Orchiectomy#

Introduction: Who This Guide Is For#

This guide is for anyone who has looked at the map of gender-affirming genital surgeries and found themselves somewhere between the landmarks.

Perhaps you're a transgender woman who wants to eliminate testosterone production and simplify your hormone regimen, but vaginoplasty feels like more surgery than you need—or more maintenance than you want to commit to for the rest of your life. Perhaps you're nonbinary and seeking a body that's neither what you were born with nor what the typical "male-to-female" surgical pathway creates. Perhaps you've heard terms like "orchiectomy" and "penectomy" mentioned in passing but couldn't find clear information about what these procedures actually involve, who pursues them, and what life looks like afterward.

Perhaps you already know exactly what you want—testes gone, penis gone, a smooth and simple anatomy that finally matches how you've always seen yourself—and you're looking for the comprehensive guide that helps you get there safely. Or perhaps you're a partner, family member, or healthcare provider trying to understand options that don't fit neatly into the binary narratives that dominate most discussions of transition.

Whoever you are, this guide welcomes you.

Orchiectomy and penectomy represent distinct surgical pathways for individuals assigned male at birth who seek gender affirmation without pursuing vaginoplasty. These procedures have historically been overlooked in medical literature, treated as stepping stones toward "complete" transition rather than valid endpoints in themselves. That framing does a disservice to the many people for whom these surgeries represent exactly the outcome they want—neither more nor less than what their bodies need to feel like home.

The research landscape is uneven. A two-center retrospective cohort of 119 people reports clinical follow-up after gender-affirming orchiectomy, including recorded complications and no recorded cases of postoperative regret; it does not report self-reported dysphoria, tucking, medication, or satisfaction outcomes (van der Sluis et al., 2025). Penectomy as a standalone gender-affirming procedure has far less formal literature—most research concerns penectomy as part of vaginoplasty or treatment for penile cancer, which serve different goals. This guide keeps those evidence gaps visible.

What follows covers the goals, eligibility considerations, surgical process, recovery, and long-term care for orchiectomy. For penile removal, see penectomy and nulloplasty. The aim is to help you make an informed choice about your body and your life.

A note on terminology before we proceed: this guide discusses procedures primarily sought by transgender women, transfeminine individuals, nonbinary people assigned male at birth, and those who identify as eunuchs or nullos. Language around gender is evolving, and the terms used here may not perfectly capture every reader's identity. If the procedures described resonate with your needs, this guide is for you regardless of how you name your gender. The clinical framework exists to help you access care—your identity belongs to you, and no diagnosis or terminology needs to define it.

Orchiectomy: Removal of the Testes#

Understanding the Procedure and Its Goals#

Orchiectomy is the surgical removal of the testes. Its operative approach, anesthesia, duration, discharge plan, and recovery restrictions depend on the proposed procedure, medical history, and operating team. The cited cohort is not used to supply a universal time or same-day-discharge promise.

The goals people seek from standalone orchiectomy can include changing testicular hormone production, reducing dysphoria, changing body maintenance, or choosing an endpoint rather than another genital operation. Medication, hormone-dose, tucking, libido, and dysphoria outcomes need individualized discussion with the surgical and prescribing teams. The previously cited cohort does not provide patient-reported data for those outcomes, so this guide does not attach percentages or a medication change to it.

People's reasons and experiences remain important. A person's own account of relief, discomfort, or a changed relationship with their body is lived knowledge; it is not a population rate.

Who Chooses Standalone Orchiectomy—And Why#

Orchiectomy can be a destination, a bridge to another procedure, or one part of an individualized plan. People's goals and the reasons a later procedure may or may not fit are personal and clinical questions, not a universal pathway. The cited 119-person cohort is not used here to assign motivation percentages or explain another person's decision.

There is no single "right" reason to choose orchiectomy. Some people know with certainty that this is all they want. Others use it as a way to buy time while they figure out their path. Still others face medical realities that make more extensive surgery inadvisable. All of these are legitimate reasons.

For some people, removing the body's main source of testosterone and simplifying medication is central. Others want relief from testicular dysphoria, a different contour, or a step that still leaves future choices open. None of these goals requires wanting a vaginal canal or a particular gender identity.

In a standalone orchiectomy, scrotal skin can be preserved for a future vaginoplasty or vulvoplasty. OHSU says its surgeons remove scrotal skin only when a patient specifically requests it, because that tissue can be used in those later procedures. Orchiectomy with scrotectomy is therefore a different choice: if you want the skin removed now, ask how that could affect future surgical options before deciding. Preserving skin keeps possibilities open without obligating you to use them.

Eligibility and the Path to Surgery#

The WPATH Standards of Care Version 8 discuss adult assessment, informed consent, reproductive effects, and health factors relevant to orchiectomy. For gonadectomy, SOC8 suggests considering at least six months of hormone treatment when it fits the person's goals, or longer if needed for a surgical result; hormones may be unwanted or contraindicated. This is clinical guidance, not a uniform insurer or surgeon rule. Ask the program and payer what they require for your operation.

