A few weeks ago, as my testicles were being palpated during a routine annual exam, my doctor said the word “cancer.” Granted, he preceded that word with “I don’t think that this is” but the fact that he uttered it at all filled the days between my visit to his office and the ultrasound he recommended with thoughts I’d never before entertained. Those novel thoughts weren’t chiefly about worst case scenarios—I quickly learned that the odds of surviving testicular cancer are around 95 percent—but about whether I would, should, or even could get a get a testicular prosthesis installed in the event that one of my own balls needed to be removed in a procedure called an orchiectomy.
The prospect of losing a testicle is a terrifying one but early on in my frenzied internet research I was heartened to learn that one healthy testicle can readily compensate for a missing hammock-mate and produce a sufficient amount of sperm and testosterone. Even in the event of a double (bilateral) orchiectomy, testosterone therapy can help restore a man’s sex-drive and function.
From more white-knuckled googling I learned that: Testicular prostheses are indeed a thing; a handful of different sizes and types are manufactured by a small number of companies; and an implant itself can cost between $2500 and $3500, not including installation. What I didn’t learn was whether my Affordable Care Act freelancer’s health insurance would cover a synthetic testicle and the surgery required to put it in.
Over live chat, the company’s representative told me I’d need to give them a Current Procedural Terminology code in order to get an accurate answer on that front. (The American Medical Association regulates these “CPT” codes in order to communicate uniform information about medical services and procedures among physicians, patients, payers, and others for administrative, financial, and analytical purposes.) Minutes later I realized that even if it was ostensibly covered, my $7,350 annual deductible would likely mean that I’d bear most or perhaps all of the cost of an ersatz bollock.
The more I read about what could potentially lie ahead for me, the more I felt a dull ache in my scrotum and lower abdomen. The pain got worse by the day and didn’t abate until the results of my ultrasound suggested that whatever the mass on my left testicle was, it bared none of the hallmarks of cancer. I was, of course, incredibly relieved. But my questions about the prospect of getting an implant remained. Through an RFI I posted on Facebook, I connected with friends and friends of friends who were given the option of having a testicular implant. I wanted to know how the choice was presented to them and what influenced their decision. They asked me to identify them by their first name only.
Jamie, an old friend I hadn’t seen since the mid-00s, had a testicular cancer diagnosis in the weeks after September 11th, 2001. While shaken by his diagnosis, the then 29-year-old resolved to try and find the humor in his situation.
“It was a self-defense mechanism but it was a pretty effective one,” he tells me when we reconnect. “So I’m sitting there, three days after I know that it’s cancer and the doctor starts talking about an implant and I’m thinking: ‘An implant for what?’ He says: ‘I don’t really recommend this, but I want you to know your options.’ Then he hands me a pamphlet for neuticles: prosthetic testicles for neutered pets. I just laughed in his face.”
Jamie’s orchiectomy took place at a strange time in the nearly 80-year history of testicular implants. The first testicular prosthesis—made from a metal alloy called Vitallium—had been implanted in during World War II and in the two decades that followed, a number of other materials were used including lucite, Plexiglass and polyethylene. In the 1960s, silastic, and solid silicone rubber prostheses were used and by 1988, a silicone-coated product became the standard device.
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In 1992 however, the FDA halted the production of silicone gel-filled breast implants due to worries about connective tissue disease and immune diseases due to something called “gel bleed." Because of these concerns, silicone-filled testicular implants were voluntarily withdrawn in 1995. From the mid-nineties through the early-noughties, getting a nut made for a mutt was the only option available to Jamie and thousands of other men who were minus one or both testicles.
“Getting an implant was the farthest thing from my mind anyway,” he continues. “But I sure as hell wasn’t about to have a fake ball made for non-human use put into my body.”
While Jamie had no real concerns about becoming what he calls a “uniballer” post-treatment, other men had plenty. Paul Turek, a men’s health and fertility specialist practicing in both Los Angeles and San Francisco, tells me about a case in which the FDA threatened to revoke a physician’s license after they got wind of his intention to put a neuticle into a human patient.
“The patient went to the press and that’s how I became involved,” he says.
