Introduction
Bilateral orchiectomy is surgery to remove both testicles. The name might sound complex, but the idea is simple. This surgery helps treat certain health issues. It’s also an option for gender-affirming care.
This guide will help you understand the surgery. We’ll explain what it involves and why doctors do it. We’ll also cover what to expect afterward. Knowing the facts helps you make good health decisions, whether for yourself or someone else.
What Is Bilateral Orchiectomy?
This surgery removes both testicles from the scrotum (the skin sac holding them). Testicles have two main jobs. They make sperm and testosterone, the main male hormone.
Doctors use different surgery methods. The method depends on why you need the surgery. “Bilateral means both sides, so we remove both testicles,” explains Dr. James Wilson, an experienced urologist. This is different from removing just one testicle.
Types of Bilateral Orchiectomy
Surgeons use several ways to do this surgery:
- Simple orchiectomy: This is the most common type. The surgeon removes the testicles but leaves the scrotum. It’s often used for prostate cancer or gender care.
- Subcapsular orchiectomy: The surgeon removes the inner parts of the testicles. They leave the outer shell. This helps the scrotum look more natural.
- Radical orchiectomy: This is common for testicular cancer. The surgeon removes the testicles and the spermatic cord (tubes and vessels connected to them). The cut is in the groin area, not the scrotum.
- Inguinal orchiectomy: This is similar to the radical type. It also uses a cut in the groin. Doctors use this if they worry cancer could spread through the scrotum tissue.
Why People Get Bilateral Orchiectomy
Advanced Prostate Cancer
Treating advanced prostate cancer is a common reason for this surgery. Dr. Sarah Chen, a cancer doctor, explains why. “Prostate cancer cells often need testosterone to grow,” she says.
Removing the testicles stops about 95% of the body’s testosterone. This can slow or stop the cancer’s growth. This method is sometimes called surgical castration. It’s a type of androgen deprivation therapy (ADT), which means reducing male hormones.
This surgery used to be the main treatment for advanced prostate cancer. Now, hormone-blocking drugs are more common. But surgery is still a good one-time choice. It means patients don’t need regular shots or pills.
A 2022 medical review found this surgery can be a good value. This is especially true for some patients who find it hard to take medicine regularly.
Gender-Affirming Care
Some transgender women and non-binary people choose this surgery. It’s part of their gender-affirming care. Dr. Maya Rodriguez specializes in transgender health.
She explains, “The surgery removes the main source of testosterone.” This means people may need less testosterone-blocking medicine. They might also take lower doses of estrogen.
For many, this surgery greatly eases gender dysphoria. That’s the distress felt when one’s body doesn’t match their gender identity. It also helps keep hormone levels steady.
The surgery can be done alone. Or it can happen before other surgeries, like creating a vagina (vaginoplasty). An important health group (WPATH) agrees orchiectomy is a key option for transgender people.
Testicular Cancer
Sometimes cancer affects both testicles. This might happen at the same time or one after the other. Bilateral orchiectomy may be needed in these cases.
Bilateral testicular cancer is rare. But it requires quick surgery as part of treatment. Dr. Robert Thompson is a cancer surgeon. He explains, “We usually treat testicular cancer by removing the bad testicle.”
“Then,” he adds, “we watch carefully, or use radiation or chemo. It depends on the cancer stage and type.” If cancer grows in both testicles, removing both becomes necessary. But this situation is not common.
Trauma or Infection
A severe injury to the testicles might require this surgery. An advanced infection that doesn’t get better might also lead to it. These cases are rare. Doctors usually try other treatments first.
The Surgical Procedure
Knowing what happens during surgery can ease worries. Here’s a look at the process if you’re thinking about it.
Before Surgery
Patients usually have these steps first:
- A physical check-up
- Blood tests
- Imaging tests (like scans, if needed)
- Talks about the surgery, other choices, risks, and expected results
- Talks about possible hormone replacement therapy (if it applies)
“Good talks before surgery are very important,” notes Dr. Wilson. “Patients need to clearly understand the effects right away and long term. This includes fertility and hormone changes.”
During the Surgery
Here’s what happens in a typical simple bilateral orchiectomy:
- The doctor gives medicine so you don’t feel pain (anesthesia). This could be local, regional, or general.
- The surgery area is cleaned.
- The surgeon makes a small cut in the scrotum (middle or each side).
- They find and bring out each testicle.
- They clamp, cut, and tie off the spermatic cord (tubes and vessels).
- They remove the testicles.
- The surgeon stops any bleeding.
- They close the cut with stitches that dissolve on their own.
The surgery usually takes 30-60 minutes. Other types (inguinal or radical) use cuts in the groin. They might take a bit longer.
Recovery Process
How fast you recover depends on a few things. These include the surgery type, your overall health, and why you had the surgery.
Right After Surgery
“Most patients go home the same day,” explains Dr. Chen. “The first day or two usually involve rest.” You’ll likely use pain medicine and ice packs to lower swelling.
Common tips right after surgery:
- Wear supportive underwear or a special support.
