, and it was a very close call that we even got what we did.

It was also a 'consensus process' in the way the document was written, and I suspect that a lot of the strange bits were part of trying to make it acceptable to the binary only crowd. That includes the "living as gender identity" bit that is such a big deal (and arguably rightly so) for the binary switchers, but that doesn't have a clear definition as to what it means... I know that when the shrinks asked me about how I did that I asked them to define what I should be doing differently and they couldn't answer... I simply pointed out that since I'd been chemically castrated and on estradiol for over a year, that I'd had no choice but to live as a eunuch since I sort of was one...

I also worry a bit about the reactions I'd get if it was widely known that I'm a eunuch, especially since coming out is almost as non-reversible as the surgery - you can't "UNtell" people. All I can say is that while we have a majority of our members that don't advertise, none of those that have said they are out have talked about getting much in the way of negative reactions. Mostly they say reactions range from nothing to mild curiosity and interest. One of the interesting things in that "Dickless Men's Round-table" video I recently posted about is that the guys in it were very out in the gay BDSM sort of channels that they were into, and reported that they got MORE interest and offers than they did before their surgeries...

I agree on the partner thing, I can't think lying to them about something this major is going to make for a good relationship. I know I couldn't lie to my late GF, and she was the first one I told when I decided to follow this path. I'm not sure she ever really understood, but she was at least OK at the "Your body, Your choice' level. I'm not sure what I would have done if she had been opposed to the idea, but it seems to me that it would have been a major problem in the relationship, IMHO it is vital that everyone in a relationship be OK with the idea before any surgery and if there is a problem, it needs to either be put on hold until the disagreement is worked out or have a separation....

WheelyFixed

[Swim1650]

It is important to remember that the SOCv8 was the first time there was any mention of eunuchs as a gender option, prior to that everything was purely binary swapping... I haven't read any versions prior to v7, and while there were a few places where it would be possible to sort of edge in, there was not any sort of clear middle option. I'm told that there was a great deal of opposition to the Eunuch Chapter, and it was a very close call that we even got what we did.

It was also a 'consensus process' in the way the document was written, and I suspect that a lot of the strange bits were part of trying to make it acceptable to the binary only crowd. That includes the "living as gender identity" bit that is such a big deal (and arguably rightly so) for the binary switchers, but that doesn't have a clear definition as to what it means... I know that when the shrinks asked me about how I did that I asked them to define what I should be doing differently and they couldn't answer... I simply pointed out that since I'd been chemically castrated and on estradiol for over a year, that I'd had no choice but to live as a eunuch since I sort of was one...

I also worry a bit about the reactions I'd get if it was widely known that I'm a eunuch, especially since coming out is almost as non-reversible as the surgery - you can't "UNtell" people. All I can say is that while we have a majority of our members that don't advertise, none of those that have said they are out have talked about getting much in the way of negative reactions. Mostly they say reactions range from nothing to mild curiosity and interest. One of the interesting things in that "Dickless Men's Round-table" video I recently posted about is that the guys in it were very out in the gay BDSM sort of channels that they were into, and reported that they got MORE interest and offers than they did before their surgeries...

I agree on the partner thing, I can't think lying to them about something this major is going to make for a good relationship. I know I couldn't lie to my late GF, and she was the first one I told when I decided to follow this path. I'm not sure she ever really understood, but she was at least OK at the "Your body, Your choice' level. I'm not sure what I would have done if she had been opposed to the idea, but it seems to me that it would have been a major problem in the relationship, IMHO it is vital that everyone in a relationship be OK with the idea before any surgery and if there is a problem, it needs to either be put on hold until the disagreement is worked out or have a separation....

WheelyFixed

[Nick2023]

Welcome to the forums, glad to see you here.

I'm actually one of the first people to go through the WPATH SOCv8 process to get an orchiectomy and scrotectomy, so I'm quite familiar with the process...

One of the first things I'd do is go to the WPATH website and download a copy of the SOCv8 https://wpath.org/publications/soc8/ It is available in other languages, not sure if Hebrew is on the list or not. I recommend reading all of it, paying particular attention to the chapters on Eunuchs and Mental Health. One of the things the process requires is convincing the doctors and shrinks that you are sincere in your desire, and fully and totally understand all of the risks and consequences involved.

