Introduction
Bilateral orchiectomy is surgery to remove both testicles. Many people aren’t familiar with this term, but the procedure helps treat certain health problems. It’s also sometimes part of gender-affirming care. This guide explains what bilateral orchiectomy is, why it’s done, how it works, and what to expect after surgery.
What is Bilateral Orchiectomy?
Bilateral orchiectomy (also called surgical castration) removes both testicles through surgery. This stops most testosterone production in the body. Testosterone is a hormone that affects many body functions.
A unilateral orchiectomy removes just one testicle, often because of cancer or injury. Bilateral means both sides are removed, which causes bigger changes in the body’s hormones.
Why People Have This Surgery
Treating Advanced Prostate Cancer
The most common reason for this surgery is advanced prostate cancer. Prostate cancer cells often need testosterone to grow. The testicles make 90-95% of the body’s testosterone. Removing them can slow down cancer growth.
As Dr. Elena Rodriguez, cancer surgeon, explains: “For some patients with spread-out prostate cancer, this surgery quickly and permanently lowers testosterone. This can help them live longer and feel better by slowing the cancer.”
Testicular Cancer
When cancer affects both testicles or might spread from one to the other, doctors may suggest removing both. This happens less often than removing just one diseased testicle.
Severe Injury or Infection
Sometimes serious injuries or infections damage both testicles beyond repair. In these cases, removal may be needed.
Gender-Affirming Care
For transgender women and some non-binary people, bilateral orchiectomy can be part of gender-affirming care. The surgery:
- Stops most testosterone production
- Reduces or ends the need for testosterone-blocking drugs
- May ease gender dysphoria (distress from body parts that don’t match gender identity)
- Allows lower doses of estrogen therapy
- Makes it easier to wear tight-fitting clothes without visible bulge
Dr. Samantha Wright, who specializes in transgender healthcare, says: “For many transgender women, this surgery is an important step in their transition. Beyond physical changes, many patients feel much better mentally when their bodies better match their gender identity.”
How the Surgery Works
Before Surgery
Before having a bilateral orchiectomy, you’ll need:
- A complete physical exam
- Blood tests, including hormone levels
- Review of your health history
- Mental health assessment (especially for gender-affirming care)
- Discussion about saving sperm for future fertility
- Information about benefits and risks so you can give informed consent
Types of Surgery
Surgeons use different methods for bilateral orchiectomy:
1. Simple Orchiectomy
- The surgeon cuts the scrotum
- Both testicles are removed while keeping the scrotal sac
- Usually done as outpatient surgery (go home same day)
- Takes about 30-60 minutes
- Uses local numbing with sedation or full anesthesia
2. Subcapsular Orchiectomy
- Only removes the inside tissue of the testicles
- Keeps the outer covering (tunica albuginea)
- Makes less visible change to how the scrotum looks
- Some people prefer this for appearance
3. Inguinal Orchiectomy
- Cuts are made in the groin area instead of the scrotum
- Usually used for testicular cancer to prevent cancer spread
- Takes slightly longer to heal than other methods
Recovery After Surgery
Right After Surgery
- Most people go home the same day
- Pain relief usually comes from over-the-counter pills or short-term prescription
- Ice packs help reduce swelling
- Wear supportive underwear or an athletic supporter for comfort
- Limit physical activity for 1-2 weeks
Recovery Timeline
- First 2 days: Rest a lot, move little, manage pain and swelling
- First week: Start light activities, keep wearing supportive underwear
- 2-4 weeks: Most people return to normal activities but avoid heavy lifting
- 4-6 weeks: Most people fully recover physically
Dr. James Chen, urological surgeon, advises: “While physical healing from this surgery is usually straightforward, be ready for hormone changes. These vary from person to person and might need ongoing medical care.”