- Keep the surgery spot clean and dry.
- Take pain medicine as told.
- Avoid heavy lifting and hard activity.
- Watch for signs of infection or problems.
Short-Term Recovery
In the first two weeks after surgery:
- Swelling and soreness slowly get better.
- Most people can go back to desk jobs in 7-10 days.
- You can usually shower once healing starts.
- Follow-up visits let the surgeon check your healing.
“Most patients are surprised how fast they return to normal tasks,” notes Dr. Rodriguez. “Just follow the instructions and don’t do too much too soon.”
Long-Term Recovery
Full physical recovery usually takes 4-6 weeks. Most patients can do all normal activities then, including exercise. But hormone changes might take longer to adjust to. This is especially true if you don’t take replacement hormones.
Physical and Hormonal Effects
Bilateral orchiectomy causes big hormone changes. These can affect many parts of the body.
Immediate Hormone Changes
The biggest change happens fast: testosterone levels drop quickly. Research shows levels fall by about 95% within 24 hours after surgery. The body’s adrenal glands make the remaining 5%.
For prostate cancer patients, this hormone drop is the goal. For transgender people, it marks progress toward their gender goals.
Long-Term Physical Effects (Without Hormone Replacement)
If you don’t take hormone replacement therapy, low testosterone can cause:
- Weaker bones: “The risk of weak bones (osteoporosis) goes up without sex hormones,” warns Dr. Thompson. Bone density checks are key for long-term care.
- Body changes: Muscle mass may decrease. Body fat might increase.
- Energy and mood changes: You might feel tired, have mood swings, or feel depressed.
- Hot flashes and night sweats: Similar to menopause symptoms.
- Sexual changes: Lower sex drive and problems with erections.
- Metabolic effects: Changes in cholesterol or how your body uses sugar.
Hormone Replacement Options
Some patients may need hormone replacement. This applies if the surgery wasn’t for gender care or hormone-sensitive cancer. Testosterone replacement therapy (TRT) can prevent problems from low hormones.
“Deciding about hormone replacement needs to fit each person,” says Dr. Chen strongly. “Prostate cancer patients usually need to avoid testosterone.” For others, replacement can help keep bones strong, energy up, and improve life quality.
Transgender people usually continue estrogen therapy. The dose might change. This helps keep bones healthy and supports desired female body features.
Psychological and Quality of Life Considerations
How this surgery affects you mentally depends a lot on why you had it. Your personal situation also matters.
For Prostate Cancer Patients
Men with advanced prostate cancer might have different feelings. The surgery helps control cancer effectively. But the side effects and the sense of loss can be tough.
Support groups can be very helpful. Groups for prostate cancer patients who had this surgery exist. Studies show patients in these groups adjust better mentally. They often report a better quality of life.
For Gender Affirmation
For many transgender women and non-binary people, this surgery often brings great relief. “Many patients report less gender dysphoria. They feel better mentally after orchiectomy,” says Dr. Rodriguez. “It can feel very right when the body matches gender identity.”
A 2021 study found 94% of transgender women were happy with their choice. They showed big improvements in life quality. Their gender dysphoria symptoms also lessened.
Coping Strategies and Support
No matter the reason for surgery, mental support is important. Helpful resources include:
- One-on-one counseling or therapy
- Support groups (in person or online)
- Info materials about what to expect
- Having partners or family involved in adjusting
“I always tell my patients it’s normal to feel many emotions after this type of surgery,” says Dr. Wilson. “Getting support isn’t weak. It’s a smart step toward full healing.”
Risks and Complications
Like any surgery, bilateral orchiectomy has some risks. You should understand these before deciding.
Surgical Risks
Risks right around the surgery include:
- Bleeding or blood collecting near the surgery area
- Infection at the cut
- Problems with wound healing
- Bad reactions to anesthesia (pain medicine)
- Long-lasting pain in the surgery area
“Serious problems are rare,” notes Dr. Thompson. “But good surgery skill and after-care are key to lower risks.” Data show the rate of major problems for simple orchiectomy is low (less than 2% of cases).
Long-Term Complications
Possible long-term issues after surgery can include:
- Weak bones (osteoporosis) and higher risk of breaks due to low hormones
- Metabolic changes that affect heart health
- Mood problems linked to hormone changes
- Changes in sexual function
- Changes in body shape or weight
You need to weigh these risks against the surgery’s benefits. Good follow-up care can often reduce these risks. Hormone replacement therapy can also help, when it’s right for you.
Decision-Making Considerations
Choosing to have this surgery requires careful thought. Think about several factors.
For Prostate Cancer Patients
If considering this surgery for prostate cancer, think about:
- Cancer stage and how fast it’s growing
- How it compares to hormone drug options
- Your age and overall health
- Costs and insurance coverage
- Your preference for a one-time surgery vs. ongoing medicine
“Hormone drugs offer a choice you can reverse,” explains Dr. Chen. “But some patients prefer surgery because it’s done once and can cost less over time.” Medical guidelines see both methods as good choices for ADT.
