Last updated July 30, 2025 > [!important] This report was produced by Gemini Deep Research. It is for educational purposes only and should not be considered medical advice. - [[#Introduction]] - [[#Understanding Gender-Affirming Orchiectomy: Definition and Purpose]] - [[#Surgical Techniques for Orchiectomy: A Step-by-Step Overview]] - [[#Motivations for Choosing Orchiectomy: Why Individuals Opt for This Procedure]] - [[#Orchiectomy with Scrotectomy: Procedure, Implications, and Considerations]] - [[#Orchiectomy without Scrotectomy: Procedure, Implications, and Considerations]] - [[#Orchiectomy as Part of Broader Bottom Surgery]] - [[#The Recovery Journey After Orchiectomy: What to Expect]] - [[#Potential Complications of Orchiectomy: Risks and Management]] - [[#Long-Term Effects and Hormonal Management Following Orchiectomy]] - [[#Conclusion: Orchiectomy as a Significant Step in Gender Affirmation]] ## **Introduction** Gender affirmation surgery encompasses a range of medical procedures designed to help individuals align their physical characteristics with their gender identity. Within this spectrum of options, orchiectomy stands out as a common and frequently considered initial surgical step, particularly for transfeminine individuals and others seeking to feminize their bodies. This surgical procedure involves the removal of the testicles and plays a significant role in the broader context of gender transition. This wiki provides a comprehensive overview of orchiectomy within the framework of gender affirmation surgery, covering its definition, techniques, motivations, variations, integration with other bottom surgery options, typical recovery process, and long-term effects, with particular focus on hormonal changes and their management. ## **Understanding Gender-Affirming Orchiectomy: Definition and Purpose** Orchiectomy is the surgical removal of one or both testicles. For gender affirmation, bilateral orchiectomy—removing both testicles—is typically performed. This procedure serves several key purposes for individuals undergoing gender transition, primarily helping to align their physical body with their internal gender identity. One of the most significant outcomes is the substantial reduction or complete elimination of the body's testosterone production, supporting feminization and reducing androgenic effects. The removal of testicles can significantly reduce or eliminate the need for testosterone-blocking medications (anti-androgens), simplifying hormone therapy regimens and potentially reducing associated side effects. In some cases, orchiectomy may also allow for lower estrogen dosages while maintaining feminizing effects, potentially decreasing risks linked to higher estrogen levels. A fundamental motivation for gender-affirming orchiectomy is alleviating gender dysphoria—the distress experienced when gender identity doesn't match sex assigned at birth. By addressing this incongruence, the surgery often positively impacts psychological well-being. It's important to note that orchiectomy results in permanent infertility due to the cessation of sperm production. This irreversible outcome requires careful consideration, especially for those who might want biological children in the future. Additionally, orchiectomy frequently serves as either a precursor to or component of other gender-affirming bottom surgeries, such as vaginoplasty or metoidioplasty. ## **Surgical Techniques for Orchiectomy: A Step-by-Step Overview** The surgical procedure for a gender-affirming orchiectomy is typically performed by a urologist in an operating room. In many cases, it is conducted as an outpatient procedure, allowing the individual to return home on the same day. Anesthesia options include local anesthesia, where the genital area is numbed, or general anesthesia, where the patient is asleep throughout the procedure. The standard surgical steps begin with positioning the patient on the operating table, often lying flat with the penis gently secured against the abdomen or sometimes in a lithotomy position. The surgical area, which may range from the nipples down to the mid-thighs or focus specifically on the genitals, is meticulously cleaned with an antiseptic solution and then covered with sterile drapes. The surgeon then makes a small incision, typically about one inch in length, in the midline of the scrotum. This incision is often strategically placed along a natural skin crease to minimize the visibility of the resulting scar. This particular incision style is frequently chosen to avoid any hindrance to a potential future vaginoplasty procedure. Following the incision, the surgeon carefully identifies, isolates, and gently separates the testicles from the surrounding tissues within the scrotum. The spermatic cord, which contains the blood vessels that supply the testicles and the vas deferens (the tube that carries sperm), is then located. The surgeon will clamp the spermatic cord, tie it off securely with strong stitches (a process called ligation) to prevent any bleeding, and subsequently cut it. In some techniques, the spermatic cord is ligated as close as possible to the external inguinal ring. This approach is believed to reduce the likelihood of palpable cord stumps and generally does not negatively affect the possibility of a future vaginoplasty. Once the spermatic cords are secured and cut, the testicles and a portion of the spermatic cords are carefully removed through the scrotal incision. Meticulous hemostasis, the process of stopping any bleeding, is then performed, often using a technique called diathermy, which utilizes heat to seal blood