Milton Thomas “Milt” Edgerton, Jr. (July 14, 1921 – March 17, 2018) was an American plastic surgeon who served our community. He is widely considered one of the most important American plastic surgeons of the 20th century.
Background
Edgerton was born in Atlanta and earned his bachelor’s degree in chemistry from Emory University in 1941. He earned his medical degree from Johns Hopkins University in 1944. Following his surgical residency, he joined the United States Army and operated on injured World War II veterans.
He joined the Johns Hopkins faculty in 1951 and got tenure in 1962. In 1970 he was recruited to the University of Virginia to found the Department of Plastic Surgery, where he worked and taught until retiring in 1994.
He had many students and colleagues who served our community as well, including Howard W. Jones, Jr. and John Gale Kenney. Edgerton was author of four books and over 500 scientific papers on plastic surgery. As shown in the selected bibliography below, his articles when read from earliest to latest read like an unfolding of the history of our community.
Dr. Edgerton died at age 96. The Milton T. Edgerton, M.D. Professorship in Plastic & Reconstructive Surgery at Johns Hopkins is named in his honor.
Selected publications
Edgerton MT. Plastic surgery: its roots and rewards. Ann Plast Surg. 2003 Mar;50(3):240-3. PMID: 12800898
Edgerton MT. Early plastic surgery at the Johns Hopkins Hospital. Plast Reconstr Surg. 2002 Jul;110(1):229-33. PMID: 12087260
Edgerton MT. Plastic surgery: the rainbow profession. Ann Plast Surg. 1997 Mar;38(3):197-201. PMID: 9088453
Edgerton MT, Langman MW, Pruzinsky T. Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients. Plast Reconstr Surg. 1991 Oct;88(4):594-608. PMID: 1896531
This paper reviews the senior author’s long-term experience with the surgical-psychiatric treatment of 100 aesthetic surgery patients with significant psychological disturbances. Patients with psychological disturbances of a magnitude generally considered an “absolute contraindication” for surgery were operated on and later assessed to determine the psychological impact of surgery. Patient follow-up averaged 6.2 years (maximum follow-up 25.7 years). Of the 87 patients who underwent operation (7 patients were refused surgery and 6 voluntarily deferred surgery), 82.8 percent had a positive psychological outcome, 13.8 percent experienced “minimal” improvement from surgery, and 3.4 percent were negatively affected by surgery. There were no lawsuits, suicides, or psychotic decompensations. Patients with severe psychological disturbances frequently benefited from combined surgical-psychiatric treatment designed to address the patient’s profound sense of deformity. This study suggests that plastic surgeons are “passing up” a significant number of patients who may be helped by combined surgical-psychological intervention. Comment in: * Plast Reconstr Surg. 1992 Aug;90(2):333-5.* Plast Reconstr Surg. 1992 Jun;89(6):1173-5.
Edgerton MT Jr, Langman MW, Pruzinsky T. Patients seeking symmetrical recontouring for “perceived” deformities in the width of the face and skull. Aesthetic Plast Surg. 1990 Winter;14(1):59-73. PMID: 2330857
This article describes plastic surgery patients who sought symmetrical recontouring of the width of the face and skull. The basic demographic and personality characteristics of these facial width deformity (FWD) patients and the surgical procedures performed on them are discussed. Details of the surgical and psychological management of three representative cases are given. Speculative conclusions regarding the general characteristics of the FWD population are offered. Suggestions are proposed for a combined surgical-medical psychotherapeutic collaboration in managing these patients.Comment in: * Aesthetic Plast Surg. 1990 Fall;14(4):299-300.
Pauly IB, Edgerton MT. The gender identity movement: a growing surgical-psychiatric liaison. Arch Sex Behav. 1986 Aug;15(4):315-29. PMID: 3741090
The evaluation and treatment of individuals with gender identity problems has resulted in an interesting and productive collaboration between several specialties of medicine. In particular, the psychiatrist and surgeon have joined hands in the management of these fascinating patients who feel they are trapped in the wrong body and insist upon correcting this cruel mistake of nature by undergoing sex reassignment surgery. Over the last two decades, some 40 centers have emerged in which interdisciplinary teams cooperate in the evaluation and treatment of these gender dysphoric patients. The model for this collaboration began at The Johns Hopkins Hospital, where the Gender Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983). This “gender identity movement” has brought together such unlikely collaborators as surgeons, endocrinologists, psychologists, psychiatrists, gynecologists, and research specialists into a mutually rewarding arena. This paper deals with the background and modern era of research into gender identity disorders and their evaluation and treatment. Finally, some data are presented on the outcome of sex reassignment surgery. This interdisciplinary collaboration has resulted in the birth of a new medical subspecialty, which deals with the study of gender identification and its disorders.
