What Is an Orchiectomy?
If you've been diagnosed with testicular cancer or are considering feminizing surgery (also called gender-affirming surgery), your doctor has probably talked to you about an orchiectomy, a surgery to remove one or both testicles. Testicles, or testes, are the male sex organs that make sperm and the hormone testosterone.
Why Get an Orchiectomy?
There are several reasons why you may need or want an orchiectomy. It's usually needed to diagnose testicular cancer or treat testicular, prostate, or male breast cancers. It can also help if your testicle is damaged by infection or injury. Sometimes it's part of prostate cancer treatment.
Orchiectomies are also sometimes used for male-to-female and nonbinary transitions. Since the testes produce testosterone, when you have them removed, your testosterone levels drop to almost zero. So, after surgery, you may be able to stop taking medicine to block your body from making testosterone or take less of the female hormone estrogen.
When both of your testicles are removed, your body cannot make sperm and you will be unable to have children. You will also produce much less testosterone, which can lower your sex drive and your ability to get an erection.
What Happens Before an Orchiectomy?
Before having an orchiectomy, you’ll meet with your surgeon who may explain how to prepare for surgery, the type of anesthesia that will be used, and any follow-up care.
If doctors suspect testicular cancer, they will likely order an ultrasound test first to check for non-cancer causes. Blood tests may also be ordered to help diagnose testicular cancer.
If you are getting an orchiectomy for gender affirmation, you will need to give consent so doctors know you understand the surgery will cause physical changes in your body that cannot be reversed. You may also need a behavioral health evaluation, during which you will be assessed for gender dysphoria, physical or mental health concerns, and your use of hormone therapy to support your gender goals.
What Happens During an Orchiectomy?
It depends on what type of orchiectomy you are getting. There are three types of orchiectomy:
- Simple orchiectomy: This type is usually used to treat advanced prostate cancer and male breast cancer. A simple orchiectomy can involve the removal of just one or both testicles. A bilateral orchiectomy (removal of both testicles) is also the type used for male-to-female transition surgery because it allows for additional feminizing surgery, if desired. During a simple orchiectomy, the testicles are removed through a cut in the scrotum.
- Subcapsular orchiectomy: This type is also used to treat prostate cancer. It’s similar to a simple orchiectomy, but only the tissue that surrounds the testicles is removed. This helps keep the appearance of a scrotum.
- Radical inguinal orchiectomy: Rather than doing a biopsy of the testes, which can trigger cancer spread, doctors almost always do what’s called a radical inguinal orchiectomy for testicular cancer. It's called "radical" because it removes the spermatic cord along with the testicle and tumor. The cord has blood and lymph vessels that could let the cancer spread to other parts of the body. A radical inguinal orchiectomy involves removing the testicles and spermatic cord through a cut in the groin area.
A simple orchiectomy takes about 30 minutes, while a radical inguinal orchiectomy can take about an hour. After surgery, you will be taken to a recovery area and monitored as you wake from anesthesia. You will probably be able to go home the same day, provided someone drives you home. But, in some cases, you may have to stay in the hospital for a night or two.
What Happens After an Orchiectomy?
You’ll probably feel fine within a few days after surgery, but you won’t be fully recovered for several weeks. During that time, you’ll have a follow-up visit with your doctor. You’ll also need to follow your doctor’s orders, which may include wearing a support garment and keeping the surgical site clean and covered with gauze for the first day or two after surgery. You’ll also need to avoid physical activity for a few weeks, like sports, lifting heavy objects, and sex.
You can manage post-surgery pain and tenderness with over-the-counter (OTC) acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). You can also apply ice packs to your groin for the first couple of days.
Orchiectomy can offer several benefits, such as:
- Effectively diagnose and remove testicular tumors
- May eliminate the need for chemotherapy or radiation therapy
- May cause prostate shrinkage
- Can lower testosterone levels to treat prostate and male breast cancers, or reduce or eliminate the need for hormone therapy if you are a transgender or nonbinary patient. Although the risk is rare, long-term estrogen therapy can cause health problems such as blood clots.
Orchiectomy Side Effects
As with any surgery, an orchiectomy comes with risks, such as bleeding, infection, blood clots, and reaction to anesthesia. Some orchiectomy side effects are caused by the drop in testosterone. These may include:
- Low sex drive
- Sexual or erectile dysfunction
- Loss of muscle mass
- Hot flashes
- Weight gain
- Mood swings
- Loss of feeling in the groin
These dos and don’ts after surgery will help you heal:
- Keep an ice pack or cold compress on your scrotum to ease swelling. It should get better in a few days. Don't keep the ice on for more than 15 minutes at a time.
- Your surgeon probably will suggest you wear a jockstrap or snug underwear for a few days to help with swelling, too.
- Take pain medicine as prescribed. Don't drive until you've stopped taking medicine and your doctor says it's OK.
- Your doctor will tell you when you can shower. You'll have to skip baths and swimming until the cut made during surgery heals.
- The doctor will show you how to take care of your cut. Check it every day for signs of infection or other problems.
- Take it easy for a few days after surgery. Don't lift anything heavy, have sex, or do hard exercise for a few weeks. Follow the directions you get from your doctor.
- If you had surgery due to cancer, you may have to have chemotherapy or radiation to lower the chances that any leftover cancer cells will spread.
Life After an Orchiectomy
Having one or both testicles removed can change the way you feel about your body. Surgery may affect how you look, your fertility, and your interest in sex.
You may be concerned about how you look to a partner or in a locker room. If it’s a problem, you can have surgery to implant an artificial testicle. It's filled with saline and is made to look like the real thing. There will be a small scar, but your pubic hair can help hide it.
If you still have one testicle, you should still be able to get an erection and have sex. If both are removed, your body won't be able to make sperm. If you want to have children, you may want to store sperm before the procedure. Talk to your doctor to plan ahead.
Without both testicles, your body won't be able to make as much testosterone as it needs. That might lower your sex drive and make it harder to have erections. You could have hot flashes, lose some muscle mass, and be more tired than usual. Talk to your doctor about a testosterone gel, patch, or shot that will help ease these symptoms.
An orchiectomy is an effective way to diagnose and treat testicular cancer. It can also help treat prostate and male breast cancers. For trans women and nonbinary people, it is also a feminizing surgery.
- Can you still get an erection after orchiectomy?
If you have only one testicle removed, you should be able to get an erection. But it’ll be more difficult with both testicles removed because of the drop in testosterone. Your doctor can prescribe testosterone supplements to increase your sex drive so you can get an erection.
- What happens to a man after an orchiectomy?
If you have one testicle removed, you can still produce testosterone and sperm. So, you can still get an erection and father children. If you have both testicles removed, you cannot produce sperm and therefore are infertile and unable to have children. Your sex drive will drop and you will have a hard time getting an erection without testosterone therapy. For nonbinary people and transgender women, the drop in testosterone means you will no longer need testosterone blockers and you may be able to reduce the amount of estrogen you are taking.
- Why do people get an orchiectomy?
People get orchiectomies to diagnose testicular cancer, treat prostate or male breast cancer, and treat an infected or injured testicle. They are also a type of feminizing or gender-affirming surgery for nonbinary people and those transitioning from male to female.
- What happens to the other testicle after an orchiectomy?
When one testicle is removed during an orchiectomy, the remaining testicle usually makes more testosterone and sperm to make up for the missing one.