Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

Wouter B van der Sluis; Thomas D Steensma; Mark-Bram Bouman

doi:10.1080/26895269.2020.1749921

Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

Int J Transgend Health. 2020 Apr 3;21(2):176-181. doi: 10.1080/26895269.2020.1749921. eCollection 2020.

Authors

Wouter B van der Sluis^{1

2}, Thomas D Steensma^{1

3}, Mark-Bram Bouman^{1

2}

Affiliations

¹ Center of Expertise on Gender Dysphoria, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands.
² Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands.
³ Department of Medical Psychology, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands.

Abstract

Background: Different surgical procedures are available for transgender women wishing to undergo genital gender-affirming surgery. Aim: To assess preoperative motivations, the frequency of orchiectomy procedures, and postoperative outcomes of orchiectomy in transgender individuals. Methods: All transgender individuals who underwent orchiectomy in the period between January 2012 and January 2020 at our institution were retrospectively identified. A chart study was conducted, recording motivations, demographics, perioperative characteristics and surgical outcomes. The frequency of orchiectomy and vaginoplasty procedures during the study period were determined and compared. Results: During the study period, an increase of performed orchiectomy procedures was observed. The orchiectomy/vaginoplasty ratio was 0.01-0.07 in the period 2012-2018 and 0.24 in 2019. A total of 43 transgender individuals were retrospectively identified. Sixteen (37%) initially wished to undergo a vaginoplasty, but did not meet institutional requirements (nonsmoker, BMI < 30kg/m²) or were not eligible for vaginoplasty surgery because of interfering somatic or mental health issues. Fourteen (33%) individuals who underwent orchiectomy regarded it as a preceding step to a future vaginoplasty procedure. Out of these fourteen, one person is now on the waiting list for vaginoplasty surgery. Thirteen (30%) others did not report a desire to pursue vaginoplasty in the future. This was mostly motivated by the absence of genital dysphoria or motivations related to their gender identity, with a desire to discontinue anti-testosterone treatment. The postoperative course was uncomplicated in 39 (91%) individuals. Conclusion: In the Netherlands, especially in the last year, the frequency of orchiectomy procedures has increased. Reasons that people chose to undergo this procedure include: not being eligible for a vaginoplasty procedure, seeing it as a preceding step to a possible future vaginoplasty or other identity-related motivations (i.e., non-binary gender identification or absence of genital dysphoria).

Keywords: Gender affirming surgery; gender dysphoria; orchiectomy; sex reassignment procedures; surgery; transgender.