Edgerton MT. The role of surgery in the treatment of transsexualism. Ann Plast Surg. 1984 Dec;13(6):473-81. PMID: 6524842
The increasing use of surgery for sex reassignment in the treatment of transsexualism is described. The author’s early experience over a twenty-year period with the Gender Identity teams at The Johns Hopkins University and The University of Virginia is summarized. Many of the reasons for slow acceptance of this type of surgery by many members of the medical profession are analyzed. The satisfactory subjective results described by patients who have received sex reassignment continue to exceed the results obtained by other methods. The author concludes that further study of surgical treatment is justified, but that it should be limited to established multidisciplinary teams working in academic settings. Physicians are urged to withhold judgment on the role of surgery in gender disorders until they have had significant personal experience with these desperate and complex patients.
Edgerton MT Jr, Langman MW, Schmidt JS, Sheppe W Jr. Psychological considerations of gender reassignment surgery. Clin Plast Surg. 1982 Jul;9(3):355-66. PMID: 7172587
Edgerton MT, Sheppe WM Jr, Turner UG 3rd, Thorup OA. Transsexualism. An insight into the power of psychologic gender–a panel discussion. Pharos Alpha Omega Alpha Honor Med Soc. 1978 Oct;41(4):31-6. PMID: 724795
Turner UG 3rd, Edlich RF, Edgerton MT. Male transsexualism–a review of genital surgical reconstruction. Am J Obstet Gynecol. 1978 Sep 15;132(2):119-33. PMID: 356612
Transsexualism is a poorly understood, uncommon, and controversial entity of recent interest to the lay public and medical profession. Important features of the condition are discussed, surgical procedures for genital conversion in male transsexuals are compared, and our experience at the University of Virginia where 53 patients have been treated surgically is presented. All patients have made satisfactory postoperative psychosocial adjustment despite a surgical complication rate approaching 50 per cent. It is concluded that alternative (better) surgical procedures for male transsexuals should be explored.
Bralley RC, Bull GL, Gore CH, Edgerton MT. Evaluation of vocal pitch in male transsexuals. Commun Disord. 1978 Sep;11(5):443-9. PMID: 730836
A 49-year-old male-to-female transsexual was administered voice therapy following surgery. Tape recordings were made of her speech prior to and each week during therapy. Selected sentences from these reocrdings were analyzed. Results indicate that changes in both fundamental frequency and perceptual judgments of femininity were statistically significant and supportive to the client. The voice of the client was still discernible from that of a female speaker, although less so than before therapy. It is suggested that a composite treatment program combined with laryngeal modification through surgical intervention may be necessary.
Thomson JA Jr, Knorr NJ, Edgerton MT Jr. Cosmetic surgery: the psychiatric perspective. Psychosomatics. 1978 Jan;19(1):7-15. PMID: 622436
Edgerton MT. Liquid silicone injections to improve scars: is this a solution to the problem? Clin Plast Surg. 1977 Apr;4(2):311-9. PMID: 852228
Edgerton MT. The surgical treatment of male transsexuals. Clin Plast Surg. 1974 Apr;1(2):285-323. PMID: 4609668
Edgerton MT. Transsexualism–a surgical problem? Plast Reconstr Surg. 1973 Jul;52(1):74-6. PMID: 4713823
Edgerton MT, Bull J. Surgical construction of the vagina and labia in male transsexuals. Plast Reconstr Surg. 1970 Dec;46(6):529-39. PMID: 4923947
Edgerton MT, Knorr NJ, Callison JR. The surgical treatment of transsexual patients. Limitations and indications. Plast Reconstr Surg. 1970 Jan;45(1):38-46. PMID: 490284
Knorr NJ, Hoopes JE, Edgerton MT. Psychiatric-surgical approach to adolescent disturbance in self image. Plast Reconstr Surg. 1968 Mar;41(3):248-53. PMID: 5644617
Knorr NJ, Edgerton MT, Hoopes JE. The “insatiable” cosmetic surgery patient. Plast Reconstr Surg. 1967 Sep;40(3):285-9. PMID: 6037160
Turner, Edlich & Edgerton, 1978
Dept. of Obstetrics, Gynecology and Plastic Surgery, University of Virginia Medical Center, Charlottville, VA, USA
In structure and representation this publication is closely related to the one of Edgerton & Meyer (1973), that is, it is no follow-up study with reliable data. Related are mostly surgical techniques for MFTs and surgical complications. Under historical viewpoints it is an interesting statement that Edgerton was already in 1963 the director of the Johns Hopkins Gender Identity Clinic in Baltimore, MD, while everywhere else the founding of this institution is generally dated two years later. Also it is interesting that a psychologist is given a key role or a veto right to the indication to surgery. For the rest, the necessity for a successful one-year-long “Real-Life-Test” as it was already in Edgerton & Meyer (1973), the experimental surgical breast enlargement is recommended as a step if the patient and treatment provider are insecure regarding the stability of the female identity of the patient. In how far the statement: “The only justification for the ongoing evaluation of surgery as a definite treatment entity is that patients with this condition have proved resistant to psychotherapy and drug therapy” (p. 121) is a general postulate or if the corresponding possibility has been tested with those who underwent surgery is not to be discerned by the publication.