In many ways I'd compare it to a job interview, where HOW you answer is almost more important than what you say, and knowing the SOC helps you know what sorts of things they are going to ask, and the sorts of things they will be looking for in the way of answers.... When you start talking and quoting the SOC It also tells them that you have "done your homework" I'd also get very good understanding of all the effects of surgery and be able to discuss them in detail....

What I'm not sure about is what the options are in Israel for any sort of trans-gender care, I'd try a search for clinics and reach out to them. I just did a quick one and most of the references were in Hebrew, but they mentioned https://eng.sheba.co.il/Gender-Reassignment-Clinic multiple times and at least one said they did all sorts of top and bottom surgery.... I'd suggest starting there unless you find a better choice. I will say that I was very pleasantly surprised at how open and accepting the clinic I went to in the US was, so don't be afraid to call them.

WheelyFixed

Thank you for taking the time for such a detailed response. I actually live in the US but did spend a lot of time in Israel when I was younger.

I understand the need for me to demonstrate I understand the procedure, how it will affect me, the risks involved, and that I’m pursuing this for the right reasons. As I read the document (about a week ago), as I recall, WPATH said a Eunuch is assigned male at birth who desires to remove or inactivate their reproductive organs. I guess the question by that definition is identifying as a Eunuch body dysmorphia or actual gender dysphoria? I still feel and desire to be otherwise masculine. Is body dysphoria enough to warrant intervention? In other contexts, I’ve seen people discuss being a Eunuch or Nullo as non-binary, which in some ways resonates less with me. On the other hand, my sincere desire to get rid of my penis is not typical of most men.

The next question I have is regarding the typical requirement to socially transition for a year and trial hormones. I’m not sure how I really socially transition to being a Eunuch. My intention if castrated would be to take testosterone to maintain my masculine physique elsewhere. WPATH mentions androgen suppression prior to castration as an option to reduce sexual function… maybe that’s worth trying but I feel like reducing T comes with a lot of undesirable issues for me like muscle loss, weight gain, depressed mood, etc. The only reason I might consider that was if maintaining lower T-levels (before and after castration) would atrophy my penis enough so that I didn’t feel the need to have a penectomy. I’m not sure that’s realistic especially without affecting my body in other un wanted ways.

I am confident to let my scrotum and testicles go. I also know I’d prefer not to have a penis, but that’s admittedly a much bigger decision to make. Is it typical that they would do the castration first and then the penectomy at a later date, or would I have to get it all done at once? (Two surgeries also means a lot more recovery.

I’m know I’m overthinking this but I’d just hate to invest a lot of time and emotional energy discussing a deep part of me only for this not to work out.

I know I just need to take that first step.

I had all of those thoughts in the years leading up to my castration and looking back, I can honestly say that it was all in my head. I had a simple orchiectomy in 2023 and my two regrets are noting having my scrotum removed and not getting castrated 2 decades sooner. The problem was access back then and the hype over the unknown. It's not as much of a big deal as it seams. Everyone knows that I'm a eunuch and nobody cares. My self image actually improved after my testicles were gone because my ideal body doesn't have balls swinging in the way down there. You can go on low dose TRT, full dose, or natural with no hormones afterward. If you go natural it's no different than a woman going through menopause. And like what woman go through it can take up to a year before you reach a new tolerable normal. T withdraws can be rough to mild. If you are worried I would go on a low dose topical gel form of TRT after surgery. It's much easier to wean yourself off of T without going through the typical hormone crash post surgery if you start weaning from a low dose to begin with.

It sounds to me that chemical castration for at least 3 months would be a good idea if you can get safe access to it. Once your testosterone clears out of your body your mind clears from all of the sexual tension and from there you can better figure it out. If you find that not having hormones isn't for you but you still want your junk removed than TRT and surgery is the way to go. Take it slow if needed, you can have things removed in stages. But overall one surgery is better than two or three as long as it feels right inside.

[WheelyFixed]

Swim1650 wrote:
Thank you for taking the time for such a detailed response. I actually live in the US but did spend a lot of time in Israel when I was younger.

