Gender-Affirming & Urological Procedures

Orchiectomy (Bilateral)

Sometimes, it is difficult or impossible to take feminizing hormones. An endocrinologist may recommend an orchiectomy, which involves removal of the testicles, to considerably reduce the production of testosterone.

Orchiectomy with Scrotectomy

During an orchiectomy, the surgeon will remove one or both testicles from the scrotum. During a scrotectomy, the surgeon will remove the entire scrotum or a portion of it.

If your transition will eventually include a vaginoplasty, the scrotal tissue may be used to create the vaginal lining. A vaginoplasty is the construction of a vagina using skin grafts. In these cases, a scrotectomy may not be recommended.

If there is no scrotal tissue available for a vaginoplasty, the next option for constructing the vaginal tissue can often include skin grafts from the upper thigh.

It is a good idea to talk to your doctor about all of your options. Be open with them about future surgeries you may plan to have. Before the procedure, talk to your doctor about fertility preservation and the impact to sexual functioning.

Male Nullification (Male-to-Nullo)

Male nullification, or genital nullification surgery (nullo/nullectomy), is a type of gender-affirming surgery where external male genitalia (penis and scrotum) are removed, the urethra is shortened, and the area is made smooth. This creates a neutral or agender appearance, often with preserved nerve endings for sensation. It is popular for non-binary individuals seeking alignment with their identity beyond traditional binary transitions.

What It Involves

• Penectomy: Removal of the penis.
• Orchiectomy: Removal of the testicles.
• Scrotal Reduction: The scrotum is reduced or removed.
• Urethral Shortening: The urethra is shortened, allowing urination through the new opening.
• Sensate Tissue Preservation (Optional): Some surgeons can preserve highly sensitive penile tissue and bury it in the mons, creating a “hidden” clitoris for heightened sensation.

Who It Is For

• Non-Binary & Agender Individuals: People whose gender identity isn’t exclusively male or female and seek a body that reflects a neutral or null gender.
• Gender Non-Conforming Individuals: Those who don’t desire a full binary transition but want genital affirmation.

Goals & Benefits

• Gender Affirmation: Aligns physical form with internal gender identity.
• Smooth Appearance: Creates a flat, unbroken transition from the abdomen to the groin.
• Empowerment: A powerful declaration of self-acceptance and authenticity.
• Improved Mental Health: Reduces gender dysphoria and increases well-being.

Key Considerations

• Recovery: Involves several weeks of healing with activity restrictions.

Female Nullification

Female nullification, or genital nullification surgery (also called nulloplasty), is a type of gender-affirming surgery for non-binary or agender individuals, particularly those assigned female at birth (AFAB). The procedure removes genital tissue (like the clitoris, labia, and uterus) and creates a smooth, flat pelvic area with only urethral and anal openings. This aligns their physical body with a non-binary identity or desire for a sexless appearance, often involving burying sensitive tissue for retained sensation.

What It Involves (for AFAB individuals)

• Removal of tissue: Vaginectomy, labiectomy, clitorectomy, vulvectomy, and sometimes hysterectomy (uterus removal).
• Urethral modification: Shortening the urethra and creating a smooth opening.
• Creation of a smooth area: Removing excess skin and tissue to create a flat, smooth transition from the lower abdomen to the groin.
• Sensation preservation: Often, clitoral nerve tissue is preserved and buried in the mons (the mound of flesh above the pubic bone) for potential sensation.

Goals and Reasons

• Gender affirmation: To align physical characteristics with an agender or non-binary identity.
• Dysphoria relief: To alleviate gender dysphoria for individuals who don’t feel male or female.
• Asexuality/Sexlessness: To achieve a body that reflects a physically sexless or asexual identity.

Recovery & Considerations

• Recovery: Involves significant pain, swelling, limited movement, and restrictions on heavy lifting for several weeks to months.
• Customization: Procedures are highly customizable to meet individual goals.

Penis Reduction Surgery

Penis reduction surgery, or reduction corporoplasty, is a rare procedure to decrease penile size (length or girth) due to conditions like macrophallism (abnormally large penis from genetics or sickle cell) or severe deformity. It often involves removing tissue to improve function, aesthetics, or allow for comfortable intercourse. Techniques include tissue excision, skin plication, and sometimes urethroplasty, aiming for better symmetry and normal function, though it is highly complex and case-specific.

Reasons for the Surgery

• Macrophallism: A condition where the penis is significantly larger than average, causing physical difficulties.
• Functional Issues: Inability to have intercourse or play sports due to size or shape.
• Partner Comfort: To alleviate discomfort for a partner during intercourse.
• Reconstruction: To reduce size after reconstructive surgery.
• Cosmetic/Psychological: Dissatisfaction with size or appearance.

Surgical Techniques

• Tissue Excision: Removing elliptical or wedge-shaped sections of tissue from the penile shaft (corpora).
• Incision & Reshaping: Using Y-shaped or curved incisions to reduce circumference and reshape the glans.
• Urethroplasty: Re-routing or adjusting the urethra (urine tube) to fit the reduced penis.
• Corporoplasty: Modifying the erectile tissue (corpora cavernosa) to reduce bulk.

Outcomes & Considerations

• Success: Case reports show successful reduction with improved appearance, symmetry, and function, with patients reporting high satisfaction.
• Risks: Potential complications include issues around the urethra and erectile dysfunction, though specialized cases report good functional recovery.