It is reported about 53 gender reassignment surgeries of MFTs that Edgerton made after changing from Baltimore to Virginia.
Forty seven females came to the follow-up study in the first year after surgery. Globally it is said that all were subjectively happy and self-secure and socially better adjusted. “Psychological testing has substantiated these subjective claims” (p. 128). Suicide attempts after surgery or desires to role re-reversal were not observed. Eighteen females had gotten married and six had adopted children.
In the series of the first 20 surgically treated, 14 females required corrective surgery; in the series of the second 20, only eight. The most frequent complication was the stenosis of the vagina. Injuries of the urethra or rectum with corresponding fistulae did not occur.
References
Smith, Harrison (July 16, 2018) Milton Edgerton, trailblazing plastic surgeon for children and transgender patients, dies at 96. Washington Post. https://www.washingtonpost.com/local/obituaries/milton-edgerton-trailblazing-plastic-surgeon-for-children-and-transgender-patients-dies-at-96/2018/07/16/28bcae0a-8836-11e8-8aea-86e88ae760d8_story.html
American Society of Plastic Surgeons (May 22, 2018). Craniofacial groundbreaker Milton Edgerton, MD, passes at age 96. https://www.plasticsurgery.org/for-medical-professionals/education-and-resources/publications/psn-extra/news/craniofacial-groundbreaker-milton-edgerton-md-passes-at-age-96
Morgan RF, Morgan EA (2019). Milton T Edgerton, MD: A Pioneer of Surgery of the Hand. Journal of Craniofacial Surgery: March/April 2019 – Volume 30 – Issue 2 – p 303–305 https://doi.org/10.1097/SCS.0000000000005063
Resources
Archival contact information:
- University of Virginia Medical Center, Gender Identity Clinic, P. O. Box 376 Charlottesville, VA 22908 USA
- Phone: (434) 924-5068
Robert Edward Barham (born January 27, 1942) is an American urologist who served our community.
Background
Barham practiced in Portland, Oregon. He has since retired.
Certification:
- American Board of Urology, 1977
Education:
- B.S., University of Utah, 1964
- M.D., University of Utah, 1969
- Internship, Providence Medical Center, Portland, OR, 1969-70
- Residency, Ohio State University, Columbus, OH, 1970-71; University of Washington, Seattle, WA, 1971-75
Research & Academic Appointments:
- University of Washington, Senior Research Fellow, 1973-74
- University of Washington, Assistant Instructor, 1974-75
- Assistant Clinical Instructor, Department of Urology, Department of Family Practice, OHSU, 1974-Present
Professional Memberships & Appointments:
- Chairman, Department of Urology, Providence Medical Center, 1980-82, 1999-Present
- Physician Advisor, Quality Management Committee, The Good Health Plan, 1997-Present
- Board Member, Inter-Hospital Physicians Association, 1990-94, 1997-Present
- member, IPA Finance and Compensation Committee, 1995-Present
- Member, Credentials Committee, Providence Portland Medical Center, 1994-Present
- Professional Assessment Committee, Oregon Cmedical Association, 1985-Present
- Chairman, Membership Committee, Northwest Urologicial Society, 1998-99
- Member, Board of Medical Directors, The Oregon Clinic, P.C., 1994
- Founding Member, The Oregon Clinic, P.C., 1994
- Chairman, Department of Surgery, Providence Medical Center, 1985-88
- Physician Research for Physician Review Committee, American Urology Association, 1989
- Second Vice Chairman, Providence Medical Foundation, 1986-88
- Member, Specialty Task Force Committee, Providence Medical Center
Providence Professional Plaza
5050 NE Hoyt, Suite 514
Portland, OR 97213
(503) 215-2399 Office
(503) 238-8373 Answering service
(503) 215-2376 Fax Number
Historic contact information
- The Oregon Clinic, Urology Division
- 5050 NE Hoyt St. Suite 514 Portland, OR 97213
- Phone: (503) 215-2399 or (503) 238-8373
- Answering service Fax: (503) 215-2376
- orclinic.com/docs/rbarham.html (through 2004)
Consumer experiences:
My orchiectomy: seven days later
Detailed report one week after surgery by K (2004) /physical/orchiectomy/barham-2003.html
I searched the Internet looking for a doctor who would perform an orchiectomy. I wanted someone of course who is familiar with transsexuals and who was skilled in performing the operation in such a manner that it didn’t interfere with future plans of SRS. One name kept coming up time and again. That of Dr. Barham whose practice is in Portland, Oregon. This is my account of our time together.