I understand the need for me to demonstrate I understand the procedure, how it will affect me, the risks involved, and that I’m pursuing this for the right reasons. As I read the document (about a week ago), as I recall, WPATH said a Eunuch is assigned male at birth who desires to remove or inactivate their reproductive organs. I guess the question by that definition is identifying as a Eunuch body dysmorphia or actual gender dysphoria? I still feel and desire to be otherwise masculine. Is body dysphoria enough to warrant intervention? In other contexts, I’ve seen people discuss being a Eunuch or Nullo as non-binary, which in some ways resonates less with me. On the other hand, my sincere desire to get rid of my penis is not typical of most men.

The next question I have is regarding the typical requirement to socially transition for a year and trial hormones. I’m not sure how I really socially transition to being a Eunuch. My intention if castrated would be to take testosterone to maintain my masculine physique elsewhere. WPATH mentions androgen suppression prior to castration as an option to reduce sexual function… maybe that’s worth trying but I feel like reducing T comes with a lot of undesirable issues for me like muscle loss, weight gain, depressed mood, etc. The only reason I might consider that was if maintaining lower T-levels (before and after castration) would atrophy my penis enough so that I didn’t feel the need to have a penectomy. I’m not sure that’s realistic especially without affecting my body in other un wanted ways.

I am confident to let my scrotum and testicles go. I also know I’d prefer not to have a penis, but that’s admittedly a much bigger decision to make. Is it typical that they would do the castration first and then the penectomy at a later date, or would I have to get it all done at once? (Two surgeries also means a lot more recovery.

I’m know I’m overthinking this but I’d just hate to invest a lot of time and emotional energy discussing a deep part of me only for this not to work out.

I know I just need to take that first step

The SOCv8 is a little bit fuzzy on the exact diagnosis. I know that my doc said she was giving me a disphoria diagnosis not necessarily because it was the exact issue, but more that it was what the insurance would want in order to fund my care. There is getting to be at least some level of acceptance in the gender care world that there can be lots of different reasons, and that not all of them fit neatly in the diagnostic boxes, but they will try to make it work once they know you are serious...

The social transition thing is pretty meaningless, I think it's somewhat of a carry over of the requirements for those doing a binary switch. I know that they pretty much skipped it for me when I asked what I was supposed to transition TO, and they couldn't answer... However if one is chemically castrated, it basically means living as a eunuch whatever that entails for you... (I pretty much didn't do anything different...)

My docs have basically said that because I'm already at extreme risk for bone health issues they would not agree to letting me 'go natural' so I had to decide what I wanted for hormone replacement. Since a lot of my motivation was to get rid of libido 'drive' I didn't want to do T (Personally I also have some trouble w/ the idea of replacing T after going through all the effort to get rid of the T factories) so I went on Estradiol patches.

As a result I have no personal experience of what low-dose T does in terms of shrinkage. I've shrunk a lot but I think it is more because I mostly stopped having erections long before I got fixed. (A lot of the size is from regular stretching of the spongy tissues in the penis by getting erections) I also think that I've always been a 'grower' rather than a 'shower' and was small when not erect to begin with played a significant role.

In terms of surgery, it is mostly a 'choose your own adventure' thing, I did the O & S at the same time, and found I almost didn't notice the orchie, because the scrotectomy was more uncomfortable and took longer to get over... My understanding is that the penectomy is an even longer and more painful recovery, but that it's about the same regardless of whether they do the O & S at the same time or previously... It is possibly worth noting that the M->F surgery is either everything at once or a simple orchiectomy early and then the rest later....

I emphatically did not want a penectomy, as I have to catheterize and it is much easier when one has a penis. However if I had, I probably would have wanted everything done at once.

However this is a very individual decision that is mostly going to need to be between you and your surgeon.

WheelyFixed

[Swim1650]

Welcome to the forums, glad to see you here.

I'm actually one of the first people to go through the WPATH SOCv8 process to get an orchiectomy and scrotectomy, so I'm quite familiar with the process...

One of the first things I'd do is go to the WPATH website and download a copy of the SOCv8 https://wpath.org/publications/soc8/ It is available in other languages, not sure if Hebrew is on the list or not. I recommend reading all of it, paying particular attention to the chapters on Eunuchs and Mental Health. One of the things the process requires is convincing the doctors and shrinks that you are sincere in your desire, and fully and totally understand all of the risks and consequences involved.

