Orchiectomy

What is an orchiectomy?

An orchiectomy (or orchidectomy) is a surgical procedure to remove one or both testicles. Testicles are two small organs that hang in a sac of skin (scrotum) below your penis. Testicles (or testes) make sperm and male hormones like testosterone.

Healthcare providers perform orchiectomies to treat or prevent testicular cancer, prostate cancer and male breast cancer. Transgender women may choose to have an orchiectomy when transitioning from male to female. Usually, an orchiectomy is an outpatient procedure, so you go home the same day.

Why do people get an orchiectomy?

Healthcare providers use orchiectomies to:

• Treat cancer: Orchiectomy is both a diagnostic tool and type of treatment for testicular cancer. The surgery removes the tissues that may contain cancer, and also allows the pathologist to examine the tissue to make an accurate cancer diagnosis. It’s also a treatment for male breast cancer and prostate cancer. Androgens (male hormones like testosterone) encourage some cancer cells to grow. Without your testicles, hormone levels drop. An orchiectomy shrinks some cancerous tumors by cutting off the hormones that help them grow and spread.
• Help transgender people transition: As part of the transition process, many transgender women (or trans women) choose to have an orchiectomy. Healthcare providers may do this procedure as a single surgery. Or they may perform it as part of comprehensive gender affirmation surgery that includes a vaginoplasty or scrotoplasty. In addition to physical changes, removing both testicles greatly reduces male hormone levels in your body.
• Remove damaged testicles: Sports injuries, motorcycle accidents and other trauma can cause severe damage to your testicles. If a healthcare provider can’t repair your testicle, they remove it and stitch up surrounding tissues. In rare cases, providers may need to remove an undescended testicle. Also in rare cases, a provider may need to remove a testicle after a testicular torsion.

How do I prepare for an orchiectomy?

Providers perform orchiectomies at a surgical center or a hospital. Most commonly, they use general anesthesia (to put you to sleep for the procedure). You won’t feel pain during surgery.

What happens during an orchiectomy?

Your healthcare provider cleans the area and makes an incision (cut). The location of the incision depends on the technique your healthcare provider uses. The incision may be in your pubic area (inguinal orchiectomy) or in your scrotum (simple orchiectomy). Your healthcare provider may remove:

• Both testicles (bilateral orchiectomy).
• One testicle (unilateral orchiectomy).
• The testicles and the spermatic cord (radical inguinal orchiectomy). The spermatic cord contains blood vessels and nerves. It carries semen from your testicles to your penis, but it can also be a vessel that allows cancer to spread to other parts of your body.

If you choose to have a prosthetic testicle, your provider will place the new testicle inside your scrotum. The prosthetic testicle is filled with salt water (saline).

At the end of the procedure, your provider closes the incision with stitches. After the surgery, you’ll need to wait in the recovery room until you’re ready to leave. Most people go home the day of surgery.

How painful is an orchiectomy?

Since you’re asleep under anesthesia for the procedure, you won’t feel pain. You may feel discomfort during the recovery period. Talk to your healthcare provider about pain medications and other ways to relieve discomfort in the days and weeks after an orchiectomy.

How long does an orchiectomy take?

Usually, the entire procedure takes between 30 to 60 minutes.

What happens after an orchiectomy?

You’ll need someone to drive you home after surgery. The entire recovery process usually takes several weeks. You’ll need to schedule a follow-up visit with your healthcare provider after the procedure. As you recover, you should:

• Avoid physical activity: Wear loose-fitting clothes and take it easy for a few days after surgery. For a couple of weeks, you shouldn’t lift anything heavy, run or have sex. Ask your healthcare provider when you can get back to sports and other activities.
• Keep the area clean and dry: Follow your healthcare provider’s instructions when caring for your incision. Use soap and water when you shower and keep the area clean and dry. You may need to wear a special garment to support your scrotum for about 48 hours after surgery to reduce swelling. You shouldn’t swim or take a bath until your provider tells you it’s OK (usually several weeks after surgery).
• Manage pain: You’ll have some pain, discomfort or tenderness after the procedure. Take over-the-counter (OTC) acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and swelling. Apply ice packs to the area every 20 minutes for the first day or two. Your provider may recommend wearing supportive underwear to help with swelling.
• Stay hydrated and eat nutritious foods: It’s important to avoid pushing too hard when having a bowel movement (pooping). Drink plenty of water and eat fiber-rich foods to help keep you regular and prevent constipation.

What are the benefits of orchiectomy?

For people with testicular cancer, orchiectomy is an effective treatment to remove the tumor and analyze the tissue for cancer. For breast and prostate cancer, it’s an effective treatment to lower hormone levels as part of a larger treatment strategy.

For many transgender people, an orchiectomy may be an important aspect of the transition process. It reduces the need for long-term feminizing hormone therapy. Hormone therapy for transgender women often includes drugs or supplements that lower androgen levels (androgen deprivation therapy or ADT) or increase estrogen. Although the risks of estrogen supplements are low, long-term use can lead to blood clots and other health problems.

A sudden decrease in hormones due to removing your testicles can have side effects. Talk to your healthcare provider about ways to manage these side effects.

What are the risks of orchiectomy?

As with any surgical procedure, the risks of an orchiectomy include bleeding and infection. You may have side effects like swelling and pain. Complications and side effects of an orchiectomy depend on the type of surgery you had.

Some of the side effects from orchiectomy result from a decrease in hormone levels (typically when both testicles are removed). While rare, a drop in testosterone and other male hormones can lead to:

• Low sex drive.
• Depression.
• Fatigue.
• Hot flashes.
• Low muscle mass.
• Osteoporosis.
• Problems with sexual function or the ability to get an erection (erectile dysfunction).

People who have both testicles removed (a bilateral orchiectomy) can’t produce sperm. This procedure makes them infertile.

An orchiectomy can affect how you feel about yourself and how you feel about sex. It’s normal to have these types of emotions after surgery. Talk to your healthcare provider about the psychological side effects of surgery. They can recommend ways to help you cope.

When can I go back to my usual activities after an orchiectomy?

It’s essential to make sure your incision heals completely before resuming physical activities, including sex. Healthcare providers usually recommend that you wait three to four weeks. Until then, you shouldn’t play sports, run or lift anything heavy. Ask your healthcare provider when you can get back to the activities you enjoy.

When should I call my healthcare provider?

After an orchiectomy, call your healthcare provider right away if you:

• Develop a fever or severe pain.
• Have problems peeing.
• Lose feeling or sensation in your scrotum.
• Notice any redness near the incision or a purple spot on the scrotum. This could be blood pooling under the skin (hematoma).
• See blood or pus coming from the incision.

If you’re having hot flashes, fatigue or problems with sexual function, call your healthcare provider. These symptoms can occur after a drop in hormone levels. Talk to your healthcare provider about taking hormone supplements, which may relieve these symptoms.

Does orchiectomy count as gender reassignment?

It could, but it doesn’t have to. Transgender people can opt to have this surgery, but it isn’t necessary for gender reassignment. The decision to have this or any other gender affirmation procedure is highly personal and unique to your situation.

A note from Cleveland Clinic

An orchiectomy is a procedure that removes one or both of your testicles due to cancer or as part of gender reassignment surgery. It’s normal to have questions about the surgery, no matter what the reason is for having it. Be sure to discuss the procedure with your healthcare provider so you know exactly what to expect. Your provider will go over the risks and benefits of the surgery as well as how you can best recover after surgery.