I phoned Dr. Barham’s office to inquire about the pricing of an orchiectomy, and his requirements. I was disappointed to find that his office staff stated I needed to supply them with a letter from a therapist stating I’ve been in their care for gender dysphoria, and another from my physician stating I have been on hormone replacement for at least 6 months. And I would need to have an AIDS test ran, also. All these must be submitted, and then verified by the office before an appointment could even be made. This makes it difficult to arrange scheduling plans as I needed to fly in from another state and would need time off from work. Now I haven’t been with a therapist in years for any gender counseling. So to start, I phoned an old therapist and ask “Do you remember me”? She did of course and was happy to write me a letter. But first, I had to inform her of how my life has been going, was I still transitioned, holding a job, and on and on. A good month passed as we worked out the letter details and finally paid her for her time. The physician was an easier task to tackle as he has been over seeing my hormones for years. The AIDS test proved a simple quick preoperative-operative test to have done.
Finally all the paperwork was in and I was able to make my appointment. Another month was required to get everyone’s time rescheduled to coincide and the plane tickets purchased. The doctor likes to have his consultations on Tuesday’s. On Wednesday he performs the procedure, with a follow up exam on Friday. I had plans to fly back home on Saturday and back to work again on Monday. I have to admit to all, there was some soul searching as I considered this step which would leave me totally without. But I found confidence in my decision as I haven’t wanted the testes for years and had been working diligently to block their efforts on my body. With this in mind, I met with the doctor on Wednesday, as I wasn’t able to meet the Tuesday date. Our Tuesday consultation was performed on the phone prior, something the doctor didn’t really want to do. He would much rather meet the individual and explain to them the procedure. I was appreciative that he could accommodate my tight scheduling.
Prior to our visit, the doctor had asked that I wash continually a couple of days before our visit with a Betadine solution so as to help cleanse the groin area. I won’t say on Wednesday when I arrived at the office I wasn’t nervous. First thing I had to do upon arrival was confirm some information on prepared paperwork. A simple quick task. Then I was asked for the thousand dollar payment agreed upon for the procedure. Upon paying that, it was a short wait in the office and I was called in prior to my appointment time. My significant other was allowed to accompany me, for which I was very much relieved. I knew about orchiectomies, what they were and all. Still, I was rather pleased when I was called into his office to meet him and discuss the procedure, and was offered a Valium so as to be relaxed. I debated if I really needed to take such a drug, but agreed to it finally. I suggest it for anyone who can accept this drug. Do yourself the favor and take the pill. While the Valium was getting into the system, he explained in very simple terms what we were going to do. He reiterated the obvious, I couldn’t have children, the procedure can’t be reversed, things like that which I suppose are needful. The time in the office seemed to pass very quickly and I was led to the room where we would have the procedure done. I was instructed to remove my bottom garments but to keep my top on. I had thought before hand about wearing a skirt as no tucking is required with those, and I would have room for movement. But on the other hand, slacks and a blouse might be more practical? There was also much conflict within myself about showing up dressed so feminine for a male procedure! I was surprised how much of a conflict that raised. I decided upon the slacks, and a long blouse which covered up the groin area naturally. This turned out to be the best choice and I do suggest the same for others who are having this procedure.
Right after undressing I got on the table, laid back and placed my knees on the covered stirrup as instructed. He began to shave the area where he was going to work. This is something it turned out that I could have done before hand, but no mention was made of it previously. He washed the area throughly, then covered me up declaring this a sterile zone. It was then his assistant came in and I knew, it was time to start.
He began by explaining he was going to inject a local into the spermatic cords so I wouldn’t feel the procedure. And that he would then inject a local into the scrotum where the incision would be made and he would work from. I saw the 1 1/2 inch needle, but not much more as I was laying on my back and unable see what was happening. He gathered up some skin, pinching off a section of the right cord, and then injected. Oh man oh man that hurts! But the pain quickly passes as the local takes effect. He then moved to the left side and did the same thing. Again, oh that hurts a lot! Then he moved to the scrotum and did the injection there. Oh yes again, that hurt quite a bit. From there on however, the pain is very minimal. Mixed with the Valium, I actually had a smile on my face which the doctor was happy to see. And he did make comments about that too, all of which were pleasant. From this point on it’s difficult to say exactly what was being done. He told me when he opened the scrotum up. He stated when the first testis was removed. He informed me also when the second one was gone. And then when he was suturing me back up again. Upon sitting up I saw what looked to be skinned testes in a shot glass. I asked him, “are those them? They look like you skinned them”? He confirmed that yes, those were them and yes, he did remove the membrane surrounding them. He stated that there is less bleeding and complications this way. Well, OK I guess. It was my hope that all material would be removed, but still, the offending testes were out and would not regrow. During the whole procedure my SO was with me. He stated that he had no idea that the spermatic cords were so large. As he indicated to me their size using his index finger as an example. Wow, neither did I!
I was given instructions as to my care when I got back to where I was staying. That included taking pain pills for which I was given a prescription. I was also to take Ibuprofen, along with regular icing to reduce swelling. I was assured I could phone the office if there were any complications, such as bleeding which would lead to swelling of the scrotum sack. As I redressed in my baggy slacks I made my way to where I was staying and applied the ice. I slept in and out during the day in relative comfort. That is until the local injections had worn off.