In many ways I'd compare it to a job interview, where HOW you answer is almost more important than what you say, and knowing the SOC helps you know what sorts of things they are going to ask, and the sorts of things they will be looking for in the way of answers.... When you start talking and quoting the SOC It also tells them that you have "done your homework" I'd also get very good understanding of all the effects of surgery and be able to discuss them in detail....

What I'm not sure about is what the options are in Israel for any sort of trans-gender care, I'd try a search for clinics and reach out to them. I just did a quick one and most of the references were in Hebrew, but they mentioned https://eng.sheba.co.il/Gender-Reassignment-Clinic multiple times and at least one said they did all sorts of top and bottom surgery.... I'd suggest starting there unless you find a better choice. I will say that I was very pleasantly surprised at how open and accepting the clinic I went to in the US was, so don't be afraid to call them.

WheelyFixed

Thank you for taking the time for such a detailed response. I actually live in the US but did spend a lot of time in Israel when I was younger.

I understand the need for me to demonstrate I understand the procedure, how it will affect me, the risks involved, and that I’m pursuing this for the right reasons. As I read the document (about a week ago), as I recall, WPATH said a Eunuch is assigned male at birth who desires to remove or inactivate their reproductive organs. I guess the question by that definition is identifying as a Eunuch body dysmorphia or actual gender dysphoria? I still feel and desire to be otherwise masculine. Is body dysphoria enough to warrant intervention? In other contexts, I’ve seen people discuss being a Eunuch or Nullo as non-binary, which in some ways resonates less with me. On the other hand, my sincere desire to get rid of my penis is not typical of most men.

The next question I have is regarding the typical requirement to socially transition for a year and trial hormones. I’m not sure how I really socially transition to being a Eunuch. My intention if castrated would be to take testosterone to maintain my masculine physique elsewhere. WPATH mentions androgen suppression prior to castration as an option to reduce sexual function… maybe that’s worth trying but I feel like reducing T comes with a lot of undesirable issues for me like muscle loss, weight gain, depressed mood, etc. The only reason I might consider that was if maintaining lower T-levels (before and after castration) would atrophy my penis enough so that I didn’t feel the need to have a penectomy. I’m not sure that’s realistic especially without affecting my body in other un wanted ways.

I am confident to let my scrotum and testicles go. I also know I’d prefer not to have a penis, but that’s admittedly a much bigger decision to make. Is it typical that they would do the castration first and then the penectomy at a later date, or would I have to get it all done at once? (Two surgeries also means a lot more recovery.

I’m know I’m overthinking this but I’d just hate to invest a lot of time and emotional energy discussing a deep part of me only for this not to work out.

I know I just need to take that first step.

I had all of those thoughts in the years leading up to my castration and looking back, I can honestly say that it was all in my head. I had a simple orchiectomy in 2023 and my two regrets are noting having my scrotum removed and not getting castrated 2 decades sooner. The problem was access back then and the hype over the unknown. It's not as much of a big deal as it seams. Everyone knows that I'm a eunuch and nobody cares. My self image actually improved after my testicles were gone because my ideal body doesn't have balls swinging in the way down there. You can go on low dose TRT, full dose, or natural with no hormones afterward. If you go natural it's no different than a woman going through menopause. And like what woman go through it can take up to a year before you reach a new tolerable normal. T withdraws can be rough to mild. If you are worried I would go on a low dose topical gel form of TRT after surgery. It's much easier to wean yourself off of T without going through the typical hormone crash post surgery if you start weaning from a low dose to begin with.

It sounds to me that chemical castration for at least 3 months would be a good idea if you can get safe access to it. Once your testosterone clears out of your body your mind clears from all of the sexual tension and from there you can better figure it out. If you find that not having hormones isn't for you but you still want your junk removed than TRT and surgery is the way to go. Take it slow if needed, you can have things removed in stages. But overall one surgery is better than two or three as long as it feels right inside.

[Swim1650]

Swim1650 wrote:
Thank you for taking the time for such a detailed response. I actually live in the US but did spend a lot of time in Israel when I was younger.

