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We present the case of a 55-year-old homeless male who presented with penoscrotal necrosis and maggot infestation) secondary to genital self-mutilation. The patient gave a history consistent with gender identity disorder and indicated that he had injected lotion and other unknown substances into his penis hoping it would fall off. The patient had no history of psychosis. He sought medical attention only after he was no longer welcome on public transportation due to the odor emanating from thisdoi:10.1080/17523280903155307 fatcat:diocx5pi6bechp4exzxz3za23m