Later that evening, about 9:00pm, I examined the work for the first time as everything was very sensitive and painful. I was shocked, the sack was larger then I have ever seen before! And it was so painful I could hardly stand up straight. Not that the sack was in pain, rather it was up higher, in the abdomen. I feared that something was dreadfully wrong and images of the sack full of internal bleeding filled my mind. I phoned his office, getting the answering service to whom I stated I thought I was having complications. Shortly the doctor phoned me back and asked some questions. It was determined that I should return to his office so he could evaluate my condition. Thank goodness because I didn’t want to see an ER room with this! We arrived in good time and found him waiting in his office. I placed myself on the table again, and removed my jammy bottoms exposing myself for the second time that day. He looked, touched, and pronounced that all was well. What I was seeing was just swelling, which was expected. Only I had no idea that I would swell from the point of a scrotum with testes, lets say the size of a golf ball. To that of a scrotum with no testes inside and having swelled to a size that totally filled my hand as I cupped it from underneath. The pain I had in the upper abdomen was caused by the local injections into the spermatic cords. So this is normal I pondered? Is he off his nut I wondered silently? He stated that I should only have concerns if the scrotum filled and became hard. Having a smooth polished look to it with black and blue bruising all over. He assured me that he had only one girl ever that went to the ER with a complication like this. I apologized for disturbing his home time for something ‘normal’ and I went back home dearly wanting that ice pack. Feeling somewhat assured that I was OK and throughly embarrassed by my panic.
It turns out that yes, I must have been okay after all. When we returned on Friday for my post operative exam, he looked his work over and declared that all looked good. I had lots of bruising on the left side, which is where there was still much swelling to be found. He stated that there had been some bleeding while injecting the local that caused that. But that it would go away and all was well. OK I guess so, were my thoughts still. It looked awful and still swollen quite a bit, more then I ever would have thought so. I was still seeping blood on my pads which he also stated is normal for there wasn’t much at all.
Now that I’m home again, and it’s been 6 days following the procedure. There is still swelling. And I must be careful to not lift, push, or struggle with anything as that causes the left side to bruise anew. I’m still taking pain pills, but comfortable all the same. I can now feel the insides and I find the membranes he left behind are hard, and very large. I assume they will shrink again and I’ll gain the small size I once had before and there won’t be difficulty tucking again. For now tucking is completely out of the question, and I must stand to urinate as sitting to do so is painful. With the swelling I find my penis sits on top of the scrotum and isn’t available for pointing down. Again, I’m sure this is a temporary thing, it had better be! I no longer find blood on my pads, but rather a clear deposit. I’m thinking soon I’ll be able to discontinue the use of pads.
To sum up my experience with Dr Barham’s office. I found his staff very professional. There never was any discomfort due to this kind of procedure versus my gender. He is a very likable man and I was comfortable in his presence exposing myself, something I do have qualms about. He was always readily available as were his office staff. Even when I called him out of his home he was pleasant and stated it was best to be sure then to worry and not be seen. I would be confident recommending his services to anyone who is seeking an orchiectomy. It’s also a comfort to know that the way he performs the incision does not conflict with the Thailand surgeons. An option I keep open for myself when the funds become available. I’ve also been assured I have a letter coming which will enable me to complete my birth certificate changes. From that of Male, to Female. Which my birth state has thus far denied me from having.
I’m back alive and well now with Update
by JG (2004) /physical/orchiectomy/barham-2003.html
‘m back alive and well
by JG
We arrived back home Thursday night [7 August 2003]. We had to rough it for most of the trip. We slept in the car while in San Francisco so we could save the motel money for after the surgery. I am still tired and sore, but that is just on the outside… 🙂
The orchiectomy was considerably more painful than I anticipated. I came up off of the table more than once! This was because there was severe scarring and inflammation from a spermatocele that I had removed back in 1993. This had been causing me a lot of pain ever since then, which increased significantly after starting on hormones in 2001.
The pain is completely gone now, though. And I feel wonderful. It is like for the first time, deep inside, something is finally starting to become right. Plus, it is like starting HRT all over again, too! The colors are brighter again! And no more anti-androgens!!! (“psst, hey buddy, wanna buy a bucket of Spiro???”)
2004 update [15 January 2004]
Yesterday Dr. Barham had to go back in and remove more of the cord that had adhered itself inside the inguinal canal. It was causing a lot of pain ever since the initial procedure in August, and multiple cortizone shots were not making things any better.
The procedure was emotionally more distressing than it was physically painful. When he gave me the local injections, the pain that I experienced made it feel like “they” were suddenly back down there again.
I had a very sudden and very intense “body dysphoria” episode. I started crying incessantly. The flood of memories and sudden distress was almost unbearable. At one point Elane said that I was begging him to stop. The pain was too much of a reminder of what I once had.