I understand the need for me to demonstrate I understand the procedure, how it will affect me, the risks involved, and that I’m pursuing this for the right reasons. As I read the document (about a week ago), as I recall, WPATH said a Eunuch is assigned male at birth who desires to remove or inactivate their reproductive organs. I guess the question by that definition is identifying as a Eunuch body dysmorphia or actual gender dysphoria? I still feel and desire to be otherwise masculine. Is body dysphoria enough to warrant intervention? In other contexts, I’ve seen people discuss being a Eunuch or Nullo as non-binary, which in some ways resonates less with me. On the other hand, my sincere desire to get rid of my penis is not typical of most men.

The next question I have is regarding the typical requirement to socially transition for a year and trial hormones. I’m not sure how I really socially transition to being a Eunuch. My intention if castrated would be to take testosterone to maintain my masculine physique elsewhere. WPATH mentions androgen suppression prior to castration as an option to reduce sexual function… maybe that’s worth trying but I feel like reducing T comes with a lot of undesirable issues for me like muscle loss, weight gain, depressed mood, etc. The only reason I might consider that was if maintaining lower T-levels (before and after castration) would atrophy my penis enough so that I didn’t feel the need to have a penectomy. I’m not sure that’s realistic especially without affecting my body in other un wanted ways.

I am confident to let my scrotum and testicles go. I also know I’d prefer not to have a penis, but that’s admittedly a much bigger decision to make. Is it typical that they would do the castration first and then the penectomy at a later date, or would I have to get it all done at once? (Two surgeries also means a lot more recovery.

I’m know I’m overthinking this but I’d just hate to invest a lot of time and emotional energy discussing a deep part of me only for this not to work out.

I know I just need to take that first step

The SOCv8 is a little bit fuzzy on the exact diagnosis. I know that my doc said she was giving me a disphoria diagnosis not necessarily because it was the exact issue, but more that it was what the insurance would want in order to fund my care. There is getting to be at least some level of acceptance in the gender care world that there can be lots of different reasons, and that not all of them fit neatly in the diagnostic boxes, but they will try to make it work once they know you are serious...

The social transition thing is pretty meaningless, I think it's somewhat of a carry over of the requirements for those doing a binary switch. I know that they pretty much skipped it for me when I asked what I was supposed to transition TO, and they couldn't answer... However if one is chemically castrated, it basically means living as a eunuch whatever that entails for you... (I pretty much didn't do anything different...)

My docs have basically said that because I'm already at extreme risk for bone health issues they would not agree to letting me 'go natural' so I had to decide what I wanted for hormone replacement. Since a lot of my motivation was to get rid of libido 'drive' I didn't want to do T (Personally I also have some trouble w/ the idea of replacing T after going through all the effort to get rid of the T factories) so I went on Estradiol patches.

As a result I have no personal experience of what low-dose T does in terms of shrinkage. I've shrunk a lot but I think it is more because I mostly stopped having erections long before I got fixed. (A lot of the size is from regular stretching of the spongy tissues in the penis by getting erections) I also think that I've always been a 'grower' rather than a 'shower' and was small when not erect to begin with played a significant role.

In terms of surgery, it is mostly a 'choose your own adventure' thing, I did the O & S at the same time, and found I almost didn't notice the orchie, because the scrotectomy was more uncomfortable and took longer to get over... My understanding is that the penectomy is an even longer and more painful recovery, but that it's about the same regardless of whether they do the O & S at the same time or previously... It is possibly worth noting that the M->F surgery is either everything at once or a simple orchiectomy early and then the rest later....

I emphatically did not want a penectomy, as I have to catheterize and it is much easier when one has a penis. However if I had, I probably would have wanted everything done at once.

However this is a very individual decision that is mostly going to need to be between you and your surgeon.

WheelyFixed

Yeah, it seems like games will definitely be played with the insurance to get approval. I don't consider myself non-binary, I'm a masculine male who identifies as a man. If I want my genitals removed is that gender dysphoria or just body dysmorphia? If the latter, I could easily see the insurance denying surgery because they think my concern is mostly cosmetic. I don't want to be dishonest with providers, but if the same time, if they are extremely rigid in how they make insurance claims, I worry I might say something that will affect a potential approval.Worst case I'm approved medically but have to pay out of pocket. I'd prefer not to pay 10's of thousands out of pocket for something insurance should presumably cover, but honestly if I make that far and still want the surgery, I''ll probably do it despite the cost.