Changes After Surgery
Hormone Changes
Bilateral orchiectomy causes major hormone changes:
- Testosterone drops: Levels fall by 90-95% within 24 hours
- Physical effects: Less muscle mass, changed fat distribution, lower sex drive, possible hot flashes
- Emotional effects: Possible mood changes, though these differ widely among people
Fertility Effects
- Permanent loss of ability to father children
- Saving sperm before surgery is the only way to preserve genetic parenthood
- Important to consider for younger people or those who want biological children later
Long-term Health Matters
- Bone health: Less testosterone can weaken bones; calcium and vitamin D often help
- Heart health: Need to watch for possible heart issues
- Hormone therapy: Some people need hormone replacement depending on why they had surgery
- Regular check-ups: Important to monitor overall health and address concerns
Risks and Problems
Surgery Risks
- Bleeding and blood collection at the surgery site
- Infection
- Ongoing pain in the scrotum or groin
- Bad reaction to anesthesia
- Surgery wound opening up
Long-term Risks
- Bone density loss (osteoporosis)
- Higher risk of heart problems for some people
- Hot flashes and other symptoms like menopause
- Changes in energy levels and mood
- Changes in sexual function, including different orgasm feelings
Making Your Decision
Things to Think About
- The surgery can’t be reversed
- Effects on fertility
- Hormone changes
- Your personal goals
- Other treatment options
For prostate cancer patients, options might include hormone therapy drugs. For transgender individuals, options might include continuing anti-testosterone medications.
Understanding What You’re Agreeing To
Dr. Lisa Patterson, bioethicist and surgeon, stresses: “True informed consent means more than just signing a form. You need to fully understand the surgery, that it can’t be reversed, all possible outcomes, and other options. This is especially important for surgeries with lifelong effects.”
Mental and Emotional Aspects
Preparing Mentally
- Counseling before surgery is often recommended
- Discuss expectations and goals
- Prepare for body changes
- Develop ways to cope during adjustment
Support After Surgery
- Follow-up with mental health professionals
- Support groups (for cancer survivors or transgender individuals)
- Education and support for partners and family
For transgender patients, research shows gender-affirming surgeries like this often improve mental health and life quality. A 2018 study found transgender women who had this surgery reported much less gender dysphoria and better body satisfaction.
Insurance and Costs
Coverage for this surgery varies:
- For prostate cancer treatment, most insurance plans cover it
- For gender-affirming care, coverage depends on your insurer and location
- Without insurance, costs typically range from $4,000 to $8,000
- Additional costs may include consultations, anesthesia, and follow-up care
Work closely with your healthcare providers and insurance company to understand coverage and out-of-pocket costs.
Common Questions
Will I need hormones after surgery?
For prostate cancer patients, extra hormones usually aren’t needed. Transgender women typically continue estrogen therapy, often at lower doses. Some patients might need small amounts of testosterone if they have side effects from very low levels.
How will surgery affect my sex life?
Effects vary by person and what other treatments you use. Many people experience lower sex drive and changes in erections. Most people can still have orgasms, though the feelings may change. Many transgender women report their sexual function feels more aligned with their gender identity after surgery.
Can the surgery be reversed?
No. This surgery is permanent and can’t be undone. Testicular implants can restore the appearance but not the function of testicles.
How does surgery compare to hormone-blocking medications?
Surgery permanently stops testosterone without needing ongoing medication. Medications need consistent use and may have their own side effects. The choice between surgery and medication depends on your health, preferences, and long-term goals.
Will my appearance change after surgery?
For patients not taking other hormones, gradual changes may include less muscle and some shift in body fat. For transgender women taking estrogen, the drop in testosterone often enhances feminine physical changes.
Conclusion
Bilateral orchiectomy is a major surgery that greatly affects hormone levels, fertility, and overall health. Whether it’s done for cancer treatment or gender affirmation, the decision requires good information and support from healthcare providers.
By understanding the procedure, its effects, and recovery, you can make informed choices and prepare for both physical and emotional changes. Since everyone’s situation is different, personal medical advice is essential.