SOC8 recommends assessment by a health-care professional competent in transgender health and says one assessment letter can be sufficient if written documentation is required. It does not impose one universal referral-letter rule. Insurers and surgical programs may ask for different documentation, so request the current written list for your care.

SOC8 does not prescribe a universal mandatory checklist for a referral letter. A surgeon, program, or insurer may request information about diagnosis, informed consent, capacity, or relevant health concerns, and those requests should be confirmed with that specific organization rather than presented as a SOC8-wide letter mandate (Coleman et al., 2022).

If you do not use estrogen—for example, if feminization is not your goal—plan hormone and bone-health care before orchiectomy. The UCSF bone-health guidance identifies inadequate hormone replacement after gonadectomy as a bone-loss risk; its patient hormone-therapy guide advises at least minimal hormone therapy until about age 50. A particular estradiol or testosterone dose cannot be chosen from this page. Ask your prescriber what hormone plan and bone-density follow-up fit your body, goals, and other risks.

The Surgery Itself#

In Francis and colleagues' surgical guide, both testes are removed through one scrotal incision while scrotal fat and fascia are preserved for possible later surgery. That paper describes its authors' technique, not a required incision size or a universal scarring result. Ask your surgeon where the incision will be and how future vaginoplasty or vulvoplasty plans affect it.

An incision through the groin is another surgical approach, especially when a possible testicular cancer needs evaluation. The Francis guide describes why its authors use a scrotal approach for transition-related simple orchiectomy. If your exam or history changes the plan, ask why and what that means for future tissue options.

A simple orchiectomy removes the testes, with details of spermatic-cord dissection set by the surgeon's plan; Francis and colleagues describe one such technique. Surgery for suspected cancer may require a different approach. Ask which operation is proposed, what tissue it removes, and why.

Anesthesia options vary by center. Most commonly, the procedure is performed under general anesthesia—you're completely unconscious throughout. Some centers offer spinal anesthesia or local anesthesia with sedation, which means you're awake but numb and relaxed. The choice often depends on your preferences, your medical history, and what your surgical team is most comfortable providing.

Preparing for Your Surgery#

Before surgery, ask which examination and tests your team needs and tell them about prior groin operations and every medicine you take. Hormone plans are individual: UCSF's feminizing-hormone guidance does not recommend automatically stopping estrogen for every person without specific clotting risks when preventive measures are used. Your surgeon and prescriber should give you a joint written plan; do not stop or continue a prescription based on a blanket statement here.

Documentation requirements are determined by the surgeon, program, and insurer. They may include an assessment, written documentation, hormone-history information when relevant to the person's care, and informed consent addressing the permanent nature of the procedure. Confirm the current requirements directly; SOC8 does not create a universal six-month paperwork rule (Coleman et al., 2022).

Smoking and other health factors can affect healing; ask your own surgical program about its current preparation rules. In the 119-person two-center cohort, BMI above 35 was associated with infectious complications (odds ratio 9.8), but the confidence interval was very wide (1.0–99.3), so this estimate is imprecise and should not be treated as a universal eligibility cutoff.

Fertility preservation deserves careful consideration before surgery. In the two-center cohort, 18 of 119 people (15%) chose sperm cryopreservation before surgery; that cohort proportion does not predict an individual choice (van der Sluis et al., 2025). If there is any possibility you may want genetically related children, discuss preservation options before an irreversible operation. Fertility covers fertility preservation in detail.

If future vaginoplasty is a possibility—even a remote one—consider consulting with a vaginoplasty surgeon before your orchiectomy. They can assess whether your tissue adequacy might be affected by how the orchiectomy is performed and ensure your surgical team preserves what might be needed later.

Recovery: What to Expect#

Discharge and early movement depend on your anesthesia, operation, and health. The Kaiser Permanente/Healthwise aftercare sheet encourages short, frequent walks and says recovery pace varies. Ask your team whether you will go home the same day, who will accompany you, and what movement is safe at first.

Swelling and bruising can occur near the incision. The Kaiser Permanente/Healthwise aftercare sheet says these often improve within two to four weeks, while each person heals at a different pace. Ask whether cold packs or supportive underwear fit your instructions, and call the team if swelling or pain worsens unexpectedly.

Pain control, supportive garments, ice, medication choices, and the point at which an unexpected symptom needs review are specific to the operation and patient. Follow the prescribing and operating teams' instructions; this guide does not use the cited cohort to provide a day-by-day pain-medication forecast.

The Kaiser Permanente/Healthwise aftercare sheet says many people resume usual activities in about two to three weeks, but explicitly leaves return to work to the clinician and the kind of job. Ask for a written plan covering sitting, commuting, lifting, and the possibility that healing takes longer.

The Kaiser Permanente/Healthwise aftercare sheet advises avoiding strenuous activity until your clinician clears it and keeping baths, swimming, and hot tubs off the plan until the incision heals or your clinician says they are safe. Ask your team when you can drive, lift, exercise, bathe, and have sex; a fixed one-month rule here would not fit everyone.