I can imagine between your age, your lower paralysis, and your use of a wheelchair the doctors being concerned about your bones. As I'm sure you know, the lack of muscle movement in your legs and low stress a from not having the same mobility as a physisically able-bodied person the signals that stimulate bone resorbition leads to loss of bone loss. "You snooze you lose" as they say... much like a hormonally deprived penis will atrophy from to the lack of erections. Being hypogonadal is a pretty unhealthy state to be in. It's not just bone health, there's significant cardiovascular risks, high rates of metabolic disorders (T2 diabetes, dyslipidemia), and so on. Plus, insulin resistance if not treated or mismanaged causes countless other problems. That said, I recognize very much the contradiction of removing your testicles only to replace your endogenous T with exogenous T... I think about a lot that myself pertaining to my own ambitions.

I suppose the effects of your SCI and hormonal modification are both effectively having the same effect, inhibiting erections. So I think it would be a little hard to pin down what one of these would do without the other. In the case of estrogen, I believe that does vasoconstrict the penile arteries, or at least inhibit vasodilation that leads to erections. So that could have an effect some additional effects?

I'm curious how you feel different on estradiol vs having your natural T levels- mentally, psychologically. Did your behavior change at all? If you don't mind me asking, I assume you've experienced some degree of physical feminization? What was that like for you personally and socially?

How long did your pain / discomfort last? Do you or did you experience phantom pain? That's one concern I haven't looked into very deeply. As much as I believe I would be more content without my genitals, if I get phantom pains that must feel absolutely terrible and potentially debilitating if frequent.

I can see having a penis makes catheters easier- I'll add that on my pro/con's list . If you didn't have to catheterize would you have considered it? My penis Is very much of the grower variety- erect I have a little advtange over the average length, granted I'm by no means "well endowed" in the way some guys are. My baseline size however is significantly below average. It doesn't help I have a high and tight scrotum that really highlights how little I am. I used to be very self conscious about this in high school.. I wonder if there's some subconscious connection with subsequent nullo interest... but I can't reconcile how having no penis would be better than a small penis (that can grow). Most teenagers have an insecurities and I haven't worried about this a very long time. A girl I dated in college told me often smaller cocks are more attractive - maybe she was just trying to boost my ego. Considering my discomfort with what I have between my legs now, I'm probably fortunate it's not larger.

[WheelyFixed]

Yeah, it seems like games will definitely be played with the insurance to get approval. I don't consider myself non-binary, I'm a masculine male who identifies as a man. If I want my genitals removed is that gender dysphoria or just body dysmorphia? If the latter, I could easily see the insurance denying surgery because they think my concern is mostly cosmetic. I don't want to be dishonest with providers, but if the same time, if they are extremely rigid in how they make insurance claims, I worry I might say something that will affect a potential approval.Worst case I'm approved medically but have to pay out of pocket. I'd prefer not to pay 10's of thousands out of pocket for something insurance should presumably cover, but honestly if I make that far and still want the surgery, I''ll probably do it despite the cost.

Remember the docs pretty much only get paid if they can get the insurance to pay, so they are pretty much the experts on dealing with them and know what boxes to check and all that. I never had to talk w/ my insurance (Medicare / Medicaid) at all - the doctors staff took care of all that. If you do end up needing to pay out of pocket, a few here have said it is less expensive, even with the travel expenses, to get their surgery from Dr. A down in Mexico than it would have been in a US hospital.

I can imagine between your age, your lower paralysis, and your use of a wheelchair the doctors being concerned about your bones. As I'm sure you know, the lack of muscle movement in your legs and low stress a from not having the same mobility as a physisically able-bodied person the signals that stimulate bone resorbition leads to loss of bone loss. "You snooze you lose" as they say... much like a hormonally deprived penis will atrophy from to the lack of erections. Being hypogonadal is a pretty unhealthy state to be in. It's not just bone health, there's significant cardiovascular risks, high rates of metabolic disorders (T2 diabetes, dyslipidemia), and so on. Plus, insulin resistance if not treated or mismanaged causes countless other problems. That said, I recognize very much the contradiction of removing your testicles only to replace your endogenous T with exogenous T... I think about a lot that myself pertaining to my own ambitions.

