Understanding the procedure

Surgery to remove testes is called an orchiectomy A gender-affirming lower surgery to remove the testicles. . Orchiectomy removes the gonads (testes) and spermatic cord. It can be done with or without scrotectomy (removal of scrotal sac).

This surgery may allow you to lower your dose of estrogen and eliminate the need for testosterone blockers (which may reduce unwanted side effects and risks). It may be a required step prior to some genital reconstruction surgeries. 

This surgery is done by a urologist.

Some people who have surgery to remove their testes go on to have vagina and vulva construction surgery in the future. In other cases, removal of testes may be done at the same time as vagina An internal organ located between the legs. A person may be born with a vagina or have one surgically created. When referring to genitals, the Trans Care BC website uses "internal genitals (vagina)" for trans people assigned female at birth (AFAB), and "vagina" or "vagina with vaginoplasty" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. and vulva construction. Some people may not have interest in future vagina and vulva construction and choose to only remove their testes. 

People may also choose to keep their external genital (scrotal) skin, while others may choose to have it removed (scrotectomy). If you're considering having vagina construction in the future, retaining your scrotal skin can be helpful but it is not necessary. You can speak with your urologist or contact a surgical centre that provides vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. surgery, such as Gender Surgery Program B.C. or GrS Montreal. 

About the surgery

The steps involved in testes removal include:

• Making an incision in the middle of the scrotum.
• Removing testes through the incision.
• Removing excess scrotal skin if scrotectomy is part of the procedure.
• Closing the incision with sutures Sterile medical threads, also called stitches, used to close surgical incisions. and covering with surgical dressing.
• Usually, people are admitted to hospital and sent home on the same day.

Risks & complications

All medical interventions have potential risks and benefits. It’s important that you understand the risks of having surgery so you can decide whether the potential benefits outweigh the potential risk of surgical complications. This list is not intended to scare you or dissuade you from having surgery but rather to help you make an informed decision.

General risks associated with surgery

• Anesthesia issues — Some people experience a negative reaction to anesthesia.
• Cardiovascular issues — Such as blood loss, blood clots and artery blockages.
• Hematoma — This is when blood collects in the surgical site, causing pain, swelling and redness. Drains Thin tubes placed in the body during surgery to remove excess fluid or blood. and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.
• Seroma — This is when clear fluid accumulates in the surgical site. Your surgeon will manage this complication. The ways in which it might be managed include monitoring, clinical exam, ultrasound or possibly drainage. 
• Infection — This is when microorganisms such as bacteria get inside the body. Infection can occur at different locations such as the surgical site or bladder and are generally treated with antibiotics.
• Abscess formation — This is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.
• Wound separation — This is when there is a partial or complete opening of incisions along the sutures.
• Nerve damage and pain — There is a wide range of possible experiences related to how nerves heal after surgery. Some changes are short term and some are long term or permanent. Some changes are mild and inconvenient, while others are painful and distressing. Changes can include numbness, increased sensitivity, burning sensations and nerve displacement (sensation may feel like it’s occurring in one place but the stimulus is in another part of the body). Speak with your surgical team about any concerns you have about sensation or pain management.
• Scarring — Scarring can be reduced by following your surgeon’s advice, which may include activity restrictions, avoiding sun, seeing a physiotherapist or massage therapist and doing massage exercises (if recommended). Severe scarring may require medical or surgical intervention.
• Postoperative regret — Regret can happen for several reasons, such as experiencing significant complications or being dissatisfied with the outcome of surgery. 

Risks specific to testes removal

• Additional skin grafts needed for future vaginoplasty — If scrotectomy is performed, this will remove tissue that often is used to create some of the vaginal lining during vaginoplasty. Depending on the vaginoplasty technique, additional skin grafts (for example, from the upper thighs) may be required.
• Numbness or loss of sensation — This can happen in certain areas around the surgical site, but it’s often temporary. 
• Stumps of spermatic cords may protrude in a way that can be felt.
• Changes in your ability to have erections — You may notice that erections are not as firm as before, or that you are not able to have them at all. If this is a concern for you, speak with your provider about whether medications (like PD5 inhibitors or a small dose of testosterone) may be appropriate for you.
• Change in libido — Your desire may no longer feel as spontaneous, requiring more time to engage in pleasurable stimuli to experience arousal.

Please note

This list is not comprehensive and you should have a detailed discussion of risks with your surgeon.