What is an orchiectomy?
An orchiectomy is surgery in which one or more testicles are removed.
The testicles, which are male reproductive organs that produce sperm, sit in a sac, called the scrotum. The scrotum is just below the penis.
There are two common orchiectomy procedures for transgender women: bilateral orchiectomy and simple orchiectomy. In a bilateral orchiectomy, the surgeon removes both testicles. During a simple orchiectomy, the surgeon could remove either one or both testicles.
Bilateral orchiectomy is the more common type of orchiectomy for transgender women.
Orchiectomy vs. scrotectomy
During an orchiectomy, the surgeon will remove one or both testicles from the scrotum. During a scrotectomy, the surgeon will remove the entire scrotum or a portion of it.
If your transition will eventually include a vaginoplasty, the scrotal tissue may be used to create the vaginal lining. A vaginoplasty is the construction of a vagina using skin grafts. In these cases, a scrotectomy may not be recommended.
If there’s no scrotal tissue available for a vaginoplasty, the next option for constructing the vaginal tissue can often include skin grafts from the upper thigh.
It’s a good idea to talk to your doctor about all of your options. Be open with them about future surgeries you may plan to have. Before the procedure, talk to your doctor about fertility preservation and impact to sexual functioning.
Who’s a good candidate for this procedure?
An orchiectomy is a relatively inexpensive surgery with a short recovery time.
The procedure may be a first step if you’re heading toward vaginoplasty. In some cases, you may be able to have the orchiectomy at the same time you have a vaginoplasty. You can also schedule them as independent procedures.
Other procedures you may consider, especially if you’re planning a vaginoplasty, include:
- Partial penectomy. A penectomy is a surgical procedure that involves removing a portion of the penis. It’s commonly used as a treatment option for penile cancer.
- Labiaplasty. A labiaplasty is a procedure used to construct labia using skin grafts.
Orchiectomy may also be a good option for people who don’t react well to feminizing hormones or want to reduce the health risks and side effects from these medications. That’s because once the procedure is complete, your body will usually produce less endogenous testosterone, which can lead to lower doses of feminizing hormones.
Additionally, research indicates that orchiectomy procedures may be metabolically protective for transgender women.
Orchiectomy and fertility
If you think you may want to have children in the future, talk to your doctor about storing sperm in a sperm bank before starting hormone treatments. That way you’ll have ensured you protected your fertility.
What can I expect before and during the procedure?
To prepare for the procedure, your doctor will likely require proof that:
- You’re experiencing gender dysphoria.
- You’re able to consent to treatment and make a fully informed decision.
- You don’t have any unmanaged mental health or medical problems.
- You’ve reached the age of adulthood in the country that the procedure will take place
Generally, a doctor will ask you to provide letters of preparedness from two different mental health professionals. You’ll also likely need to complete one year (12 consecutive months) of hormone therapy before you undergo an orchiectomy.
The procedure will take 30 to 60 minutes. Before surgery begins, your doctor will use local anesthesia to numb the area or general anesthesia to make you fall asleep so you don’t feel anything. A surgeon will then make an incision in the middle of the scrotum. They’ll remove one or both testes and then close the incision, often with sutures.
The surgery itself is an outpatient procedure. This means that if you were dropped off in the morning for the procedure, you’ll be able to leave before the end of the day.
What’s recovery like?
Physical recovery from the procedure will last anywhere between a few days to a week. Your doctor will likely prescribe pain medications to manage pain and antibiotics to prevent infection.
Based on your reaction to the orchiectomy, your physician may reduce your estrogen dose and taper off any preoperative androgen blocker medication.
Are there side effects or complications?
You may experience side effects and complications that are typical to surgery. These may include:
- bleeding or infection
- injury to surrounding organs
- dissatisfaction with results
- nerve damage or loss of feeling
- decreased libido and energy
Transgender women who undergo an orchiectomy are also likely to experience a number of positive side effects, including:
- a drastic decrease in testosterone, which may allow you to reduce your dose of feminizing hormones
- reduced gender dysphoria as you take a step closer to matching your physical appearance with your gender identity
What’s the outlook?
An orchiectomy is a relatively inexpensive outpatient surgery in which the surgeon removes one or both testicles.
The surgery can be part of a treatment plan for someone with prostate cancer, but it’s also a common procedure for a transgender woman undergoing gender confirmation surgery.
One major benefit to this surgery is, once completed, your doctor may recommend reducing your dose of feminizing hormones.
An orchiectomy is also often considered an important step toward a vaginoplasty, in which the surgeon constructs a functioning vagina.
Recovery from the procedure — if it’s done independently of the vaginoplasty — may take between a couple days to a week.