Exactly, it is primarily the paralysis that is the big bone health risk factor. You also quite correctly point out the risks of 'going natural' although it is also worth noting that there are multiple studies (including the Indiana study from relatively recent times) showing that eunuchs lived longer than intact males without any supplementation.... My recollection from surveys done on EAv2 was that it was about even w/ 1/3 claiming to be 'natural', 1/3 using some level of T, and 1/3 using E... (Perhaps JesusA can pop in with the study references on both of these topics?) At any rate, in terms of the health benefits T and E are almost interchangeable in what they do for you. (remember that your body metabolizes T into estrogen and that estrogen is what drives a lot of things like bone growth)

I suppose the effects of your SCI and hormonal modification are both effectively having the same effect, inhibiting erections. So I think it would be a little hard to pin down what one of these would do without the other. In the case of estrogen, I believe that does vasoconstrict the penile arteries, or at least inhibit vasodilation that leads to erections. So that could have an effect some additional effects?

The SCI didn't stop me from getting erections, but it did leave me unable to ejaculate, which was IMHO worse - I'd get to the 'edge' and then NOTHING, and if I tried to keep going it became painful just like it would have if I had tried to continue after climaxing w/o that needed refractory period rest break... I found that so frustrating that I basically quit trying, and that is when the erections mostly stopped....
From what I've heard E doesn't really stop erections - and after all women get clitoral erections which are using the same mechanism on the same basic structure. I think that the erections are more of a mental thing, they don't happen if not interested.

I'm curious how you feel different on estradiol vs having your natural T levels- mentally, psychologically. Did your behavior change at all? If you don't mind me asking, I assume you've experienced some degree of physical feminization? What was that like for you personally and socially?

I don't know if I lack the 'proper sensitivity' but I can't say I noticed a lot of difference in how I felt from when I was intact, w/ low T and supplementing, back to low T, no T thanks to Lupron, to being on E... Less frustrated now because I don't have the same unfulfillable desire to get my rocks off, and perhaps a bit more mellow generally. I know I'm significantly less aggressive when driving. I have had some feminizing but it mostly isn't terribly obvious. The biggest change was growing bigger boobs, to the point where I'm not sure I'd feel comfortable in a bathing suit, but not where I feel that I'm outside the 'normal male range' if I have even a T-shirt on... There may have been some fat shifting, but my clothes still fit, and the ladies underwear doesn't show... My beard is shorter but still there, etc... I still present as 'normal male in wheelchair' and nobody seems to question it...

How long did your pain / discomfort last? Do you or did you experience phantom pain? That's one concern I haven't looked into very deeply. As much as I believe I would be more content without my genitals, if I get phantom pains that must feel absolutely terrible and potentially debilitating if frequent.

I had a lot of discomfort for the first several days but was basically back to 'light duty' action after about 4 days. It was probably about a month before I felt 'healed'. The worst aspect was that I got a Foley cath before surgery (I was worried about potentially leaking) and per Dr's orders pulled it after 48 hours. However I was still so swollen that I couldn't get to my urethra to cath normally, so I had to go to the ER, where they put in another Foley which I used for another 10 days or so until the swelling was down enough I could cath w/o problems.

I can see having a penis makes catheters easier- I'll add that on my pro/con's list . If you didn't have to catheterize would you have considered it? My penis Is very much of the grower variety- erect I have a little advtange over the average length, granted I'm by no means "well endowed" in the way some guys are. My baseline size however is significantly below average. It doesn't help I have a high and tight scrotum that really highlights how little I am. I used to be very self conscious about this in high school.. I wonder if there's some subconscious connection with subsequent nullo interest... but I can't reconcile how having no penis would be better than a small penis (that can grow). Most teenagers have an insecurities and I haven't worried about this a very long time. A girl I dated in college told me often smaller cocks are more attractive - maybe she was just trying to boost my ego. Considering my discomfort with what I have between my legs now, I'm probably fortunate it's not larger.

I'm not sure what I would have done if I didn't need to cath. I definitely would have considered it more, but I don't feel like I was as drawn to the idea of getting rid of my penis the way I was to getting rid of my balls... All my fantasies seemed to revolve around orchiectomy and possibly scrotectomy, and the penis didn't really come into the question either way... I also can't say that I was overly insecure about my genitals as a teen, I got the 'pink monkey' treatment in lots of other ways, so I think it was sort of a 'least of my worries' thing...

WheelyFixed