When the orchiectomy was performed in August, Elane was there, too. She said I showed no dysphoric reaction. I remember crying then, too, but they were tears of relief and an overwhelming sense of peace when I saw the “evidence” there in a shot glass on the instrument tray. Of course, it did hurt a lot physically then, too. But there was no dysphoria.
Thank goodness my precious Elane was there again to comfort me during the procedure. When w were leaving, Dr. Barham almost tearfully thanked her for being there! She later told me that the terrified look in my eyes emphasized to her the importance of what I needed to do.
I feel that this is something that others who are going to have this procedure may want to know about and be prepared for in case they have to go back for follow-up work. Dr. Barham has only had one “re-do” in the past other than me, and Elane said that he had not seen this reaction before. He is also concerned that, with a total of three incisions to date (1993, 2003 and 2004) that any future work there might complicate the vaginoplasty, so we all hope that this is the last time.
Afterwards, Dr. Barham wrote me a letter stating that he had performed “irreversible genital surgery for Julian, which under the standard of care for gender reassignment, allows Julian to change her gender to that of female. This entitles her to the appropriate gender credentialing”
Wow. WOW!
Memo: be sure to tell people to ask him for the letter! And BTW, I fully intend to challenge that new SSA ruling on the requirement of completion of the process before they change the GM. I worked at HCFA (a branch of SSA) as a contractor in the early 1990s, which may or may not be of help. But I will not stop until not only I get my F, but until I find out who and what was respsonsible for this arbitraty (and ultimately discriminatory) ruling. And I will publicize it. Because I can’t imagine it was anything but a purposeful decision by someone in the know with an axe to grind. If either of you have any suggestions, please let me know.
My orchiectomy with Dr. Barham: a sweet and sour tale!
by R. Crosby (2003) /physical/orchiectomy/barham-2003b.html
by R. Crosby
I received this note in October 2003:
Having traveled to Portland from the Buffalo area I met with Dr. Barham the day before the procedure to discuss what I should expect.
He stated I would feel a slight tugging but otherwise no significant pain. Well, while I have no doubt that Dr. Barham believed this to be true it just didn’t happen that way for me.
I felt absolutely everything other than the incision.
From the initial injections in the groin area to the removal of the testicles I felt excruciating pain that radiated up along the inside of my pelvis into my lower back. As the procedure progressed it became that ‘kicked in the balls’ feeling and this didn’t diminish until shortly following the complete removal of the gonads.
While I was disappointed with this I was still glad to have gone to Dr. Barham because he and his staff were incredibly kind and respectful. I have no doubt that he is a skilled surgeon and he did apologize for what he described as uncommon discomfort.
I still highly recommend Dr. Barham and have no regrets having gone there, just be aware that wherever you go for this procedure where you are only given a local … “you takes your chances” with the level of pain you may encounter, regardless of where you get the surgery done.
Pain During Orchiectomy: A Cautionary Tale by J (2002) http://www.annelawrence. com/castrationpain.html
My Orchiectomy with Dr. Robert Barham in Portland, Oregon by Debra Kohlrust (2001) http://www.annelawrence. com/kohlrustorchiectomy.html
The Big O day: my orchiectomy by Robyn Browning (2001) /physical/orchiectomy/barham-robyn.html
The Big O day: my orchiectomy
by Robyn Browning
August 8, 2001 Wednesday
Today I took shower when I woke and scrubbed my genitals with Betadine scrub as Dr. Barham asked me to. Then I got dressed wearing a pair of pants I knew would be easily removed and comfy to wear after my family jewels were removed.
I piddled around at work until about 10:30. I read the book I got from a friend “Urologic Surgery” and found that the section that covered the radical orchiectomy was just one page long.
My fiancée, Georgiana, messaged me about 10:30 and asked how I was doing (emotionally/psychologically). Instead of sending a return message on the computer I called her on the phone and told her that I was doing really badly, and started to huff like I was about to break down and cry and I acted as though I wasn’t sure that I could go through with the procedure.
She replied to hearing this with “Oh, baby…” in a tone of sympathy. I abruptly interrupted and said “Nah, just kidding.” I followed explaining that as the last couple hours counted down that I was really fine with the procedure and ready to get it over with. We talked and finalized our plans for lunch. I had expected to be nervous, but as the time approached I felt ready and sure.
Karen from downstairs came up for a rest break and gave me a hug wishing me good luck on the orchi. That was really sweet of her I thought and I wished her luck on her upcoming IUD procedure.
Georgiana and I met at 12:00 for lunch. I carried down a bunch of stuff from the office I thought I could work on while I would be recovering. We went to Big Town Hero and grabbed lunch. We walked over the two blocks from my office to the water front and sat down to eat under the large shade trees.
While we ate I took my Valium that I had been saving for two months. I was going to smoke some pot too for extra relaxation but we forgot the lighter. I had read accounts of this procedure being very discomforting and painful. I was not looking forward to that part.
