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Orchiectomy: Purpose, Benefits, Risks, and Recovery

Medically reviewed by Jennifer Richman on June 25, 2025.

Understanding Orchiectomy

An orchiectomy is a surgical procedure that removes one or both testicles. It is performed for various reasons, including treating certain types of cancer or as a part of gender-affirming care.

The testicles (also known as testes) are two small, oval-shaped organs located in the scrotum, a pouch of skin situated below the penis. The testicles produce sperm and testosterone. The scrotum is a pouch of skin that holds and protects the testicles, helping regulate their temperature for sperm production.

There are two types of orchiectomy:

• Unilateral orchiectomy: the removal of one testicle. 
• Bilateral orchiectomy: the removal of testicles.

The choice depends on the patient’s specific medical needs and surgical goals. It’s important to know that this surgery has permanent effects, such as infertility.

Candidacy for Undergoing an Orchiectomy

Each patient has unique reasons for undergoing orchiectomy. At the Gender Confirmation Center (GCC), Dr. Ley (she/her/they) offers orchiectomy, sometimes called MTF orchiectomy, to trans women and trans feminine non-binary patients. 

Cancer Treatment and Prevention

Some healthcare providers perform orchiectomies on cisgender men, trans, and non-binary patients to treat various types of cancer, including: 

• Testicular cancer 
• Breast cancer
• Prostate cancer

Damaged Testicles

An orchiectomy may also be performed due to severe damage to one or both of the testicles from accidents and other trauma. 

In this case, on the patient’s request, after the testicle(s) are removed, the surgeon can put a prosthetic one(s) in place. Modern testicular prosthetics are typically made of solid silicone or silicone filled with saline.  

Gender Affirmation to treat Gender Dysphoria

Testicle removal can also be part of a patient’s gender-affirming treatment. It is one of the most common, quick, and inexpensive gender confirmation surgeries. Undergoing a bilateral orchiectomy can:

• Lower the production of testosterone: meaning a patient may reduce or stop taking testosterone blockers or anti-androgen medication
• Could allow a patient to reduce their estrogen dosage 
• Help alleviate gender dysphoria
• Decrease discomfort from tucking
• Increase overall quality of life

Please note that some patients choose to undergo an orchiectomy before or as part of a vaginoplasty or vulvaplasty. If done prior, we recommend waiting 8–12 weeks between the orchiectomy and any future bottom surgery to allow for proper healing.

At the GCC, Dr. Ley (she/her/they) offers ochiectomy to transgender and non-binary patients. You can request a free consultation with her for bottom surgery, top surgery, or body contouring here.

Orchiectomy Benefits

Removing the testicles (orchiectomy) eliminates the body’s primary source of testosterone. This can reduce muscle mass, reduce body hair growth, alleviate gender dysphoria symptoms, and eliminate the need for testosterone blocker medications.

Risks and Side Effects 

Like any surgical procedure, an orchiectomy involves rare but possible risks. Undergoing surgery with an experienced, board-certified provider like Dr. Ley can seriously reduce your risk of the following complications:

Surgical Risks

• Bleeding
• Infection
• Blood clots
• Anesthesia-related complications
• Delayed healing 

Orchiectomy Side Effects

With reduced amounts of testosterone, patients should expect to experience the following symptoms:

• Hot flashes
• Reduced libido
• Erectile changes
• Infertility (permanent)
• Loss of testicular hormone production (primarily testosterone)

Preparing for an Orchiectomy

Fertility Preservation

Since testicles are responsible for the production of sperm cells, which are necessary for reproduction, their removal irreversibly sterilizes the patient. For those interested in preserving fertility, there are educational resources available to learn about their options. The most common preservation is by sperm cryopreservation. This procedure involves collecting and freezing semen for future use. It can be done before undergoing bottom surgery.

Hormone Therapy

It’s common for practitioners to require that patients be on HRT continuously for at least 9-12 months before surgery, since the orchiectomy eliminates the main source of testosterone.

Finding a Trusted Hormone Provider

The following are resources for finding providers offering gender-affirming care.

