Unfortunately, my testicular implants didn’t work out and both had to be removed 10 weeks after they were put in. While I’m working to keep it all in perspective I’m still pretty crushed about this and don’t know yet what my next move will be.

Within a few days of having them put in, I noticed that the left implant (size large) had moved out of position, despite having been sutured in. I could feel the silicone “tab” at the top of the implant, where the suture goes through it, pushing forward. Within a few weeks, the implant was sitting at a 45 degree angle, with the top jutting forward painfully. The right implant (size medium) sat between my legs, completely invisible.

I was in near constant pain from the left implant. The pressure from it had created a painful, red “hot spot” on my scrotum and the skin there was really thin and getting thinner daily. The only part of my scrotum that wasn’t between my legs was that hot spot.

I sent Dr. Berli photos and he said that it was only a matter of time before the left implant would extrude through the scrotum. This made me feel pretty anxious! Where would I go for help if it did?

Dr. Berli initially wanted me to have implant removal done locally in case there was an infection, as I wouldn’t have insurance coverage if I needed to be hospitalized for an infection in the US. However, no one in BC was available or willing to remove the implants.

I had scarier looking things happen after stage 1 and stage 2, but I was close to OHSU which was reassuring. Being hours away—and on the other side of a border—from my surgeon and having no surgeons in BC available to help was not a good feeling. Even my local ER, which would be a last resort, is not accessible to me at night due to my remote location. My doctor was less than helpful through this, disagreeing with Dr. Berli’s assessment—despite having never heard of testicular implants before!—and refusing to send out multiple referrals for me as TransCareBC has recommended to expedite the search for a provider who could help, because it was “too much paperwork.” I emailed Dr. Berli and asked him to reconsider and take the implants out for me. After all, I’d been on antibiotics for almost a week with no sign of infection. He agreed.

I was relieved but heavy-hearted as I made my way back down to Portland. I was about to lose my hard-earned balls! Limping from the pain, I went for a slow, sad walk by the water before my appointment with Dr. Berli.

Dr. Berli removed both of the implants in the clinic OR. (Like the length reduction surgery that I had in March, I was awake for this procedure.) While the right implant wasn’t extruding, its positioning between my legs instead of out front was prohibitive to cycling (I tried, total fail!) and visually disappointing. I didn’t see the point in keeping it if it was going to keep me off my bike, and the appeal of a uniball just wasn’t there.

It was quite a relief to have the implants out and not have the pain or the worry of the left one bursting out of my scrotum on its own timeline! Healing from the removal went OK. I had an expected month-long rash from the glue that was put on the incisions (I got the same glue rash when the implants were put in) and some residual pain for about 6 weeks.

Now I have an empty sac and not very much can be done about it.

The source of the problem you see, isn’t the implants, it’s my scrotum. It’s between my legs, tethered too far back on the perineum, not out in front of my legs as it should be. Despite the fact that my scrotum is on the large side, you can’t see it at all.

While smaller implants would have been more appropriate than the medium and large that were put in, I might not have ever been a candidate for implants at all because of the positioning of my scrotum, plus an active lifestyle. (Apparently Dr. Bluebond-Langner, the gender surgeon at NYU, said there’s only a 45-55% chance that the scrotum will be out front after scrotoplasty. So, I imagine there are plenty of post-phallo people out there who have balls between their legs, but if they don’t have an active lifestyle it might not bother them so much.)

The only way that I could attain my goal of having a visible scrotum that is out of front of my legs would be if I have a fairly extensive scrotal lift surgery and then have implants put in again in another surgery. However, Dr. Berli said there’s a chance that this could negatively impact my urethra. As far as I know, Dr. Berli has never done a scrotal lift but Dr. Curtis Crane has done many, so I asked him about this. He said that he’s never gone into the urethra doing a scrotal lift. The thing is though, wound breakdown and infections can happen to anyone, regardless of who is doing the surgery. The payload of that kind of complication could be a fistula, and in turn, that could develop into a stricture. I would never forgive myself if I went forward with a scrotal lift and then had urethral complications. The successful urethroplasty was my highest priority with Phalloplasty and I never want to forget that.