vessels. The scrotal incision is then closed in layers using absorbable stitches that will dissolve naturally over time. Finally, the incision site may be covered with a surgical adhesive or a sterile dressing to protect it during the initial healing phase. The entire surgical procedure typically takes around 20 to 60 minutes to complete. It is also standard practice for the removed testicles to be sent to a pathology laboratory for histopathological examination, which involves a detailed microscopic analysis of the tissue. ## **Motivations for Choosing Orchiectomy: Why Individuals Opt for This Procedure** Individuals choose to undergo gender-affirming orchiectomy for a variety of deeply personal reasons. A primary motivation for many is to alleviate gender dysphoria and achieve a greater sense of psychological well-being through physical congruence with their gender identity. The surgery also plays a crucial role in hormone therapy by significantly reducing or eliminating the body's production of testosterone. This hormonal shift can simplify or even eliminate the need for anti-androgen medications and may potentially lower the required dosage of estrogen, leading to fewer side effects and potentially reduced medical costs. For many, orchiectomy is a significant step towards future gender-affirming surgeries, particularly vaginoplasty or vulvoplasty. In these cases, the scrotal skin is often intentionally preserved during the orchiectomy to be utilized in the creation of the neovagina and labia. However, orchiectomy is not always a precursor to further genital surgery. Some individuals choose it as a standalone procedure, particularly if they do not desire vaginoplasty or other genital reconstruction but wish to significantly reduce their testosterone levels. The motivations for orchiectomy also extend to non-binary individuals who seek a body that aligns more closely with their unique gender identity. For some, this may even be part of a broader gender nullification process. In certain situations, individuals may opt for orchiectomy because they are not yet eligible for more complex surgeries like vaginoplasty due to factors such as a high body mass index, smoking habits, or other underlying health concerns. In these cases, orchiectomy can serve as a crucial intermediate step. Other reasons for choosing orchiectomy include a fear of the risks or the perceived invasiveness of more extensive surgeries like vaginoplasty, a personal preference for the outcomes of orchiectomy alone, or a lack of genital dysphoria related to the penis itself. Additionally, some individuals find that orchiectomy improves their comfort with genital tucking. ## **Orchiectomy with Scrotectomy: Procedure, Implications, and Considerations** Scrotectomy involves the surgical removal of all or part of the scrotum, the sac of skin that contains the testicles. This procedure is most commonly performed simultaneously with an orchiectomy, though it can occasionally be done as a separate surgery. Combining orchiectomy with scrotectomy has several implications. It completely removes both the primary testosterone-producing organs and the scrotal sac. For some individuals, this combination creates a smoother genital area, which may be desired for aesthetic reasons or enhanced comfort. However, a significant consideration when opting for scrotectomy is the reduced availability of scrotal tissue for any potential future vaginoplasty. Scrotal skin is frequently used in vaginoplasty to construct the labia majora and to line the neovaginal canal. Therefore, if an individual anticipates potentially undergoing vaginoplasty in the future, a scrotectomy might not be recommended. Conversely, for individuals who are certain they do not want to pursue vaginoplasty and who experience dysphoria specifically related to the presence of the scrotum, combining orchiectomy with scrotectomy during the same surgical procedure can be beneficial. This combination can also be a component of a gender nullification procedure, aiming to create a more ambiguous or neutral genital appearance. There are different surgical techniques for performing a scrotectomy, including the excision of the majority of the scrotal tissue with primary closure of the perineal wound, or the excision of all rugated skin with mons and groin (Y-flap) advancement. Ultimately, it is crucial for individuals considering orchiectomy to have a thorough discussion with their surgeon about their future surgical plans before deciding whether or not to include a scrotectomy. ## Orchiectomy without Scrotectomy: Procedure, Implications, and Considerations In orchiectomy without scrotectomy, only the testicles are surgically removed while preserving the scrotal sac. This procedure effectively reduces testosterone production while maintaining the scrotal skin for potential future use in vaginoplasty or vulvoplasty. For individuals planning to undergo vaginoplasty later, this approach is typically recommended because the preserved scrotal tissue plays a crucial role in creating the labia and lining the neovaginal canal. A key consideration with this approach is that the empty scrotal sac remains after surgery. While this is advantageous for those planning future vaginoplasty, individuals who don't intend to pursue additional surgeries might find the empty sac aesthetically undesirable or may continue to experience dysphoria related to it. Over time, the scrotal skin typically undergoes atrophy, becoming smaller and less prominent due to the absence of testicles and reduced testosterone levels. Although this atrophy occurs, it generally doesn't significantly