• World Professional Association for Transgender Health (WPATH) has a directory that allows you to search for gender-affirming providers in any healthcare field or specialty.
• LGBTQ+ Healthcare Directory is a free, searchable database of doctors, medical professionals, and healthcare providers who are knowledgeable about and sensitive to the unique health needs of LGBTQ+ people in the USA and Canada.
• OutCare Health is an organization that empowers LGBTQ+ individuals through comprehensive resources, support, and education to provide access to quality healthcare. The OutList provides a directory of LGBT affirming healthcare providers.
• Plume and Folx Health are two online, telehealth providers of hormone replacement therapy (HRT) and other healthcare services for trans, non-binary, and gender expansive folks.

What to Expect During Surgery

Procedure Details

Orchiectomies are typically an outpatient surgery and are performed under general anesthesia. Each surgeon may approach the procedure with a different method. Incisions are typically made in the scrotum, although some approaches may utilize incisions in the pubic area. Providers can remove one (unilateral orchiectomy) or both (bilateral orchiectomy) testicles and the spermatic cord, if needed. After surgery, patients typically recover and can go home the same day.

Is an orchiectomy painful?

Due to the general anesthesia, you will not feel any pain during the surgery. However, mild pain and discomfort are normal during the recovery process. Talk to your healthcare provider about pain relief and what to expect during recovery.

How long does surgery last?

The duration of surgery is typically between 30 to 60 minutes. With general recovery taking 6 weeks, after which you should be able to resume vigorous exercise. A reduction of residual side effects occurs after a few months.

Surgical Recovery

The following are post-op recommendations. Be sure to follow the specific instructions given to you by your surgical team.

• Have someone pick you up from the surgical center and drive you home after the surgery.
• Avoid strenuous exercise, swimming, baths, sex, or heavy lifting for the first few weeks, until your provider clears you for these activities.
• Eat nutritious foods and stay hydrated to maintain regular bowel movements.. 
• Pain can be managed with over-the-counter medicines like acetaminophen or ibuprofen.
• Maintain good hygiene around the incision and keep the area dry.

Surgical Costs and Insurance Coverage

How much does an orchiectomy cost?

Costs vary by provider. In the US, the out-of-pocket cost can be between $2,000-$8,000. Quotes do not always include anesthesia and facility fees.

Will my insurance cover an orchiectomy?

Insurance providers that cover gender-affirming surgeries will often cover an orchiectomy when provided with the following:

• Support letter provided with gender dysphoria diagnosis
• 12 months of continuous HRT 

Frequently Asked Questions about Orchiectomy

Can a patient still have erections after an orchiectomy?

Yes, a patient can still have erections after an orchiectomy. The testicles produce testosterone, which contributes to sexual desire and erectile function, but erections also depend on blood flow, nerves, and psychological factors.

Unilateral orchiectomy: If only one testicle is removed, testosterone levels often remain normal, and erections are usually unaffected.

Bilateral orchiectomy: If both testicles are removed, testosterone levels significantly decrease. This can lead to reduced libido and less frequent or effective erections. Some patients still experience erections due to residual testosterone from other sources in the body and psychological or nerve stimulation.

For those who want to maintain sexual function, testosterone replacement therapy (TRT) can help restore erections and libido after bilateral orchiectomy.

Will my hormone replacement therapy (HRT) dosages change after an orchiectomy?

Trans women and trans feminine non-binary patients often seek these procedures to streamline their gender-affirming hormone replacement therapy (HRT) process. 

Receiving an orchiectomy can eliminate the need for testosterone blockers. Additionally, it can enhance the body’s ability to naturally produce estrogen. As a result, a patient may take a lower dosage of external estradiol, which can decrease risks like blood clotting.

Do I need to undergo an orchiectomy before a vaginoplasty?

This depends on the provider and patient. Some providers like Dr. Ley can do both an orchiectomy and a vaginoplasty simultaneously. If you want to get an orchiectomy beforehand, we recommend you undergo it 8-12 weeks before your vaginoplasty. 

Should I undergo a scrotectomy with an orchiectomy?

The choice to remove the scrotum depends on what your goals are. If your goal is to undergo a vaginoplasty or vulvoplasty, it is advised not to remove the scrotum, as this skin can be used to construct a vulva and/or part of the vaginal canal.