An orchiectomy is a surgical procedure in which one or both testicles are removed. The word comes from Greek, combining "orchis" (testicle) and "ektomie" (removal). In medicine, orchiectomy describes the complete or partial surgical removal of the male reproductive glands.
When is an orchiectomy carried out?
An orchiectomy is used in a number of different situations. Most often, it becomes necessary because of certain conditions affecting the testicles, such as testicular cancer or serious injury. It can also play a role in advanced prostate cancer, because removing the testicles significantly reduces the production of the male sex hormone testosterone. Testosterone can encourage the growth of certain tumours, which is why removing the testicles is considered a treatment option in these cases.
Another use is in gender-affirming surgery for trans women, that is, people who identify as women and were assigned male at birth. Here, an orchiectomy is carried out as part of the gender-affirming process, usually at the person's own request.
How the procedure works
In most cases, an orchiectomy is performed under general anaesthetic, though a local anaesthetic is sometimes used instead. Through a small cut in the scrotum or groin area, the affected testicle is exposed and removed along with the spermatic cord. Depending on the medical situation, either one testicle (unilateral orchiectomy) or both testicles (bilateral orchiectomy) are removed. The wound is then carefully closed.
The procedure usually takes less than an hour. In many cases, only a short hospital stay is needed, and sometimes the operation can even be carried out as a day procedure. Recovery is straightforward in most cases, and mild pain or swelling in the first few days after the procedure is normal.
Possible effects and concerns after an orchiectomy
Many people have significant worries before an orchiectomy, particularly about the possible physical and emotional effects. After the removal of one testicle, the other testicle usually continues to work normally. This means that both testosterone production and fertility are generally preserved.
The situation is different after a bilateral orchiectomy. No testosterone is produced at all, which leads to various changes in the body. These can include a drop in sex drive, erectile difficulties, loss of muscle mass, weight gain, fatigue, and mood changes. Fertility is also lost entirely, as no sperm are produced. This can be very hard to come to terms with emotionally.
Fear of losing one's sense of masculinity is very common. It is important to know that identity and self-worth are not defined solely by the testicles or the ability to father children. Many people find that, after a period of adjustment, they are able to live a full and satisfying life.
Treatment options after the procedure
After a bilateral orchiectomy, hormone therapy is usually needed to make up for the lack of testosterone. This can be given in the form of injections, patches, or gel, for example. Many of the physical changes can be reduced or prevented with the right hormone treatment. Muscle mass, bone health, and general wellbeing can all benefit from a well-managed hormone therapy plan.
For those who are concerned about their appearance, a testicular prosthesis is worth considering. This is a small implant that is placed inside the scrotum to restore a natural look. It is purely cosmetic and has no effect on how the body functions.
Psychological support can be very helpful if feelings of uncertainty, anxiety, or low mood arise. Talking to a professional or connecting with others who have been through the same experience can help in coming to terms with the new situation.
What to keep in mind before and after an orchiectomy
Before the procedure, there will be thorough discussions with doctors about the reasons for the operation, possible risks, alternatives, and the changes to expect. In some cases, it is recommended to freeze sperm beforehand, in case there is a wish to have children in the future.
After the operation, rest is important. Physical activity, sport, and sexual intercourse should only be resumed after speaking with a doctor. The wound needs time to heal, and regular check-ups help to make sure recovery goes well.
If unusual pain, significant swelling, fever, or problems with wound healing occur, medical advice should be sought straight away.
Life after an orchiectomy
With the right aftercare and support, an active life after an orchiectomy is very much possible. Most people find their way back to their usual daily routine after some time. The physical and emotional changes vary greatly from person to person and also depend on the reasons for the procedure.
It is important to allow time to process everything and to accept help when needed. Modern medicine offers many ways to maintain quality of life, both physically and emotionally.
