Gender-Affirming Self-Orchiectomy in a Nonbinary Patient

Self-orchiectomy is a rare occurrence primarily documented in the context of psychosis. We present the case of a nonbinary individual without psychotic symptoms who performed self-orchiectomy to alleviate gender dysphoria.

An adult nonbinary individual who was assigned male sex at birth presented to the emergency department after removing their testicles several hours earlier. Psychiatry was consulted to assess capacity to refuse testicle reattachment. There was no psychosis, substance use, or suicidal ideation. The patient verbalized all necessary criteria for decision-making capacity. Urology performed wound closure, and the patient was discharged.

Few similar cases in the existing literature discuss capacity assessment following self-orchiectomy in nonbinary patients.

While our patient recovered, self-surgery is dangerous. This case illustrates that self-orchiectomy is not limited to cases of psychosis or substance use and emphasizes the importance of broad access to gender-affirming care.