We then drove over to Dr. Barham’s office. It was only twenty mintues from my office. I told the receptionist my name and that I had an appointment. She knew instantly what I was there for. I also said that on the phone when I made the apointment to remind the nurse ‘something about a pill before hand’. I knew it was another Valium.. hey the more the merrier, I thought.
G and I sat down and a couple minutes later a blonde nurse came into the waiting room with a pinkish pill and a glass of water. I swallowed it down too. Yum… Valium. By this point I don’t think passing tornado would have phased me. I was feeling really mellow.
It wasn’t even ten minutes and the nurse poked her head out the door and called for “Robyn”. Hmmm, that must be me.. the old guy to the left with the urine bag doesn’t look like a “Robyn”. I asked if Georgiana could accompany me and she said it was Ok.
So George and I walked down the hall to the room where it would be done holding hands all the way. We sat in the two chairs that were in the tiny room. We were left alone for a few minutes. There was a window, a table and drawers in front of the window, a medical table with stirrups and white towels wrapped around the knee part of the leg stirrups, two chairs in which we sat. To the left was “the table”, a surgical pack wrapped in blue fabric fresh from the autoclave sat on small stand at the foot and to the side of the table.
I got up after a minute feeling a bit fidgety and peaked into the drawers… seeing if there were any cool medical toys to play with. G verbally shunned me for being curious. About the time that I shut the drawers and sat down Dr. Barham came in followed by a nurse. He greeted Georgiana, sat down on the stool at the end of the table and asked if ‘I was ready to do this’. I replied to him that I would not be sitting here if I was not ready and smiled broadly to him. Honestly, I almost felt like his question was a joke. I had stewed on this decision for weeks. Yes, by the gods, I was wholly ready to do this.
He asked me to get undressed. I asked if he meant everything or just the pants and underwear…he said that was it.. I could leave the top on (thank goodness), just they lower bits.
After doing this G moved her chair to the head of the table and I had climbed up on it. Dr. Barham asked me to place my butt on the metal plate on the table at the foot of it with white lines of goo on it then to place my legs in the stirrups. Now that boys and girls was a new, frightening and yet interesting experience for someone who has never placed their legs on medical table stirrups. I tried to ease back. My butt slid on the metal plate that was covered with it’s white conductive jelly goo.
I was scrubed thoroughly with more Betadine. They didn’t need to shave as I had done a great job of shaving that area that morning. Doc reach out and took my scrotum in his hand and started to feel out the cord of my right teste and found a point high up… above the top edge of the scrotum and but still able to feel the cord. There he made a couple injections deep into tissues and into the cord and injected Lidocaine. The injection, to my surprise, didn’t hurt. There was a tiny prick but that was it. It hurt I tiny bit, but not even enough to say “ouch”. I never really noticed my testes getting numbed. He repeated the procedure on the left side. Next he told me he was going to inject the scrotum where the incision would be. I had heard in previous accounts that this hurt the most. For me, however, it was no more or less discomforting than the cord injections. I had expected much worse. I had Georgiana’s hand as he began the incision to remove my “manhood”. After the initial scrotal incision he used the cautery tool to cut and cauterize through the tissues that held the teste inside the end of the course, a thin, yet strong fibrous tissue and muscle on the distal end of the teste.
I heard accounts from other people who had orchies saying the room stank of burning flesh, however, I could really only smell a faint odor from the cautery and I would not have called it burnt flesh or any such thing. Organic yes, but not vile.
As I realized that I couldn’t really feel a damn thing, I just had to sit up and watch what he was doing. I was surprised to see the cord and all was as thick as it was. From what I could feel all my life through my own scrotum the cord didn’t seem so large and thick. As I had read the book ,Urologic Surgery, the night before I asked Doc a few questions about what he was doing like “Are you doing to suture the primary teste artery to the ligament so you don’t end up with advanced arterial retraction that could lead to hematoma post op?” He said that he would. Turns out he was using 2-0 SAS instead of the 3-0 SAS suture I had anticipated. Personal choice I suppose, I would have gone with 3-0 I think.. but then I wasn’t looking at the cord at the time so tissue friability would matter.
The doc finally had to ask me to lay down as I kept myself propped up on my elbows trying to see what he was doing. Years studying and working in medicine will do that too you. I have such a deep scientific curiosity. I was propped up so much and so fascinated that I hardly held G’s hand during the procedure.
The same removal and cautery process was used on the left side. This time as he was about to ligate and cut the cord I could actually feel the cord being pulled on deep with in my lower abdomen. The tugging could be felt someplace deep in the center and toward the back. It was not painful, but not a wholly comfortable experience either. Nothing to be scared of that is for sure.
Before I knew it the last teste was removed.
This experience ended up being more like a science field trip than the deeply emotional process and surgical amputation I had expected. I was more curious than anxious, scared or in pain.
Dr. Barham made subcu SAS sutures which was really nice. It means it will not be necessary to return to have the suture removed. Also they tend to hold better, cause less scaring and are less likely to get infected. They take a little more time to do than regular mattress sutures and tiny bit more patience and skill but are the best in the long run. I was pleased to see him use that suture.
