The Journal of Sexual Medicine recently published a report entitled “Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report.” In it physicians from the GW School of Medicine and Health Sciences discuss the case of a transsexual woman who presented to the emergency room hemorrhaging after undertaking self-castration.
Unsurprisingly, the researchers found that the health care costs associated with treating a patient after self-castration were almost four times greater than if they had undergone an elective outpatient surgical castration.
In this particular case the patient had to undergo emergency surgery including bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, complicated scrotal exploration, debridement, and closure. The patient was then admitted to the psychiatric service for a hospital stay of three days. The total bill was $14,923, rather than the $4,000 it would have cost for an elective outpatient orchiectomy in the patient’s geographical area.
So what on earth would make a patient do this? According to the authors, the out-of-pocket cost for an elective castration are not covered by health insurance. Additionally, lack of access to a surgeon willing to perform the operation, long waiting times, and underlying psychological and psychiatric conditions may lead transsexual women to attempt the ultimate act of self-mutilation. Patients are often frustrated at the slow pace of their male-to-female transition or lack the money to make it.
But as this report demonstrates, from a financial standpoint, an elective orchiectomy can cost the health care system significantly less than an emergency hospital admission. 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.
The authors urge healthcare providers of transsexual women to carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy.
Additionally, in order to reduce the number of self-castrations, Word on Health suggests that more urologists who are willing to perform surgery on transsexuals should be identified and more pressure needs to be put on health care insurance companies to cover the procedure.