impact future vaginoplasty procedures. However, for individuals with limited scrotal tissue before surgery, a consultation with a vaginoplasty surgeon can help assess potential impacts on future tissue availability. Ultimately, the decision between orchiectomy with or without scrotectomy depends on the individual's personal goals, bodily comfort, and plans for future gender-affirming procedures. ## Orchiectomy as Part of Broader Bottom Surgery Orchiectomy frequently plays a significant role as part of more comprehensive gender-affirming bottom surgery procedures. Its relationship with vaginoplasty and metoidioplasty is particularly noteworthy. **Relation to Vaginoplasty:** Orchiectomy is often a necessary component of vaginoplasty, a surgical procedure aimed at creating a vagina, labia, and clitoris. The removal of the testicles can be performed either simultaneously with vaginoplasty or as a separate preceding procedure. Performing orchiectomy before vaginoplasty offers several advantages, including shorter wait times, reduced procedure duration, and less complex outpatient recovery compared to concurrent procedures. A crucial aspect of this connection is that scrotal skin preserved during orchiectomy without scrotectomy is commonly used during vaginoplasty to create the labia majora and provide lining for the neovaginal canal. Additionally, undergoing orchiectomy prior to vaginoplasty eliminates the need for testosterone-blocking medications leading up to the more complex surgery, potentially simplifying hormone therapy management. Individuals might choose to separate these procedures to manage hormone therapy more effectively, due to personal preference for a staged approach, greater comfort with undergoing two less complex surgeries rather than one more involved procedure, or when not yet eligible for vaginoplasty. **Relation to Metoidioplasty:** Metoidioplasty is a gender-affirming bottom surgery option for transgender men that involves creating a phallus using existing genital tissue, specifically the clitoris, which has typically been enlarged through testosterone hormone therapy. While orchiectomy is not always a direct component of the metoidioplasty procedure itself, it is frequently performed in conjunction with it. The primary reason is that individuals undergoing metoidioplasty often still desire a reduction in their natural testosterone production. Orchiectomy can be performed before, during, or after metoidioplasty, depending on specific goals and the overall surgical plan. Additionally, for individuals undergoing metoidioplasty, a scrotectomy and the placement of silicone testicular implants (scrotoplasty) can also be performed either simultaneously with metoidioplasty or in a subsequent stage to create a more typical masculine genital appearance. The relationship between orchiectomy and metoidioplasty thus primarily focuses on achieving hormonal goals and enhancing the overall masculine aesthetic of the genitalia. ## The Recovery Journey After Orchiectomy: What to Expect The recovery period following an orchiectomy varies among individuals, but generally, most people can expect to return to their usual activities within a couple of weeks, with full healing taking up to approximately eight weeks. Common post-operative symptoms include pain and discomfort in the surgical area, which is typically manageable with prescribed or over-the-counter pain medications. Bruising and swelling in the scrotum and the surrounding groin area are also common and usually subside within two to four weeks. Some individuals may experience numbness or tingling sensations in the groin area due to nerve healing, and this can sometimes persist for several months. General aftercare instructions typically include keeping the surgical wound clean and dry by showering gently with mild soap, avoiding any harsh scrubbing of the incision. Patients are usually advised to refrain from applying any ointments, lotions, or creams to the incision unless specifically instructed by their doctor. Wearing supportive underwear, as recommended by the medical team, is often advised to help with comfort and healing. It is crucial to avoid strenuous activities, heavy lifting, and driving for a few weeks following the surgery to prevent complications and allow for proper healing. Sexual activity should also be avoided until the surgical site has fully healed, and the individual has been cleared by their doctor to resume such activities. Maintaining adequate hydration and consuming a healthy, balanced diet can also aid in the recovery process. Patients should strictly adhere to their doctor's instructions regarding the use of pain medications and any prescribed antibiotics to prevent infection. Attending all scheduled follow-up appointments with the surgical team is essential for monitoring the healing process and addressing any potential concerns. ## Potential Complications of Orchiectomy: Risks and Management As with any surgical procedure, gender-affirming orchiectomy carries potential risks and complications, although the likelihood of these occurring is generally low. Potential immediate complications can include bleeding and the formation of a hematoma (collection of blood in the scrotum). Infection at the surgical site is another possible risk. Poor wound healing or wound dehiscence, where the incision opens prematurely, can also occur. As with any surgery involving anesthesia, there is a risk of adverse reactions to the anesthetic agents used. In rare instances, there could be injury to surrounding organs during the procedure. Nerve damage in the groin area, potentially leading to