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7091876 
Journal Article 
Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report 
St Peter, M; Trinidad, A; Irwig, MS; , 
2012 
Yes 
Journal of Sexual Medicine
ISSN: 1743-6095
EISSN: 1743-6109 
WILEY-BLACKWELL 
MALDEN 
9 
4 
1216-1219 
English 
22240147 
WOS:000302071600029 
Introduction. The out-of-pocket cost for an elective orchiectomy, which is often not covered by health insurance, is a significant barrier to male-to-female transsexuals ready to proceed with their physical transition. This and other barriers (lack of access to a surgeon willing to perform the operation, waiting times, and underlying psychological and psychiatric conditions) lead a subset of transsexual women to attempt self-castration. Little information has been published on the financial costs and implications of self-castration to both patients and health care systems.Aim. We compare the financial and psychological costs of elective surgical orchiectomy vs. self-castration in the case of a transsexual woman in her 40s.Methods. We interviewed the patient and her providers and obtained financial information from local reimbursement and billing specialists.Results. After experiencing minor hemorrhage following the self-castration, our patient presented to the emergency department and underwent a bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, and complicated scrotal exploration, debridement, and closure. She was admitted to the psychiatric service for a hospital stay of three days. The total bill was US $ 14,923, which would compare with US $ 4,000 for an elective outpatient orchiectomy in the patient's geographical area.Conclusions. From a financial standpoint, an elective orchiectomy could have cost the health care system significantly less than a hospital admission with its associated additional costs. From a patient safety standpoint, elective orchiectomy is preferable to self-castration which carries significant risks such as hemorrhage, disfigurement, infection, urinary fistulae, and nerve damage. Healthcare providers of transsexual women should carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy to reduce the number of self-castrations and costs to the overall health care system. Further research on the financial implications of self-castration from different health care systems and from a series of patients is needed. St. Peter M, Trinidad A, and Irwig MS. Self-castration by a transsexual woman: Financial and psychological costs: A case report. J Sex Med 2012; 9: 1216-1219. 
Self-Castration; Transsexual; Orchiectomy; Cost; Sex Reassignment Surgery; Economics