From now until sometime in early 2023, we’ll be writing about gender affirming procedures. We’re starting with bottom surgeries and will end with office visit procedures such as fillers and botox. This week, we’re discussing orchiectomy, with or without scrotectomy. It is sometimes shortened to “orchi” or “orchie.”
Content advisory: we will be using anatomical terms and discussing surgical procedures in this article and this series. External sites that we link to may contain graphic images.
What are Orchiectomy and Scrotectomy?
Orchiectomy is the removal of one or both testicles. It is often shortened to “orchi” or “orchie,” and may be called an orchidectomy.
Scrotectomy is the removal of the scrotal skin.
While an individual may have an orchiectomy without scrotectomy, it is rare to have scrotectomy without orchiectomy. Dr. Hanna of the Hanna Gender Center offers a testicle-sparing scrotectomy (we just learned about this option while researching this article!) Scrotal tissues may be used in both vulvoplasty and vaginoplasty, so the timing of additional procedures may be important:
- Tunica vaginalis – the membrane which encases the testicles is sometimes used in during vaginoplasty.
- Scrotal skin – may be used both in a new vagina and for labia creation. If an orchiectomy is done but a scrotomectomy is not, this skin can be used in a later surgery.
Orchiectomy and scrotomectomy may also be done as part of nullifcation/nullectomy.
When: Expected Prep and Recovery for Orchiectomy and Scrotectomy?
Prep is similar for other bottom surgeries, but may not be as involved. If only an orchiectomy/scrotomectomy is desired, hair removal may not be required. If vulvoplasty or vaginoplasty are desired, hair removal is required. UCSF recommends that testosterone levels be in the female range prior to orchiectomy, as the body will no longer produce testosterone post-orchi. A sudden drop may have unwanted and uncomfortable side effects.
Orchiectomy can be an outpatient procedure, with no hospital stay needed. Soreness, bruising, and swelling are to be expected, as well as a couple of days of limited activity. MozaicCare (Doctors Wittenberg and Bonnington) recommends 2 weeks off of work.
It is important to let your surgeon know if you are thinking about or want future genital surgeries. This information can change how they perform your orchiectomy.
Who: Surgeons Who Offer Orchiectomy and Scrotectomy
Orchiectomy is a common gender affirming procedure, as it is often done alone to remove the body’s main source of testosterone and decrease or eliminate the need for an androgen blocker. Individuals who wish to proceed to vulvoplasty or vaginoplasty (or both!) can choose to have orchiectomy with or without scrotectomy (or choose to not have orchiectomy at all.) If scrotectomy is chosen, there is less tissue available for use in creating labia and the vaginal canal.
How to find a surgeon:
- talk to others in the community
- gender care centers at academic institutions such as OSHU, UCSF, UW
- well-known private practices such as MozaicCare, Align Surgical, Crane Center, etc.
- TransHealthCare.org
- findplasticsurgery.org
- WPATH Provider Directory
- OutCare Health
- The r/TransSurgeries wiki on Reddit
- our gender affirming surgery page
How: Common Surgeon and Insurance Requirements for Orchiectomy and Scrotectomy
Like other lower surgeries, you will likely need a letter from a mental health provider for your surgeon, along with a letter from your surgeon and/or hormone provider for insurance. They may require hormone use for a certain period of time or want documentation for why hormones were not part of your journey, and they may wish to know that you have “lived as” for a certain period of time. Some policies may require that you document your support and housing plans during recovery.
Why: Some Things To Think About When Choosing Orchiectomy and Scrotectomy
Orchiectomy and scrotectomy may change how you have sex, and how you experience sexual arousal and orgasm. This, of course, may be exactly what you want. P.S. – check out our Sex Toys For Trans Folx blog!
If having a biological child is important to you, discuss fertility preserving options with your doctor, as your body will no longer produce sperm after orchiectomy.
Your primary endogenous source of testosterone will be absent (again, this may be exactly what you want!) If you are not already supplementing your body’s supply of sex steroids, talk to your provider about hormones. For bone health and many other body processes, you need some sex steroids. If you are taking anti-androgens or estradiol prior to orchiectomy, your use of and dosage may change after surgery.
Orchiectomy may change how your pelvis balances and may affect how you walk, stand, and sit. Pelvic physical therapy may help you get acquainted with your new alignment.
Download our Questions To Ask Your Surgeon handout.