temporary or permanent loss of sensation, is also a possibility. Other less common immediate complications include small blood collections within the scrotum and the formation of a seroma (collection of fluid beneath the skin). Potential long-term complications are less frequent but can include chronic pain in the operative area and the possibility of feeling the remaining stumps of the spermatic cords. A hernia, although rare, is also a potential long-term risk. Some individuals may experience dissatisfaction with the cosmetic outcome of the surgery. Due to the significant reduction in testosterone production, there is a potential long-term risk of developing osteoporosis if hormone levels are not appropriately managed with estrogen replacement therapy. Changes in sexual function, such as a decrease in libido or erectile dysfunction, can also occur as a long-term effect. Research suggests that undergoing both orchiectomy and vaginoplasty at the same time may carry a higher risk of complications compared to having either procedure performed separately. Additionally, a higher body mass index (BMI) has been identified as a potential risk factor for developing infectious complications following orchiectomy. It is crucial for individuals considering orchiectomy to have an open and detailed discussion with their surgeon about all the potential risks and complications associated with the procedure. ## Long-Term Effects and Hormonal Management Following Orchiectomy **Hormonal Changes:** The most significant long-term effect of a bilateral orchiectomy is a substantial and permanent reduction in the body's testosterone production. This hormonal shift leads to a decrease in male secondary sex characteristics and facilitates feminization in individuals undergoing gender transition. Following surgery, individuals will no longer produce sperm, resulting in permanent infertility. Some research suggests that after orchiectomy, the body may have an increased ability to produce estrogen naturally, potentially allowing for a reduction in supplemental estrogen dosage required for feminization. Consequently, anti-androgen medications, which block testosterone effects, are typically no longer necessary after testicle removal. However, it's important to be aware that if reduced testosterone levels are not appropriately managed with estrogen replacement therapy, individuals may experience side effects associated with low sex hormone levels, such as decreased sex drive, difficulties with erectile function, and reduced energy levels. Studies have indicated that testosterone levels in transgender women undergoing feminizing hormone therapy decrease significantly within the first three months and remain low, with no further substantial changes observed after gonadectomy. Similarly, adrenal androgen levels tend to decrease during hormone therapy and do not typically increase after gonadectomy when anti-androgens are discontinued. It's worth noting that not all individuals who undergo orchiectomy identify as transfeminine or seek feminization. Some AMAB (assigned male at birth) individuals may maintain a male gender identity and masculine presentation while still experiencing genital dysphoria. These individuals may choose to undergo orchiectomy to address their specific dysphoria while continuing or beginning testosterone replacement therapy post-surgery to maintain masculine secondary sex characteristics. This approach allows for genital configuration that aligns with their personal needs while preserving their desired gender expression through hormone management. **Management Strategies:** Following orchiectomy, lifelong hormone therapy, primarily with estrogen, is usually necessary to maintain feminization and to prevent potential health issues associated with very low sex hormone levels, such as osteoporosis. For those maintaining masculine presentation, testosterone replacement therapy would be prescribed instead. This ongoing hormone management is a critical aspect of post-operative care. Hormone dosages will likely need adjustment after surgery, and regular monitoring by an endocrinologist or other qualified healthcare provider is essential to ensure optimal hormone levels and overall health. Individuals may also experience changes in mood, energy levels, and sexual desire after surgery, which should be openly discussed with a healthcare provider to determine the best management approach. For those who may wish to have biological children in the future, it is crucial to discuss fertility preservation options, such as sperm banking, before undergoing orchiectomy, as the procedure results in permanent infertility. It is important to recognize that gender-affirming orchiectomy can have significant positive long-term effects on mental health by alleviating gender dysphoria, potentially leading to reduced depression and anxiety, and an overall increase in life satisfaction and psychological well-being. ## Conclusion: Orchiectomy as a Significant Step in Gender Affirmation Gender-affirming orchiectomy is a surgical procedure involving the removal of one or both testicles, typically performed bilaterally for transfeminine individuals and others seeking to reduce testosterone production and align their physical bodies with their gender identity. The procedure can be performed with or without a scrotectomy, with the decision often depending on individual goals and whether or not the individual plans to undergo future vaginoplasty. Orchiectomy frequently serves as a component or precursor to more complex bottom surgery procedures. 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