Requirements

In order to be accepted as a patient for Orchiectomy, Dr. Movagharnia requires a letter written by the patient to him explaining as why he wants to have Orchiectomy. This letter must indicate the true reasons for such a request and also in the letter,you need to write that you are aware and understand all of the complications associated with the Orchiectomy surgery and post Orchiectomy surgery and the risks of not having your testicles post surgery in short and long terms.You must also understand and declare that you know this procedure is NOT reversible and in order to replace the missing Testosterone not available because of Orchiectomy, you will need to be on hormonal replacement therapy.

REQUIREMENTS - PRIOR TO SURGERY

SOCIAL HISTORY - All patients must follow the Standards of Care for Gender Identity Disorders (http://www.hbigda.org/soc.htm) developed by HBIGDA ( Harry Benjamin International Gender Dysphoria Association) (http://www.hbigda.org) before they can have their operation. If you have taken hormonal therapy, you also need to indicate when it was started. We would also like to know how long you have been living in your non-biological gender role. Other information should include your recent employment history, relationship status, etc. We would like to have a photograph of you to place in your file to help us recognize you upon your arrival. Application is available here in PDF Format.

MEDICAL AND SURGICAL HISTORY - Please indicate any medical problems that you have or have had along with past surgeries. Use the Medical History Form available on this website in PDF Format.

GENITAL HAIR REMOVAL - Hair grows in cycles of 13 weeks so all cannot be cleared at one time. With that in mind, we strongly recommend that you have laser hair removal/ electrolysis of your scrotal area prior to your surgery.

Although during your surgery I try to clear hair follicles from the scrotal area, there are always hairs that cannot be removed, and so hair removal is suggested prior to surgery. The recommended areas to have hair removed are:

The scrotal sac (most important). Follicles will be scraped and zapped during surgery, but hair growth cycles prevent us from getting all of the dormant hair.
The central 2/3 of the scrotum is most important. Leave some along the sides for scar cover-up. You may wish to taper the bottom portion down to a point 1 inch above the anus.
The penile shaft (important)

In my opinion, it is the penile shaft and the scrotal areas that are most important as these are uniformly utilized to create the female vagina. Remember to plan ahead since you will need multiple treatments over a 5-6 months period to ensure Effective and permanent hair removal. Please make sure you stop using hair removal treatments at least TWO weeks prior to your GRS to permit the area to heal and recover. Also, remember that no matter how well your surgery goes, there will be two scars running along each large labia. These will be nicely covered by hair - so the hair on the outer scrotum and higher than the shaft should be left intact for maximum coverage.

PSYCHIATRIC EVALUATION - Per HBIGDA Standards of Care, two (2) psychiatric evaluations must be provided, usually by a psychologist or psychiatrist or someone working in the field of clinical sexology, with recommendation for surgery. For patients who have been living full-time for more than five (5) years, with well-documented real-life experience, a second letter may be waived with prior approval by Dr. Fara Movagharnia. In general, Dr. Movagharnia is required by the
hospital and insurers to require two letters of approval, particularly for those with real-life experience of less than five years. Please be sure your letters of recommendation are received by us no less than 3 weeks prior to your surgery date.

SUITABILITY FOR SURGERY - Please note that the final determination indicating acceptance for surgery is made by Dr. Movagharnia, usually no later than the day prior to surgery. Consultation prior to setting a surgery date is offered if you are in the area.

Acceptance criteria include:

a) Weight less than 210 pounds.

b) Non-smoker (unless specifically accepted by Dr. Movagharnia). For smokers, tissue healing is truly poorer and the risk of surgical complications greater.

If you are over 45, please provide us with a copy of an EKG performed within 6 months of your scheduled surgery. If you are unable to provide a copy, you will need to have an EKG performed at our hospital, for which there will be additional charges for the EKG and a professional fee from the cardiologist who is reading your EKG. You will be billed separately for these charges.

Surgery simply takes longer in heavier patients and puts you at greater risk for complications. If you arrive greater than this weight, you risk postponement, and you will be charged our indicated fee for cancellation of your surgery. Please read and inquire about our cancellation/postponement surcharge policy.

We require TWO letters of recommendation, per the HBIGDA Standards of Care. Our rigid adherence to a standard of care allows Dr. Movagharnia and the hospital to retain insurance for this important, but still rare, practice of medicine.

HIV STATUS - Please send an HIV result from an accredited laboratory performed no sooner than 12 weeks prior to surgery. HIV status, however, is not a pre-requisite for acceptance or rejection for surgery. If you have not sent us an HIV test result, you will have to perform this test locally at your cost and that may delay your surgery.

SKIN GRAFTING - The need for non-scrotal skin grafting to create the neovagina is necessary in no more than 5% of cases. However, this determination does need to be made at the time of the clinical evaluation and is an additional $1000.00 (possibly more as the cost of supplies varies). Skin from the scrotal sacs is preferred as the graft-donor site and allows us to almost always have enough skin to achieve suitable vaginal length / depth. Grafted skin from the lower abdomen, buttocks, or Repliform (http://www.lifecell.com) is subject to an additional fee.

If you do consider yourself to be on the unusually small size, or have specific requirements or expectations for post-surgical depth please include that information in your medical history and consider a consultation with Dr. Movagharnia.

You will need to arrive in Atlanta at least 1 day prior to surgery for a pre-operative consultation performed at that time with Dr. Movagharnia. This will need to be arranged with our office in advance. There is a consultation fee which will be deducted from your surgical fee.

Want to schedule your surgery? Please use this Application Form in PDF Format when sending in a deposit for surgery.

Have a date set? Please submit your Medical History Form in PDF Format at least one month prior to your surgery.

Already started your countdown? We have put together a GRS/SRS Checklist for you to make sure you have got everything, in PDF Format..