During an orchiectomy, doctors surgically remove one or both testicles. Some transgender women seek this surgery as part of gender affirming care.

An orchiectomy can also be part of a broader set of procedures that allow surgeons to construct a vagina and a vulva, which is sometimes called “bottom surgery.” However, not everyone has an orchiectomy for this reason.

Combined with hormone therapy, this procedure alone may reduce gender dysphoria, encourage breast growth, and reduce the need to take certain medications.

This article explains what an orchiectomy involves, who can get one, the recovery time, and the potential risks and side effects of this surgical procedure.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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An orchiectomy is a surgical procedure that removes one or both testicles. The testicles are reproductive organs that produce sperm and testosterone. Testosterone is the sex hormone most abundant in males.

Transgender women typically undergo a bilateral orchiectomy, which removes both testicles. This can:

  • reduce gender dysphoria, which is the distress that occurs when a person’s sex and gender do not align
  • allow a person to stop taking testosterone-blocking medications
  • allow a person to take less estrogen
  • reduce the discomfort of tucking
  • expand clothing options, which may make it easier for a person to dress in a way that reflects their identity

The procedure is usually simple and quick. However, orchiectomies are irreversible.

An orchiectomy also causes infertility. However, a person can take additional steps to preserve their sperm before the surgery if they want to conceive a child in the future.

Orchiectomy vs. scrotectomy

The testicles sit inside the scrotum, which is a sac below the penis. While an orchiectomy only involves removing testicles, a scrotectomy also includes the complete or partial removal of the scrotum.

A person may or may not want to have a scrotectomy at the same time as their orchiectomy. Whether they do or not depends on their level of discomfort around this part of their body, and whether they are having any additional procedures.

For people who only want an orchiectomy, it may be beneficial to remove the scrotum and the testicles together during the same surgery.

However, for people who want surgery to create a vagina and a vulva in the future, doctors advise keeping the scrotum intact. Doctors may use the skin of the penis or scrotum for these procedures.

Yes, an orchiectomy can sometimes help a person develop physical characteristics that people associate with femininity.

Because the testicles produce testosterone, removing them depletes levels of this hormone in the body. Combined with hormone therapy, this may encourage breast tissue growth. Lower amounts of testosterone may also reduce muscle mass.

According to the World Professional Association for Transgender Health (WPATH), a person may be a good candidate for an orchiectomy if they:

  • are legally an adult
  • have the capacity to make informed decisions
  • have received hormone therapy for 12 continuous months, unless hormones are clinically unsuitable
  • have persistent and well-documented gender dysphoria
  • do not have mental health conditions that are affecting their thinking and judgment

The WPATH’s recommendations are guidelines for medical professionals rather than laws. The legal or medical requirements for an orchiectomy may vary depending on location.

The United Kingdom’s National Health Service (NHS) also recommends that people seeking gender affirming surgeries:

  • do not smoke
  • maintain a moderate body weight
  • have well-managed chronic conditions, if they have any

These steps can lower the risks of surgery.

Before an orchiectomy, a person needs to take several steps.

If a person is at the beginning of their transition, they may need to speak with an expert in trans healthcare to discuss any gender dysphoria they experience and how it affects them.

The doctor may recommend socially transitioning first and, if relevant, trying hormone therapy.

Socially transitioning involves nonmedical steps, such as choosing a different name or dressing in a different way. This may help reduce dysphoria and help a person determine which procedures, if any, they require.

Most doctors recommend treatment with cross-sex hormones for at least 12 months before any surgeries. If a person is eligible for an orchiectomy, the doctor may schedule a date and discuss the advantages and risks of the procedure.

Some people may want to allow enough time to freeze their sperm before undergoing the orchiectomy if they want to have children in the future. Sperm freezing can allow a person to have children using fertility treatments, such as in vitro fertilization (IVF), with a female partner or surrogate.

At the start of the orchiectomy, a medical professional uses local anesthesia to numb the genitals and surrounding area. Alternatively, they may use general anesthesia so the person sleeps during the procedure.

Next, a professional cleans the skin from the nipples to the mid-thighs. They then drape a sheet over the body to isolate the sterile area.

A surgeon then makes an incision to access the testicles. This could be in the crease of the groin or down the middle of the scrotum. The surgeon isolates and closes off the blood vessels and cord for sperm connected to the testicles.

The surgeon uses gentle dissection to separate the testicles from the surrounding soft tissues, removing them from the scrotum.

Next, the surgeon clamps or closes the tubes that connect to the testicles.

If the person is having other gender affirming procedures, the surgeon may leave the incision open to continue their work. If the person is only having an orchiectomy, the surgeon closes the scrotum with stitches.

Then, a medical professional applies a dressing to the wound.

The person may be able to go home a few hours later, but some people may stay in the hospital overnight.

Recovery from an orchiectomy may take 2–8 weeks, depending on the technique the surgeon used.

Until the wound has healed completely, a person should not:

  • lift heavy objects
  • drive
  • have sex

A person may experience some bruising, pain, or numbness in the groin area while they recover.

The immediate risks of an orchiectomy are the same as for other surgeries. They can include:

  • bleeding
  • bruising
  • infection
  • adverse reactions to anesthesia

In rare cases, surgery may cause death. It is also possible for the surgery to injure nerves in the groin, which could cause numb skin. It may raise the risk of a certain type of hernia, too.

Other side effects can occur due to the rapid drop in testosterone after an orchiectomy. However, these side effects vary depending on which hormones and medications a person is taking. Side effects could include:

  • decreased sex drive
  • difficulty getting erections
  • fatigue

A doctor may be able to suggest options for reducing any side effects and minimizing risks before the surgery.

The cost of an orchiectomy can vary depending on how many procedures a person is getting, their location, insurance coverage, and the doctor performing it.

Some medical insurers may cover an orchiectomy as part of a person’s gender affirming care. Medicare also covers gender affirming surgeries when they are medically necessary.

The average cost a person pays for an orchiectomy as a hospital outpatient under Medicare is $706.

Without insurance, the price may range anywhere from $2,000–$8,000.

An orchiectomy is a surgical procedure that removes one or both testicles. It is one of the most common procedures for transgender women.

The surgery may reduce gender dysphoria, allow a person to stop taking testosterone-blocking drugs, and may have additional benefits.

A person may decide to undergo an orchiectomy and a vaginoplasty during the same surgery, or they may have an orchiectomy on its own, with or without surgery to remove the scrotum too.

The procedure has some risks and irreversible effects. People considering an orchiectomy can discuss the benefits and risks with a doctor.