Orchiectomy: Meaning, Procedure, Effects, and Risks

The testicles produce:

• testosterone;
• sperm;
• other hormones involved in sexual and reproductive function.

After both testicles are removed, testosterone production falls significantly, and the person can no longer produce sperm naturally.

In gender-affirming care, orchiectomy may help someone reduce testosterone without continuing a high dose of testosterone-blocking medication. However, it is optional and does not determine anyone’s gender identity.

• orchi- or orchid-, relating to a testicle;
• -ectomy, meaning surgical removal.

Orchiectomy may be uncountable when discussing the procedure generally:

• Orchiectomy may reduce testosterone production.
• The clinic provides consultations about orchiectomy.

It may be countable when referring to a specific operation:

• He underwent an orchiectomy.
• The surgeon performed several orchiectomies.

Common expressions include:

• undergo an orchiectomy;
• perform an orchiectomy;
• recover from orchiectomy;
• bilateral orchiectomy;
• unilateral orchiectomy;
• simple orchiectomy;
• radical inguinal orchiectomy;
• discuss fertility before orchiectomy.

Bilateral Orchiectomy

A bilateral orchiectomy removes both testicles.

In gender-affirming care, this is the form most commonly discussed because it substantially lowers testosterone production. Johns Hopkins identifies bilateral orchiectomy as one possible gender-affirming treatment for transgender women and nonbinary people.

Unilateral Orchiectomy

A unilateral orchiectomy removes only one testicle.

The remaining testicle may continue producing enough testosterone and sperm for ordinary hormonal and reproductive function, although this depends on its health.

Simple Orchiectomy

A simple orchiectomy generally removes the testicle through an incision in the scrotum.

This approach may be used in gender-affirming care or for some noncancerous conditions. The scrotal skin may be preserved, especially when future vaginoplasty remains possible.

Radical Inguinal Orchiectomy

A radical inguinal orchiectomy removes the testicle and spermatic cord through an incision in the groin.

It is commonly used when testicular cancer is suspected because it allows the testicle to be removed without cutting through the scrotum. Orchiectomy is an important method for confirming and treating testicular cancer.

Partial Orchiectomy

A partial orchiectomy removes only diseased tissue while preserving some healthy testicular tissue.

It may be considered in selected medical situations, although complete removal remains more common for many testicular tumors.

Possible goals include:

• substantially reducing testosterone;
• reducing the need for antiandrogen medication;
• decreasing testicular or genital dysphoria;
• making tucking easier;
• preparing for later vaginoplasty;
• reducing unwanted testosterone-related effects;
• feeling more comfortable with genital anatomy.

Orchiectomy may be chosen as a standalone procedure. A person does not have to pursue vaginoplasty afterward.

A healthcare professional may therefore adjust:

• estrogen dosage;
• antiandrogen medication;
• other hormone-related treatment;
• laboratory monitoring.

Many people can reduce or discontinue testosterone-blocking medication after bilateral orchiectomy, but medication changes should be made only with professional guidance.

Some form of appropriate sex-hormone management may remain important for bone and general health, especially in younger people. Hormone needs depend on age, health, treatment goals, and whether estrogen or testosterone is being used.

• performed separately before vaginoplasty;
• completed during vaginoplasty;
• chosen without any plan for later vaginal construction.

During vaginoplasty, removal of the testicles is commonly combined with removal of much of the penile tissue and construction of a vagina, clitoris, and labia.

Someone who may want future vaginoplasty should discuss preservation of scrotal skin with the surgeon. That tissue may be useful for constructing parts of the vulva or vaginal canal.

Scrotectomy removes some or all of the scrotal skin.

They are not the same procedure. During a standalone gender-affirming orchiectomy, the scrotum may be left in place. Preserving it may help with future genital reconstruction.

A person who does not plan to have vaginoplasty may discuss whether scrotal reduction or removal matches personal goals.

Before surgery, a person may consider:

• sperm freezing;
• fertility counseling;
• embryo creation;
• future genetic parenthood;
• financial and storage requirements.

Fertility preservation is optional, but the irreversible effect should be clearly understood before surgery.

A unilateral orchiectomy may not cause infertility if the remaining testicle functions normally.

After bilateral orchiectomy, possible changes may include:

• reduced spontaneous erections;
• changes in erectile firmness;
• reduced sexual desire;
• changes in ejaculation;
• reduced semen volume;
• emotional or psychological changes in sexual experience.

