(copied in large part from TS Surgery Guide)
An Orchiectomy (spelled orchidectomy in British English), is the medical term for the surgical procedure to remove one or more of the testicles. A bilateral orchiectomyl is the removal of both testicles and is commonly referred to as castration. Our fee is perhaps one of the most affordable in the US, namely $2,500 which includes use of the operating room, local anesthesia with IV sedation, surgery and any aftercare we provide.
An orchiectomy doesn’t remove the penis, which would be a penectomy. It is also different from a vasectomy, which leaves the testicles and their function intact while still causing sterilization. While sex reassignment surgery (SRS) for male to female transsexuals also removes the testicles and penis, it is different because it also creates a functional vagina in the process.
What Are the Effects of an Orchiectomy?
The effects of an orchiectomy are caused by the reduction of testosterone. They can vary based on the age of the person and on the number of testicles removed.
If castration is done prior to puberty then the person won’t develop male secondary sex characteristics without testosterone replacement therapy.
Male body hair
Reduced or complete lack of sex drive
Possible slight breast growth
If Castration is Done After Puberty:
Loss of body hair
Loss of muscle mass
Increased body fat
Possible reduced sex drive
Possible slight breast growth
Prevent or stop baldness
In most cases of castration after puberty facial hair growth is slowed but not stopped, libido is reduced but still exists and the voice remains deep.
If only one testicle is removed, the other testicle increases testosterone production and there won’t be too much of a change.
Antiandrogens such as spironolactone and cyproterone acetate can be taken to block testosterone. A more expensive option are gonadotropin-releasing hormone (GnRH) agonists that block testicular function.
Why Do Some Trans Women Get Orchiectomies?:
Male to female (MTF) transsexuals, as well as some other transgendered people, sometimes undergo orchiectomy. An orchiectomy can be done before or instead of sex reassignment surgery (SRS). This is an option for those that either can’t afford, aren’t in good enough health or do not want to have SRS.
It is often recommended to get a bilateral orchiectomy when antiandrogens such as spironolactone or cyproterone acetate cause unwanted and dangerous side effects. Kidney, liver, and thyroid damage are common after long term use. There is also an increased risk of blood clots, hyperkalemia and some people are allergic to the medications. Cyproterone acetate is not used in the United States for this purpose.
Benefits of an Orchiectomy for Trans Women:
The Benefits for Transgendered Women Are:
1. Ability to stop taking antiandrogens and reduce estrogen
2. Increased health from reduction of medications
3: Saves money on medications
4: Might be able to legally change sex with an orchiectomy
5: Easier to “tuck” and hide genitals
6: Taken more seriously by society
7: Increased body image
8: Improved and faster feminization
9: Can no longer have testicular pain
10: Never detransition even if you can’t take medications
There are also some possible downsides to getting an orchiectomy if you are planning on later sex reassignment surgery (SRS). The scrotal skin could possibly shrink resulting in less for later, and the money could have been saved for SRS. However, if you aren’t close to affording SRS then you can save on medication costs. If an orchiectomy is done improperly then there is the chance of scar tissue.
Who Else Gets Orchiectomies?:
The most common reason for an orchiectomy is as a treatment for testicular cancer. If only one testicle is found to be cancerous then only that one is removed. Even if both testicles are removed, male sexual function can be restored and maintained through the use of testosterone injections or patches. However without testicles there is no production of sperm and so the person will be infertile.
Some men seek this procedure in order to remove what they consider uncomfortable, uncontrollable or dysfunctional sexual urges. Others may seek it in order to fulfill a fetish or fantasy. The most common reason for control of sexuality is as part of rehabilitation for sex offenders. However, any patient who has had an orchiectomy can take testosterone and restore full libido.
There are also eunuchs, which get castrated for religious or alternative gender identities.
The Different Types of Orchiectomies:
A simple orchiectomy is one in which the incision is made down the center of the scrotum. It can be done under general or local anesthesia. The various layers of muscle and fasciae are cu into and the testicles are extracted. The spermatic cord is tied off with two triple square knots. We prefer high ligation of the cord to obviate the “tootsie roll” effect. This also reduces scrotal bulkiness.
Operating time is generally 30 minutes in an outpatient setting with a checkup within 24 hours.
Radical, or Inguinal Orchiectomy:
An inguinal (groin area) orchiectomy may be either unilateral, involving only one testicle, or bilateral, involving both. The reason for complete (radical) removal, in the cases of cancer treatment, is that testicular cancers frequently spread from the spermatic cord into the lymph nodes near the kidneys.
For trans women, an inguinal orchiectomy may be chosen to prevent scrotal scar tissue which may interfere with future sex reassignment surgery. However, our experience working with patient who have had prior orchiectomy is there is absolutely no difference in procuring a scrotal graft for inverted penile skin vaginal extension.
A 2.5 inch (about 6 cm) incision is made above the pubic bone on the side above the testicle that is being removed. If you are getting both removed then an incision will be made on both sides.
The testicle is then pulled up through the inguinal canal, the spermatic cord is clamped off in two places to prevent blood loss and then cut between the clamps.
After the cord and testicle have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged. The procedure is usually finished in 45 minutes to an hour and a half.
The full recovery time after a bilateral inguinal (radical) orchiectomy is usually between 2 to 8 weeks. Some light activity may be resumed after about 3 to 4 days.
Someone that has been castrated will no longer produce enough testosterone to prevent osteoporosis. They will need to take hormone replacement therapy (HRT) for the rest of their lives. Either estrogen or testosterone will prevent osteoporosis and rapid aging.
If castration is done before puberty then the person will be taller than average, since the sex hormones in puberty stop long bone growth.
Recovery After an Orchiectomy:
The recovery time for an orchiectomy is usually anywhere from a week to two months. Complications increase the length of healing time. The most common complications for an orchiectomy include bruising on or around the scrotum, spotting of blood, swelling and scrotal and abdominal pain.
A slightly less common complication is a hematoma, which is the pooling and swelling of the blood in the scrotal skin. It can cause a lot of swelling and changes the skin color to black and purple.
Castration should not be done without a doctor’s care. Those who have done self cutting have generally regretted the outcomes or have had a difficult SRS due to scar tissue. Some have even died from the blood loss. If you choose to have this done by some that isn’t medically trained, it can result in major health problems due to blood loss, excessive scar tissue formation or life threatening infections.
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami