There are many surgeries a transgender person can choose to have to help their body align with how they feel it should be, this is just one such surgery.
CONTENT NOTE: mentions of and discussions of various surgeries, but nothing in graphic detail. This article is mostly about the recovery process.
When it comes to transgender people and surgeries, most people know about “Bottom Surgery”. An orchiectomy is not full “bottom surgery”, but is an option. It removes the testicles but leaves the penis intact. More on that later.
Side Note: Unless you’ve been given permission, it is extremely uncouth to ask a trans person if they’ve had surgery, so pretty much don’t do that.
For the purposes of awareness, context, and comparison, I’ll be talking about both types of “bottom surgery” for trans women in this article. I’ve also written two previous articles about trans surgeries, links at the end of this article.
Bottom surgery in the case of trans women and/or trans feminine people, is a vaginoplasty, which is a full conversion from penis and testicles to a vulva and vagina.
For trans men, bottom surgery would be either a phalloplasty or a metoidioplasty. A phalloplasty is a full conversion from vulva+vagina to a penis made from a skin graft. A metoidioplasty which is a lengthening of the urethra and clitoris. It is also possible to get a scrotum with artificial testicles added.
If you’re interested to learn more about these trans male surgeries, YouTuber Jammidodger has done many videos about it, including this video where he specifically talks about why he chose the metoidioplasty over the phalloplasty.
Somewhat similarly, I chose the orchiectomy over the full vaginoplasty, and that is for a variety of reasons which I will get into later in this article.
Unlike for my other two surgery articles, for this article I’m mostly just going to talk about my experience of recovery and won’t be including any graphic photos in this article, nor sharing much graphic detail.
So let’s get started.
The Orchiectomy (often shortened within the trans commuity to “orchi”) is the removal of the testicles only.
This procedure is commonly done for cis men who get testicular cancer, to help ensure the cancer does not return. An orchiectomy can be performed to remove one or both testicles. Transgender women (or trans feminine people) typically get rid of both testes.
Of course this surgery leaves behind the penis, which you would think a trans woman would not want anymore, and it’s true in many (but not all) cases that trans women prefer not to have a penis anymore. But there can be various factors that might limit a trans woman from being able to get the full bottom surgery —one of the biggest is financial.
I had heard that a full vaginoplasty out-of-pocket can cost upwards of $20,000, but when I asked my surgeon about this, he said it’s likely much more than that. Obviously most people don’t have 20K+ just laying around, especially not most transgender people.
Since an orchiectomy is a much simpler and more common procedure, it’s much cheaper. I’ve heard figures around $1,000–1,500 cited, but when I asked my surgeon, he told me that he only gets paid $170 by OHIP to perform the procedure, though private surgeons can charge whatever they want (hence how it can be over $1,000). But it’s definitely cheaper than a vaginoplasty, and this makes it a more viable option for many transgender women.
I happen to live in Ontario, Canada. We have socialized medicine, and at least at the moment, top and bottom surgery costs (for both trans men and trans women) can be covered by the government. Of course they don’t just hand you the money, you have to jump through many hoops including getting referrals, getting a letter from a registered social worker, and filling out a bunch of forms. This obviously takes time. Then, once your funding has been approved, you proceed to booking your actual surgery, and that can take anywhere from weeks to months to years more.
I don’t know anything about the wait times for phalloplasties or metoidioplasties, but the wait time for a vaginoplasty under the system I described above is typically 8–10 months, after you get approved for funding.
So it’s really not uncommon to be waiting for more than a year, possibly upwards of two, because before you even begin the application process, you have to have been on Hormone Replacement Therapy (HRT) for at least a year first, then you start the process of getting the necessary documents and forms sorted, then you submit and wait for approval, then you book and wait some more. Unless you’re one of those extremely lucky few who can afford the surgery out of pocket. And this is just one of many surgeries trans people pursue.
Most Canadian trans women go to Montreal for the surgery. I have heard that there is also a surgeon in Vancouver who does vaginoplasties, and Women’s College Hospital in Toronto has also just begun to do it as well, but they aren’t doing many yet from what I’ve heard. Some people travel overseas, with Thailand being a common destination.
Beyond the cost and wait time, the recovery period for a vaginoplasty is typically a minimum of 2 months. While you can walk again within a few days of surgery, but you can’t really work for several weeksbecause your body needs to use most of it’s energy to heal (it’s a major surgery!). Plus the lifetime of maintenance — dilations and visits to the gynecologist.
As I mentioned, some people, for various reasons, choose to not get full bottom surgery. I can only speak for myself and my personal motives in this article.