In leading a five-year study that began in 1997, Turek helped develop the first and only implant approved by the FDA for use in the US. Had Jamie’s diagnosis come a year later, he would have been given the option of having the silicone-shell, salt-water filled testis prosthesis fitted but he tells me he’d still have passed. Jamie was already living with his future wife; a woman with whom he would later have two children and who also considered a fake testicle to be surplus to requirements. In addition, Jamie maintains his pubic hair camouflaged any discernible visual difference and he’d never been particularly fond of having his testicles played with anyway.
“I wouldn’t have had an implant put in but I guess I could see why guys who are going to have new partners would be more open to the idea,” he says.
Unlike Jamie, the next two guys I speak with were single and dating at the time of their orchiectomies. The removal of Oscar’s testicle was not the result of a cancer diagnosis but due to a mishap with a giant slingshot while on a camping trip in 2012.
“We were launching rocks and the thing misfired,” he explains. “I got rushed to hospital and when I woke up I was told that my testicle couldn't be salvaged.” The doctor went on to tell Oscar that should he want an implant in the future he could have one put in at any time and he wouldn’t have to pay a penny for it. Oscar is Canadian.
“I was pretty nervous when I had sex with new partners,” he tells me. “I guess you could say it gave me some stage fright. But I met my current girlfriend soon after this all happened and I haven’t thought about it much since.”
Bryan, who had a cancerous testicle removed at about the same time also declined to have a implant. “I definitely considered it,” he tells me. “In my experience, partners either don’t notice that I’m missing one, notice but don’t say anything, or look up at me and say ‘are you okay?’ To which my response is: ‘I’m fine. Let’s carry on and I’ll tell you all about it afterward.”
The only time Bryan is cognizant of his missing ball, he tells me, is when he’s taking a picture of his junk. “You have to get the angle just right or it looks more like a uvula than a nut sack,” he says. “But other than that, I’m cool with it. And I can have one put in whenever if I change my mind but I think they’d have to have one that does something cool for me to be really interested. Like, one that doubles up as a wifi hotspot.”
Though an orchiectomy doesn’t seem to be in my immediate future, I can’t help thinking that unlike the three guys I spoke with, I would definitely opt for an implant had I found myself in their situation. “Our published study on testis implants showed that they were not simply cosmetic in nature,” Turek says, which helps to make me feel a little less vain. “Men genuinely felt better about themselves as assessed by Rosenberg and other self esteem scores.”
For Turek, this finding and years of experience presents a huge gender-disparity-in-health coverage. “Despite the fact that providers and insurers must discuss breast implants with patients undergoing mastectomy for breast cancer, no such similar requirement exists for men and testis cancer,” he says. “So, in essence having two testicles is a ‘cosmetic’ thing but having two breasts isn’t.”
He goes on to tell me that despite a slight uptick in testicular prosthesis implantation due to gender reassignment surgeries, manufacturing these suckers is not a profitable venture.
“Fewer companies are making them,” Turek explains, adding that in anticipation of more companies halting production, he bought a couple dozen to have on hand in a pinch. “This is a really important thing to a lot of men.”
When I explain that I’ve had a hard time finding men who have had an implant, he explains that for many patients, their fake testicle is a closely guarded secret. “Testis implants are very popular among single adult men, both gay and straight, as it reduces the need for having to explain what happened down there to curious folk in the bedroom or locker room,” he says, adding that married men don’t get them as often as their single counterparts.
“I see quite a few middle age men who are single again and want implants placed, maybe to improve their perceived sexual marketability. There’s also a group of men who take testosterone hormone replacement which results in significant testicular shrinkage who are interested in having implants place below or in front of their intact native testicles which is also possible.”
I’m put in touch with one of Turek’s patients. Ivan lost a testicle due to an injury as a child. He had a replacement that served him for 38 years before it started to become misshapen and had to be removed. He wasn’t happy with the replacement he got courtesy of Britain’s National Health Service at the beginning of 2017 and flew to California to have Turek insert what he hopes will be his third and final decoy ball.
Ivan, now 51, tells me that he didn’t deliberate much about getting a prosthetic when given the option. “When you’re 12, that last thing you want to be is different when changing in front of your school mates.” he says. “Kids can be cruel.”
As one of very few circumcised boys in my school in England, I knew this to be true. I wondered if the experience of being different at a young age played into why I’d be more inclined to have a phony ball if it had come to that.
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