If I did choose a scrotal lift, who would do it? I think my choice of surgeons would be limited by insurance to the new team in Vancouver and as far as I know, they’ve never done a scrotal lift either. Dr. Crane has that experience but he’s not familiar with the anatomy of how my urethra was constructed (he and Dr. Berli use pretty different techniques.) Ideally, I could continue my care under Dr. Berli but I think it would be hard to secure that funding given that he doesn’t have significantly more experience performing scrotal lifts than the Vancouver surgeons.

If I did get a scrotal lift and it was successful, would I get implants again? Yes, but I would want solid silicone implants rather than the Coloplast saline filled implants that were put in. The Coloplast implants felt squishy enough when I had them in my hands at my pre-op appointment but in my sac they felt too hard and I didn’t like that I could feel the tab at the top and the little depression at the bottom. Honestly, they just felt plastic and fake to me. Dr. Berli told me that as a cyclist, I would have been better off with the solid silicone implants as they are squishier, but they are not FDA approved so OHSU only allows Coloplast to be used. (<- This is no longer true. Dr. Berli now also offers Implantech solid silicone implants.)

Is there anything I could do without getting a scrotal lift? Dr. Berli suggested that I might benefit from serial fat grafting into the scrotum. This wouldn’t create “balls” and it would need to be done several times to achieve a consistent volume, but it could fill out the sac a bit more yet remain squishy enough that it shouldn’t be an issue with cycling. He can do this in the clinic OR (no sedation) so I wouldn’t have to go through insurance, which wouldn’t cover this anyway.

What if I do nothing at all? In that case, I would have to mentally adjust to not having balls or a visible scrotum—hello dysphoria! (I would also continue to have to squeeze my scrotum to get rid of post-void dribble. Unexpectedly, the testicular implants completely solved the issue of post-void dribble for me, presumably because they changed the angle of the urethra. That was a big bonus! Without them, I have to squeeze my scrotum at the end of peeing, otherwise about a teaspoon or two of pee gets trapped in the perineal part of the urethra and then leaks out later.)

At this point, I don’t think I will be getting a scrotal lift because it just seems too risky. Sometimes I lean toward the fat grafting but then I wonder if it’s even worth it, knowing that it probably won’t result in a natural looking scrotum. Maybe Dr. Berli will have come up with some ideas by the next time I see him.

I’m disappointed in myself for not doing more research about scrotoplasty and testicular implants before surgery. Could extra knowledge have changed anything? Maybe. When Dr. Berli said my scrotum was large enough to accommodate one medium and one large implant, I could have suggested small implants instead. Apparently, small implants are recommended by other surgeons when the scrotum is not forward enough. (I didn’t know this at the time.) There’s a chance that the extra skin, not being filled with larger implants, could have enabled me to pull my scrotum forward to ride my bike, and with smaller implants I wouldn’t have had the extrusion complication. Those small implants looked like grapes though and I’m not sure I would have been satisfied with them. Going back to last fall… what if at my pre-op appointment for Stage 2 I had brought up that it was really important to me that my scrotum be out in front of my legs, not only for cycling but to also be more anatomically correct? If I had pressed the issue would the surgery had been done differently? Impossible to say, but Dr. Berli let me know that he updated his scrotoplasty technique to bring the scrotum more out front a week after I had my implants removed. Bittersweet.

I’m trying to focus on the positive results from my surgeries. After all, I got through five surgeries in a year fairly well, and I got a penis that I can pee out of! That is really great!! But I can’t deny that I’m bummed about losing my balls. I was really hoping that these surgeries would allow me to focus on other things in life but the disappointment from this last surgery looms large. I wonder if I’m going to be able to let this go or not?