I am fortunate to not have extreme genital dysphoria like many trans people do. I’ve fluctuated between wanting the full thing and not wanting it. If the recovery period for a vaginoplasty was only half of what it actually is, I’d have been a lot more inclined.
After last fall, when I had 2 minor surgeries 2 months apart, that really took a lot out of me and it was especially difficult going into winter which is a time of year when I always struggle with energy.
After the unexpected trauma that I experienced from having my tracheal shave procedure done while awake, I chose this time to be put under general anesthetic so I was completely unconscious for this procedure. Hormones have really amplified my emotions and I think I would have had a very strong reaction if I’d been awake for it. That would have depleted me of a lot of energy and I wanted to save my energy for initial healing.
Fun Fact — trans women’s genitals tend to shrink while on hormone replacement therapy, whereas trans men’s genitals tend to grow larger. (Breasts are not technically genitals, they have just been over-sexualized to the point that most people think of them as genitals)
I can say honestly that with how much hormone replacement therapy has led to natural shrinkage of my genitals, it has helped me a lot in not feeling as burdened or bothered by it.
But when I really stopped and asked myself did I want to wait a year (and risk having my surgery end up being booked in the dead of winter) and then be benched for 2 months, the answer wasn’t a strong enough yes. I felt “okay enough” with the partial measure.
I also had a legitimate concern that our current provincial government — headed by Premier Doug “Slash and Burn” Ford — could cut the funding at any moment leaving a lot of trans people with no option or hope. Getting the orchiectomy was much faster, and I felt it would be good enough for me, and certainly better than nothing.
I should also note that it’s not necessarily a strict “one or the other” choice, it is possible to get a vaginoplasty after having already gotten an orchiectomy, it depends on how much skin is left behind, and might just require an extra skin graft.
With all that said, now it’s time to talk about my actual experience.
Day Of Surgery
My surgery was originally scheduled for 12:40pm on Wed, Jul 31st, though I was told that could change and I would get a call the day before to confirm (it did end up getting bumped to 2pm). I had to be at the hospital 2 hours before. I was not allowed to eat after midnight the night before, and clear fluids were OK but not within 4 hours of the surgery. I misunderstood that last instruction and accidentally had a bit of water within the 4 hr window, but not enough that be an issue it turned out.
I arrived early as instructed, I spent about 90 minutes in the waiting room after getting changed into my surgical gown. I had to put all my stuff in a locker.
I had just made a new friend the day before, someone who it turned out had just gone through this procedure herself a month ago, whereas all my other orchi comrades had had their surgeries anywhere from one to several years ago, so their memories of the experience were hazy and they weren’t able to recall much specificity.
It was a great relief and benefit to be able to ask questions of someone with fresh experience.
The entire floor of the hospital that I was on was pretty cold, if I had to guess it was probably about 18C, maybe even less. Given that it had been at least 25–30C outside for the last two months leading up to this point, a 10 degree drop is rather noticeable.
The actual surgery room was even colder, despite wearing a fabric gown and a blanket I was shivering.
They put in my IV and within just a couple of minutes I was unconscious. I literally remember starting to feel a bit spacey and then I just woke up in recovery. It’s a bit startling how you don’t just slowly fade away into sleep, but rather just blink out and then blink back on later.
I woke up suddenly, but unlike the last time I’d been put under, this time waking up wasn’t such a shock. Still startling in a way, but I knew better what to expect this time.
For the first few minutes I could barely lift my head and barely talk. I was disoriented but that improved fairly quickly with each passing minute.
After about 5 or 10 minutes, I was awake and aware enough to be able to ask for my phone, which was in my bag which they had brought from my locker.
I wanted to let everyone know I was awake and OK. I was in the middle of trying to take a picture when a nurse walked in, which resulted in this drunken-looking half talking, half smile:
I look worse than I felt. After about 10 minutes I was probably at least 80% awake and aware. I realized that there was a large ice pack strapped to my crotch (which made sense), and that it was probably more than 50% melted. But it had been there for at least a couple of hours already, so that also made sense.
One thing I have experienced consistently through all three of the surgeries I’ve had now, is that the day of surgery is the easiest.
Your body takes some time to realize something has happened and for your nerves to respond accordingly. It’s kind of strange actually, because when I’ve injured myself, it’s a lot worse right after, but also the first few days afterwards are not fun. With a surgery, unconscious or not, my body has been relatively comfortable and composed up until I went to sleep that first night. Of course, I haven’t had any really major surgeries. The most “severe” one of these three was my tracheal shave, and I wonder if that one would be seemed better/easier had I not been awake for it.