For Gender-Affirming Care
Transgender people thinking about orchiectomy often consider:
- How it fits with their gender identity goals
- Plans for other possible surgeries later
- How hormone therapy might need to change
- Mental health readiness
- Options for saving sperm (fertility preservation)
Most doctors follow guidelines from WPATH. These suggest a mental health review. They often require living in your affirmed gender role for some time before surgery. Many doctors also need letters from mental health experts.
Questions to Discuss with Healthcare Providers
No matter why you’re considering this surgery, ask your doctors:
- What are all the other choices besides this surgery?
- What can I really expect for recovery time?
- How will this affect my hormones? What symptoms might I have?
- Is hormone replacement therapy suggested for me?
- What follow-up care will I need long term?
- What lifestyle changes might help me get the best results?
Insurance Coverage and Cost Considerations
The cost of bilateral orchiectomy varies a lot. It depends on location, the facility, surgery type, and the reason for it.
Insurance Coverage
Coverage mainly depends on the medical reason:
- For prostate cancer: Most insurance plans, including Medicare, cover it if medically needed for cancer.
- For gender-affirming care: Coverage differs greatly. “Many insurance companies now cover more gender-affirming surgeries,” notes Dr. Rodriguez. “But policies are very different. Patients should check their benefits carefully. They might need to fight denials.”
Laws like the Affordable Care Act ban unfair treatment based on sex. Many courts say this includes gender identity. This might help get coverage for needed gender care. But coverage still varies by plan and state.
Cost Ranges
Without insurance, the surgery can cost from $4,000 to over $10,000. This depends on:
- Where you live
- Hospital vs. outpatient surgery center
- Type of anesthesia used
- Surgery method
- Any hospital stay needed
Some hospitals and LGBTQ+ health centers offer fees based on income. They might also have payment plans to make it easier to afford. This is sometimes an option for gender affirmation patients.
Future Trends and Research
Things are changing in this area. New research and practices continue to develop.
Minimally Invasive Approaches
New surgery methods are making the operation less invasive. They use smaller cuts and allow faster recovery. Some centers explore single-cut methods. These leave less scarring and cause less soreness after surgery.
Alternatives for Prostate Cancer
For prostate cancer, research keeps improving drug options instead of surgery. “Newer hormone blockers and targeted drugs expand treatment choices,” explains Dr. Chen. “But bilateral orchiectomy is still useful. It’s reliable, cost-effective, and a one-time fix.”
Advances in Gender-Affirming Care
In gender care, doctors increasingly tailor care to each person. Some transgender people choose orchiectomy by itself. They may not plan for more complex surgeries like vaginoplasty. This shows the varied needs within the transgender community.
“The medical world sees that gender care isn’t one-size-fits-all,” says Dr. Rodriguez. “For some people, bilateral orchiectomy gives enough relief from dysphoria. They may not need bigger surgeries.”
Frequently Asked Questions
Does bilateral orchiectomy affect height or voice?
In adults, no. Height doesn’t change because bones have stopped growing. Voice changes are also unlikely if your voice already deepened during puberty. If done before puberty (which is very rare), it could affect growth.
Will I need to take hormones after?
It depends. For prostate cancer, avoiding testosterone is often the goal. For others, doctors might suggest testosterone replacement. This prevents bone loss and other issues. Transgender people usually keep taking estrogen, maybe at different doses.
How soon can I go back to work?
Most people return to desk jobs in 7-10 days. If your job involves heavy work, you might need 3-4 weeks off. Your surgeon will give you specific advice.
Will it affect my sexual function?
It usually lowers sex drive due to less testosterone. Erections might also be affected. How much varies per person. For transgender people on estrogen, these changes are often wanted. If you want to keep sexual function, talk to a urologist who specializes in sexual health.
Is bilateral orchiectomy reversible?
No, it’s permanent. Doctors cannot reattach testicles once removed. This makes careful thought and pre-surgery talks essential.
How does it compare to chemical castration for prostate cancer?
Both methods lower testosterone to treat prostate cancer. Surgery is a one-time fix with clear results. It might cost less long-term. Chemical castration uses drugs, is reversible, but needs ongoing shots/pills and checks. The choice depends on personal preference, health factors, and life quality.
Can I still get prostate cancer after?
Yes, though the risk is much lower due to low testosterone. If you already have prostate cancer, surgery helps control it but might not cure it. This is especially true if cancer cells no longer need hormones to grow.
Conclusion
Bilateral orchiectomy is a major surgery. It has deep effects on hormones and the body. People get it for cancer treatment, gender affirmation, or other health reasons. The decision needs careful thought about benefits, risks, and other choices.
Success depends on good surgery. But it also relies on full counseling, careful after-care, and proper long-term follow-up. Understanding all parts of this surgery helps patients make informed choices. These choices should match their health needs and personal goals.
If you are considering this surgery, talk openly with your doctors. Discuss your hopes, worries, and personal situation. With good support and information, you can handle this big medical decision confidently.