You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-13 MEDICAL, GENDER DYSPHORIA, AND QUALITY-OF-LIFE BENEFITS OF PRE-VAGINOPLASTY BILATERAL ORCHIECTOMY Nance Yuan, Grace Lee, Robert Victor, and Maurice Garcia Nance YuanNance Yuan More articles by this author , Grace LeeGrace Lee More articles by this author , Robert VictorRobert Victor More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gender-affirming bilateral orchiectomy can be performed: 1) as a stand-alone procedure, 2) as a separate surgery before vaginoplasty, or 3) as part of vaginoplasty. As the testicles are the primary source of endogenous testosterone, orchiectomy allows for cessation of anti-androgen therapy and usually allows for decrease in estrogen dose. Hormone therapy has known side effects, including cardiovascular and urinary effects. In this study we measure postoperative decrease in gender-affirming hormone therapy after pre-vaginoplasty orchiectomy. METHODS: We performed retrospective review of 40 trans-feminine patients who underwent gender-affirming orchiectomy as a separate procedure prior to planned vaginoplasty. We recorded surgical data, preoperative and postoperative gender-affirming hormone dosages and regimens. Hormone regimens were managed by patients’ endocrinologists. RESULTS: Forty patients underwent pre-vaginoplasty orchiectomy from 4/2017–9/2020. Mean age was 37.5 and mean BMI was 28.7. Mean outpatient surgical time was 28 min. via a single scrotal incision.All (100%) patients were taking estradiol (Mean PO dose: 5.3 mg/day; Route: PO 63.1%; IM 23.7%; transdermal 5.3%, SL 3% of patients, implant 3%), 77.5% were on Spironolactone (mean dose 163 mg QD), and 27.5% were on Progesterone (mean dose 106 mg QD). Following orchiectomy, all (100%) patients taking spironolactone were able to discontinue it. Of patients taking progesterone, 50% patients were able to discontinue it post-op. For patients on Estradiol, 60% of patients decreased their dose post-op. Patients that took a decreased estradiol dose postoperatively were on dosages that were 53% of their preoperative dose.Approximately 95% of patients endorsed decreased gender dysphoria regarding their genitals and greater daily comfort, and 100% reported significant satisfaction with surgery. CONCLUSIONS: This is the first study to characterize dose changes in hormone therapy after gender-affirming orchiectomy. After orchiectomy, patients benefit from decreased requirements for gender-affirming hormone therapy, which reduce risks of drug-related side effects and improve quality of life. As patients preparing for vaginoplasty must often wait a year or more due to long wait lists and requirements for hair removal, pre-vaginoplasty orchiectomy should be offered as an elective option. Potential benefits of decreased hormone requirements and partial alleviation of gender dysphoria should be discussed. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e72-e72 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nance Yuan More articles by this author Grace Lee More articles by this author Robert Victor More articles by this author Maurice Garcia More articles by this author Expand All Advertisement Loading ...