Dr. Barham had placed both testes into a small glass container that looked very much like a shot glass on would take tequila shots with. When he had finished the procedure I asked him if he could put “those” in 10% formalin for me to take home. I thought that was a long shot request… but he was like “Sure” and the nurse got a specimen jar for me and he placed them in there. Pics
Dr. Barham wiped up the mess on me that had been made and placed some cotton on my incision line. I stood up, took a paper towel from the Dr. and wiped the conductive goo from my buttocks and put my panties and pants back on. I was surprisingly pain free immediately after the procedure. I could no more tell if I had testes or not.
When we left to pay the receptionist she asked if I could would like a brown bag for “them”. I told her I would very much like a brown bag. The idea of walking around with my testes in a clear jar visible to the public is simply really bad form. We left and walked down the hall remarking that I was in fact, in reality, was this very moment, holding my own testicles in my right hand. I was really tripping on that concept.
We drove from the Dr.’s office my work to print off some invoices. I was surprisingly mobile still but starting to feel pain. Then we drove to the pharmacy to get my meds. But his time.. some 40 minutes later I was really quite needing my pain medication. I went in with Georgiana thinking that they may want to verify who I am before giving out the script and I didn’t want any delay caused simply because I sat in the car and didn’t come in.
The woman was quite prompt as I think she could read the expression of pain on my face. I took a pill as soon as I could.
We drove home and I immediately hit the sack to lay down. I stayed that way until late the next day. I got up to pee a couple times and found that pushing when I had to go number two only caused greater pain than before. So potty had to come slowly and naturally.
48 hours post op:
Up, mobile and feeling little pain, only mild discomfort. Minor swelling.
72 hours post op:
Decided to be active and ran around town shopping.. got sore.
96 hours post op:
Less active. Had to take a pain pill and get off my feet.
120 hours post op:
Quiet day, wore too tight of pants all day, was at work. Mild soreness. Walking fine. Occasional momentary instances of pain that come quickly and leave just as fast.
142 hours post op:
Noticed a throbbing bulge appear in my right teste blank spot. Feels like the artery end inside the sutured cord has blood some and the closed cord has swollen a little. Reducing activity, wearing lose clothing, no aspirin, only Ibuprofen. Seems ok by night.. Swollen but stable, mild throb once periodically.
11 days post op:
Majority of swelling is gone. Only minor soreness when pressure is applied directly to the area of the cord. No further swelling. Very active and can wear almost all my clothes. The firmness of the remaining swelling prevents good tucking of the penis back:
14 days post op:
No sensations of pain. Only soreness when pressing on the area of removal. Incision is mostly healed. Tiny bit of suture where it was tied is visible and should fall away in about another week. Occasional itching due to the suture and the body breaking it down. Feeling great overall. Glad to be off the anti-androgen pill.
Emotional state:
All in all feeling wonderful that I had it done. They are gone. I fell them gone. I can feel the absence of T in my body. No more Spiro than the gods. Wonderful procedure. I should have been less active for one week.. my fault for the later swelling. Highly recommend procedure for suitable candidates. I expected to have a decrease in sex drive but have experienced none. In fact feeling more sexual now. Having had the procedure has taken a lot off my mind and feel freed to think about other things. I can still be become erect when stimulated and that discovery surprised me. It’s interesting to see that sexual function and sex drive are not both uniformly controlled by the amount of testosterone in the body. In just one week I have seen a slight increase in breast fullness and overall size. I’m 110% pleased about having the orchiectomy.
Cost $750.00 Total. Procedure time under 1 hour. Recovery really, one week for 60% reliable ability, mobile but not with great exertion, i.e…. no running, lifting, etc.
Robyn Browning
Addendum: August 16, 2001
I am still not able to tuck things out of the way due to the swelling that remains in the sac at the in end of the cord. All my pants and slacks fit snuggly in the groin and not being able to tuck is really limiting my options. I have only minor pain now… and it is brief. The middle and lower back part of the scrotum hangs down in a funny fasion. More accurately it hangs in an empty fassion. A word of advice is to STAY INACTIVE for at least a week after the procedure. I a small hematoma internally due to the fact that I was feeling better after a few days and got up and was doing all kinds of stuff. DON’T. I’m lucky my sac didn’t fill up like a purple orange. I feel great though. Sex drive is still intact.. adjusting to high dose spiro long term really helped me I think. I can even get erect manual and orgasm. That was a big surprise that I could still do that. Though there is zero fluid coming out. I expect over time even manual stimulation will fail.
Addendum: October 21, 2001
That tucking issue has long be put behind me. As the internal swelling has gone and the scrotum has contracted I can now *cough* put things away much easier. Jeans fit better and there doesn’t seem to be much to hide. I’m so please to have had it done. Interestingly, my sex drive has dramatically increased after stopping anti-androgen therapy and having the orchiectomy.
