Inclusion Criteria:  Aged 18 years and older Identify as a transgender woman Have taken estradiol and spironolactone for at least one year Currently taking oral or transdermal or injectable estradiol Have not yet undergone but desire orchiectomy  Exclusion Criteria:  Under 18 years of age Don't identify as a transgender woman Not currently taking estradiol or spironolactone Have been on estradiol and spironolactone for less than one year History of orchiectomy Not deemed a candidate for orchiectomy Current tobacco smoker Current illicit drug use History of prior or active estrogen-dependent neoplasms Acute liver or gallbladder disease Venous thromboembolism Hypertriglyceridemia >500 mg/dL Fasted plasma glucose >7.0 mmol/L or previously treated diabetes Resting blood pressure >140/90 mmHg