What’s an orchiectomy?

An orchiectomy is surgery done to remove one or both of your testicles. It’s commonly performed to treat or prevent prostate cancer from spreading.

An orchiectomy can treat or prevent testicular cancer and breast cancer in men, too. It’s also often done before sexual reassignment surgery (SRS) if you’re a transgender woman making the transition from male to female.

Read on to learn more about the different types of the orchiectomy procedure, how the procedure works, and how to take care of yourself after you’ve had the procedure done.

There are several types of orchiectomy procedures depending on your condition or the goal that you’re trying to reach by having this procedure done.

Simple orchiectomy

One or both testicles is removed through a small cut in your scrotum. This may be done to treat breast cancer or prostate cancer if your doctor wants to limit the amount of testosterone that your body makes.

Radical inguinal orchiectomy

One or both testicles is removed through a small cut in the lower part of your abdominal area instead of your scrotum. This may be done if you’ve found a lump in your testicle and your doctor wants to test your testicular tissue for cancer. Doctors may prefer to test for cancer using this surgery because a regular tissue sample, or biopsy, can make cancer cells more likely to spread.

This type of surgery may also be a good option for a transition from male to female.

Subcapsular orchiectomy

The tissues around the testicles are removed from the scrotum. This allows you to keep your scrotum intact so that there’s no outward sign that anything has been removed.

Bilateral orchiectomy

Both testicles are removed. This may be done if you have prostate cancer, breast cancer, or are transitioning from male to female.

Your doctor may do this surgery to treat breast cancer or prostate cancer. Without the testicles, your body can’t make as much testosterone. Testosterone is a hormone that can cause prostate or breast cancer to spread more quickly. Without testosterone, the cancer may grow at a slower rate, and some symptoms, such as bone pain, may be more bearable.

Your doctor may recommend orchiectomy if you’re in generally good health, and if the cancer cells have not spread beyond your testicles or far beyond your prostate gland.

You may want to do an orchiectomy if you’re transitioning from male to female and want to reduce how much testosterone your body makes.

This surgery effectively treats prostate and breast cancer. You can try hormone therapies with antiandrogens before considering an orchiectomy, but these can have side effects, including:

  • damage to your thyroid gland, liver, or kidneys
  • blood clots
  • allergic reactions

Before an orchiectomy, your doctor may take blood samples to make sure you’re healthy enough for surgery and to test for any indicators of cancer.

This is an outpatient procedure that takes 30-60 minutes. Your doctor may use either local anesthesia to numb the area or general anesthesia. General anesthesia has more risks but lets you remain unconscious during the surgery.

Before the appointment, be sure that you have a ride home. Take a few days off work and be ready to limit your amount of physical activity after the surgery. Tell your doctor about any medications or dietary supplements that you’re taking.

First, your surgeon will lift your penis and tape it to your abdomen. Then, they’ll make an incision either on your scrotum or the area right above your pubic bone on your lower abdomen. One or both testicles are then cut out from the surrounding tissues and vessels, and removed through the incision.

Your surgeon will use clamps to prevent your spermatic cords from gushing blood. They may put in a prosthetic testicle to replace the one that’s removed. Then, they’ll wash the area with a saline solution and sew the incision shut.

You should be able to go home a couple hours after an orchiectomy. You’ll need to return the next day for a checkup.

For the first week after an orchiectomy:

  • Wear a scrotal support for the first 48 hours after the surgery if instructed to by your doctor or nurse.
  • Use ice to reduce swelling in your scrotum or around the incision.
  • Wash the area gently with a mild soap when you bathe.
  • Keep your incision area dry and covered in gauze for the first few days.
  • Use any creams or ointments following your doctor’s instructions.
  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) for your pain.
  • Avoid straining during bowel movements. Drink lots of water and eat high-fiber foods to keep bowel movements regular. You can also take a stool softener.

It can take two weeks to two months to fully recover from an orchiectomy. Don’t lift anything over 10 pounds for the first two weeks or have sex until the incision has fully healed. Avoid exercise, sports, and running for four weeks after surgery.

See your doctor right away if you notice any of the following side effects:

  • pain or redness around the incision
  • pus or bleeding from the incision
  • fever over 100°F (37.8°C)
  • inability to urinate
  • hematoma, which is blood in the scrotum and usually looks like a large purple spot
  • loss of feeling around your scrotum

Talk to your doctor about possible long-term side effects due to having less testosterone in your body, including:

An orchiectomy is an outpatient surgery that doesn’t take long to fully recover from. It’s much less risky than hormone therapy for the treatment of prostate or testicular cancer.

Be open with your doctor if you’re getting this surgery as part of your transition from male to female. Your doctor may be able to work with you to reduce scar tissue in the area so that future SRS may be more successful.