These effects vary and may also be influenced by hormone therapy, age, health, medication, relationships, and emotional well-being.

Orgasm may remain possible after orchiectomy, although the experience can change.

• medical assessment;
• review of medications;
• discussion of hormone treatment;
• fertility counseling;
• blood tests;
• instructions about eating and drinking;
• stopping nicotine;
• arranging transportation;
• planning time away from work;
• discussing future genital surgery.

The healthcare team should know about medicines or supplements that affect bleeding.

A person should also understand whether the surgeon plans to preserve the scrotal skin and how the procedure may affect future reconstructive options.

During a simple bilateral orchiectomy, the surgeon typically:

1. makes an incision in the scrotum;
2. locates each testicle and spermatic cord;
3. seals and divides the relevant blood vessels and cord structures;
4. removes the testicles;
5. closes the incision.

The exact approach differs for cancer-related surgery, partial removal, or procedures combined with other genital surgery.

Early recovery may involve:

• soreness;
• swelling;
• bruising;
• temporary numbness;
• mild drainage;
• difficulty walking comfortably;
• the need for supportive underwear.

Cleveland Clinic advises avoiding heavy lifting, running, and sexual activity for a period after surgery, although the individual surgeon’s instructions should take priority.

A cold pack wrapped in cloth, prescribed medication, wound care, and rest may help during early recovery.

• bleeding;
• infection;
• blood collection under the skin;
• swelling;
• scarring;
• pain;
• numbness;
• injury to nearby structures;
• complications from anesthesia;
• blood clots;
• dissatisfaction with appearance.

When both testicles are removed, long-term effects may also involve:

• infertility;
• very low testosterone;
• hot flashes;
• changes in sexual desire;
• changes in energy or mood;
• reduced bone density without appropriate hormone management.

Bleeding and infection are recognized risks of orchiectomy and other surgical procedures.

Fever, increasing redness, heavy bleeding, severe swelling, worsening pain, discharge, chest pain, or breathing difficulty requires prompt medical attention.

• treatment or diagnosis of testicular cancer;
• reduced androgen production;
• relief from pain or disease;
• decreased need for testosterone blockers;
• reduced genital dysphoria;
• easier tucking;
• progress toward desired genital reconstruction;
• increased gender euphoria.

Benefits and priorities differ between individuals.

A person may feel positive about reduced testosterone while also experiencing concerns about:

• fertility;
• permanent bodily change;
• appearance;
• sexual function;
• future relationships;
• social judgment.

These feelings do not necessarily indicate regret. Emotional support may be useful before and after surgery.

Others should not ask invasive questions about:

• the appearance of the genitals;
• hormone levels;
• erections;
• fertility;
• sexual activity;
• planned vaginoplasty;
• photographs or scars.

Knowing that someone had an orchiectomy does not provide permission to disclose the surgery or speculate about the person’s anatomy.

Every orchiectomy is gender-affirming surgery.
No. It is also used for cancer, injury, pain, and other medical conditions.

Orchiectomy and vasectomy are the same.
No. Vasectomy blocks sperm transport but leaves the testicles in place. Orchiectomy removes testicular tissue.

Orchiectomy always prevents orgasm.
No. Orgasm may remain possible, although sexual function can change.

A person can naturally produce sperm after bilateral orchiectomy.
No. Removing both testicles permanently stops natural sperm production.

Every transfeminine person needs an orchiectomy.
No. The procedure is optional and does not determine gender validity.

1. Orchiectomy is the surgical removal of one or both testicles.
2. She considered orchiectomy to reduce testosterone production.
3. Does orchiectomy always form part of vaginoplasty?
4. His unilateral orchiectomy was performed to treat testicular cancer.
5. Bilateral orchiectomy permanently affects natural fertility.
6. The surgeon discussed hormone management before the orchiectomy.
7. Their orchiectomy was performed as a standalone gender-affirming procedure.
8. Understanding orchiectomy helps readers distinguish testicle removal from vasectomy, scrotectomy, and complete genital reconstruction.

It is connected to sexuality and reproductive health because it can permanently affect fertility, semen production, sexual desire, erectile function, and the hormonal conditions influencing sexual response.

Orchiectomy is not required for femininity, womanhood, transgender identity, or a satisfying sexual life. Understanding the procedure helps readers discuss hormones, fertility, genital anatomy, sexual function, and gender-affirming care accurately and respectfully.