So even though I felt reasonably OK after waking up from this surgery (not much pain, some discomfort), I knew the next day would be much more telling.
My friend arrived to pick me up shortly after. We had to go down to the pharmacy to get some pain meds, then off to another friend’s place for me to spend the night.
I have to say it was really appreciated to get to spend that first night with familiar friends. I could have come home and been alone, and as much as trying to sleep somewhere unfamiliar is always a bit of a challenge, it was comforting. They cooked me some soup and we talked a bit to catch up.
The doctor said the painkillers would probably make me kind of drowsy, but they do have caffeine in them and I think they actually make me feel more tweaked than tired. I took one at 9pm, and tried to go to sleep at 11pm, but it didn’t work. I finally succeeded at midnight, just after taking this photo out the window:
Day One Recovery
I woke up around 4:30am the next day, and couldn’t get back to sleep, so I got up, took a pain pill and changed my ice pack, and started watching some TV shows online, figuring after an hour I’d be tired again and could go back to sleep for a bit longer. No such luck.
Once my friend got up to go to work at 8am, I also chose to return home, even though they told me “you’re welcome to stay here as long as you need today, we’re not going to kick you out”. Even still, I felt quite decent and I really do feel more relaxed and comfortable at home. So home I went.
I was alternating between two ice packs, but the instructions on them each said at least 1 hour in the freezer before using, but I was finding that was not enough to really get them cold enough to last for more than an hour.
Since getting home, I added a third ice pack to the rotation to try to give each one longer to get really cold. I found having ice constantly on the area seemed to help the most, even more than the painkillers.
Also, the more frozen my groin area is, the easier it actually was to move and walk, though I definitely still had to go slow.
Day Two Recovery
Last night at 8pm I took an extra strength muscle relaxer because my lower back was getting quite stiff and sore from near constant sitting/lying down for over 24 hrs. I also took one pill of melatonin (a sleep aid).
I fell asleep at 9:30pm, and slept for 10 hrs. When I woke up, it had been over 24 hrs since my last painkiller, and I felt OK. Obviously still some discomfort, but the constant ice had really been helping.
I felt much better upon first waking up, much less sensitive, initially I thought I didn’t even need ice anymore, but after a few minutes I felt a bit more uncomfortable and decided I should probably still stick with ice today, but maybe won’t need it anymore as of tomorrow.
I’d still been mostly sitting or laying down today, but was definitely also feeling more comfortable overall. I could walk more easily (though still slower than usual). Most of the sensation I was feeling in my groin area at that point was in my inguinal canal area, as well as where my “invisible ovaries” would be. But it was very tolerable.
If you’re not sure what/where the inguinal canals are, here is an illustration:
By 3:30pm, I was definitely feeling stir crazy. I had just taken the ice pack off after having it on all day again, there wasn’t really any pain, just a bit of hazy discomfort.
I slowly and carefully went to the store across the road to get a snack and that was a nice break.
Not much else happened, I went back to laying down/resting, and went to bed early.
Day Three Recovery
I slept without ice last night, and it was fine. My lower back hurts more than my groin does for the most part. I noticed that most of my discomfort was in the area of my inguinal canals.
Today is Saturday, which is the day I normally do my grocery shopping. Luckily, there is a grocery store very nearby, so I was able to go and just keep my shopping list a bit light.
I also had to run a more “long distance” errand this day (a weekly errand), normally I bike to do this errand but this time I took transit and walked as much as was necessary beyond that.
Before heading out to run that errand, I decided to take another painkiller, just in case. I took it about an hour before I ended up leaving, and was very surprised that it made me quite wobbly for a short time. I guess I didn’t notice that on day 1 because I was already being so careful about moving around.
But after an hour the wobbly feeling had largely subsided. I was also able to walk to a nearby friend’s place to help them with something (basically just sit and point a camera at something for them).
After three walking errands in one day after spending 2 straight days walking as little as possible, I was quite tired.
Once the painkillers totally wore off, fortunately, I still felt quite fine. My inguinal canals are still the main issue, but even just between first getting up this morning and getting close to bed time, the sensitivity has greatly reduced.
I was also able to go up stairs 2 steps at a time again, although more slowly and carefully than usual, but this felt like very rapid progress!
Day Four Recovery
To my surprise, I woke up today with no feeling of “ghost ovaries”. My inguinal canals are no longer so sensitive.
I can however now feel the actual incision site. It’s a faint, dull ache.
I did my laundry this morning without issue, cleaned my apartment up a bit, and went out on foot to a nearby store to run an errand.
