School of Medicine, The George Washington University, Washington, DC 20037, USA.
J Sex Med. 2012 Apr;9(4):1216-9. doi: 10.1111/j.1743-6109.2011.02621.x. Epub 2012 Jan 12.
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.
We compare the financial and psychological costs of elective surgical orchiectomy vs. self-castration in the case of a transsexual woman in her 40s.
We interviewed the patient and her providers and obtained financial information from local reimbursement and billing specialists.
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 U.S. $14,923, which would compare with U.S. $4,000 for an elective outpatient orchiectomy in the patient's geographical area.
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.
对于选择进行睾丸切除术的跨性别女性来说，手术费用通常不在健康保险范围内，这是她们进行身体性别转变的一个重大障碍。除此之外，还有其他障碍（如无法找到愿意进行手术的外科医生、等待时间以及潜在的心理和精神状况），导致一部分跨性别女性试图自行阉割。目前，关于自我阉割对患者和医疗保健系统的经济成本和影响，相关信息发表得很少。
我们比较了一位 40 多岁的跨性别女性选择手术睾丸切除术和自我阉割的经济和心理成本。
我们采访了患者及其医疗服务提供者，并从当地报销和计费专家那里获得了财务信息。
在自我阉割后出现轻微出血后，我们的患者前往急诊室，接受了双侧腹股沟探查、结扎和双侧精索切除，以及复杂的阴囊探查、清创和缝合。她因需要住院三天而被收入精神科。总账单为 14923 美元，而在患者所在地区，选择性门诊睾丸切除术的费用为 4000 美元。
从经济角度来看，对于医疗保健系统来说，选择性睾丸切除术的费用可能明显低于因相关额外费用而导致的住院费用。从患者安全的角度来看，选择性睾丸切除术优于自我阉割，因为后者存在严重的风险，如出血、毁容、感染、尿瘘和神经损伤。跨性别女性的医疗服务提供者应仔细探讨患者对自我阉割的态度，并努力改善选择性睾丸切除术的途径，以减少自我阉割的数量和对整个医疗保健系统的成本。需要从不同的医疗保健系统和一系列患者中进一步研究自我阉割的经济影响。