Hormonal Changes and Long-Term Management#

Removing both testes sharply reduces testicular testosterone production. OHSU notes that a testosterone blocker usually can be stopped and an estrogen dose may be lowered after orchiectomy; neither change should be made from a universal timeline on this page. Ask the clinician who prescribes your hormones when to change medication and how levels and symptoms will be monitored.

After orchiectomy, hormone needs and medication changes should be individualized by the prescribing clinician. This guide does not use the cited cohort to supply an estrogen-dose percentage, an anti-androgen discontinuation rate, or a risk-reduction promise.

Bone health deserves long-term attention after orchiectomy, especially if sex-hormone replacement is absent or inadequate. UCSF's guidance recommends individualizing bone-density screening by age and risk factors and considering it after five or more years without hormones following gonadectomy. Discuss hormone therapy, nutrition, activity, smoking, and screening with your clinician; the cited review does not establish a single post-orchiectomy bone-loss percentage for everyone.

If you have spent years without adequate sex-hormone replacement after orchiectomy, or have other bone-health risks, ask whether bone-density testing would help. UCSF's bone-health guidance uses age and risk factors rather than one automatic scan date for every person.

Complications: What Can Go Wrong#

In the two-center retrospective cohort, 102 of 119 people (86%) had no recorded complications during a median 2.3-year clinical follow-up (range 0.3–9.4). Five people had hemorrhage requiring return to the operating room and seven had an abscess. Those are recorded outcomes in that cohort, not an individual forecast or a complete nulloplasty/penectomy rate (van der Sluis et al., 2025).

A U.S. national surgical database study of 246 gender-affirming orchiectomies recorded complications within 30 days in 9 people (3.7%), including infection in 2.4% and reoperation in 2.0% (Saltman et al., 2023). Its comparison with orchiectomy for testicular torsion or pain found no statistically significant difference in overall complication rate; that does not mean every person's risk is the same. Ask your team how its patients and follow-up compare.

Long-term pain, appearance, hormones, and complications deserve individual discussion. The 119-person retrospective cohort recorded two cases of pain lasting more than three months (1.7%); it did not measure the earlier claimed self-reported satisfaction, tucking, or dose-change outcomes. Ask your team how it monitors and treats persistent symptoms.

Long-Term Outcomes and Satisfaction#

The reviewed 119-person cohort reports no recorded cases of postoperative regret, but it does not provide a validated self-reported satisfaction measure or a quality-of-life package. That chart-based result cannot predict an individual outcome. Broader mixed-procedure literature also cannot supply those outcomes for this operation. People considering surgery can ask programs for their own definitions, denominators, follow-up, patient-reported instruments, and management pathways.

Other possible metabolic associations require their own population and design limits; they are not used here to promise a health benefit from orchiectomy.

Orchiectomy can be an important option for many people, but its value and trade-offs are personal rather than a package of guaranteed outcomes.

References#

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F., Monstrey, S. J., Motmans, J., Nahata, L., ... Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(S1), S1-S259. https://doi.org/10.1080/26895269.2022.2100644

Francis, C., Grober, E., Potter, E., Blodgett, N., & Krakowsky, Y. (2020). A simple guide for simple orchiectomy in transition-related surgeries. Sexual Medicine Reviews, 8(3), 492–496. https://doi.org/10.1016/j.sxmr.2019.11.004

WebMD Ignite Staff. (2026, May 5). Orchiectomy for gender affirmation: What to expect at home. Kaiser Permanente. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.orchiectomy-for-gender-affirmation-what-to-expect-at-home.acp8994

Oregon Health & Science University. (n.d.). Gender-affirming surgery. https://www.ohsu.edu/transgender-health/gender-affirming-surgery

van der Sluis, W. B., Smit, J. M., Schäfer, T., & Bouman, M.-B. (2025). Gender-affirming orchiectomy in transgender and non-binary individuals: A large cohort study with middle- to long-term follow-up. International Journal of Transgender Health, 26(2), 459–463. https://doi.org/10.1080/26895269.2024.2396939

Saltman, A. J., Dorante, M. I., Jonczyk, M. M., Chiu, M., Bene, N. C., Kasabwala, K., & Freniere, B. B. (2023). Outcomes of orchiectomy for gender-affirming surgery: A national surgical quality improvement program study. Urology, 180, 98–104. https://doi.org/10.1016/j.urology.2023.07.003

American College of Surgeons. (n.d.). Quit smoking before your operation. https://www.facs.org/for-patients/preparing-for-surgery/quit-smoking/

UCSF Transgender Care. (n.d.). Overview of feminizing hormone therapy. https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy

UCSF Transgender Care. (n.d.). Bone health and osteoporosis. https://transcare.ucsf.edu/guidelines/bone-health-and-osteoporosis

UCSF Transgender Care. (n.d.). Information on estrogen hormone therapy. https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy

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