I’m very much craving to get back on my bike again but trying not to rush that too much.
Day Five Recovery
So, the incision site is tingling/dull pain a lot this morning. Otherwise I felt fine.
That tingling/dull pain feeling mostly went away after a couple of hours.
Day Six Recovery
My first day back to work (I work an office job). The only thing that’s still kind of an off-and-on issue is sensitivity in/around my inguinal canals. But it’s also pretty much just when I’m moving. It was a fine day, no problems really.
I haven’t needed painkillers since day 2 or ice since day 3.
Day Nine Recovery
On Day 9, I decided I wanted to try a careful, short bike ride and see how it felt. Surgeon’s orders were to not do this for at least 2 weeks, but I was impatient (and also going to be very careful).
I chose a route that was only downhill or level with an escape plan to put my bike on the subway to get back home if need be.
Unfortunately, downtown Toronto has a lot of roads that are older and thus have a lot of large cracks or small potholes, and my route for my short errand was not able to avoid these old bumpy roads. All the bumping as I rode was not feeling good, so I stopped when I got to my destination.
I also noticed (and kind of freaked out a bit) that my legs felt significantly weaker while I was riding, I was down 3 gears from normal, which is usually how much strength I lose over the entire winter when I can’t ride as much. To lose that much in just 9 days seemed very alarming. However, thankfully this was an anomaly, as the next time I got on my bike on day 14, it was mostly normal (though some understandable weakness).
Day 10 Recovery
I noticed the area around my incision site had been a bit more sensitive (and itchy) since later on Day 9, which was not ideal. Turned out this was the scab over the incision starting to naturally come off. Crisis averted!
My follow up with the surgeon isn’t for a few weeks, but my healing feels very well underway and I think so long as I don’t attempt to do the splits anytime soon, life is pretty normal again. Minus the bike riding.
Day 14 Recovery
I was feeling really good and my incision site seemed to have healed quite a bit. The scab on the scar was even beginning to fall off naturally.
I did another test ride, the same short/easy route as last time, and it was totally fine this time. No discomfort, no issues. It felt really good to get back on the bike again. It feels like home to me.
Since Day 14 life has been pretty busy, dealing with work stuff and other personal stuff now that I’m mostly back fully in gear again.
Post-Surgery Follow-Up (Aug 22, 3 weeks post op)
I met very briefly with my surgeon to make sure everything was OK. I told him the healing had gone very smoothly, and that I had no concerns. I had him take a look just in case and he said I was totally healed, yay!
To re-iterate from earlier in the article, I chose to get this surgery for a couple main reasons:
- The recovery time and post-op maintenance of the “full” bottom surgery was just enough to dissuade me from that option, even though I know many trans women who’ve had that surgery and been fine.
- With concerns that Ontario’s Conservative government could pull the funding for these surgeries at any time, it felt like if I don’t get something now, I may never be able to. For me, something was absolutely better than nothing. This really should not be how one makes medical decisions, but it is what it is.
Post Op Thoughts and Feelings (slight TMI warning)
- Once again, I genuinely believed that this surgery would be “good enough” for me, and that I probably wouldn’t want or feel the need for more. I’m definitely glad I got it done (in the sense of this or nothing), and I’m pleased enough with the results.
- It is more comfortable. I honestly didn’t tend to “tuck” a lot before, but it’s even less necessary now. The bonus now is if I do choose to tuck, that is a lot easier and more comfortable. Definitely less “bulge” either way. And still being able to pee standing up is convenient.
- I’ve noticed specifically when I look in the mirror after a shower, it can be a bit disappointing sometimes. But if I’m in my bedroom in front of the mirror and just wearing underwear, doesn’t bother me too much.
- My hormone situation has been simplified. I no longer deal with the testosterone blocker and its annoying side effects.
- Pretty much every trans woman I personally know who has gotten a vaginoplasty has not enjoyed having to do the dilations and can’t wait for them to no longer be as necessary. But they also definitely don’t regret the choice they made either. That option isn’t totally off the table for me, unless the funding does get cut.
- That all said, to be honest, if I could go back in time knowing how I feel now, and if I could be certain that the funding definitely wouldn’t be cut, I think I would go for the full thing. Sometimes you can’t truly know how you will feel about something until you’ve made some kind of other decision related to it and see how that makes you feel.
- It’s frustrating to want something but also not want it, both for totally valid and legitimate reasons. But in the strict sense of “this or nothing”, I’m glad I got at least “this”.
- Now, after 3 minor surgeries in 11 months, I’m taking AT LEAST the next year off from anything else! So this could be the last surgery article from me.