Orchiectomy

Surgeries are an option for anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.

This might include hormone therapy and transition-related surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person has surgery – it’s a decision that’s yours to make. 

What is orchiectomy?

Orchiectomy is a surgery to remove the testicles and the cord that connects them to your body. The surgeon leaves the penis and prostate intact, and you can choose if you would like the scrotum removed (scrotectomy) as well.

You can have orchiectomy under local or spinal anesthetic (which numbs you from the waist down) or under general anesthetic. Most people will have this under local anesthetic. You can also go home the same day as surgery.

Why do people get orchiectomy? 

There are many reasons someone might get orchiectomy. The most common is that it can help ease feelings of dysphoria, which improves your wellbeing. It lets you stop or significantly reduce androgen blockers, which can help if you are experiencing side effects. It can help you lower your dose of estrogen, because estrogen’s feminizing effects are stronger when there is less testosterone in your body. It also can make tucking easier, safer and more comfortable.

Alternative treatment options

If you’re not ready for surgery or are still exploring your options, tucking is a way to change the shape of your genitals. There’s some safety tips to bear in mind though, and this guide from Trans Care BC has a helpful summary. Vaginoplasty is another surgical alternative, but this is a more invasive procedure.

Surgical techniques

When having orchiectomy, the surgeon will either make incisions in your scrotum or your groin (an inguinal incision). You can also decide if you would like the scrotum removed (scrotectomy) or not, and what kind of anesthetic you have. All these options are offered in Canada and/or covered by OHIP in Ontario and Alberta Health in Alberta (if you have received a funding approval letter). 

The method you choose will come down to your surgeon, your current anatomy and your goals. In your pre-surgery consultation you’ll have a chance to discuss all of your options and find what works best for you.

Side effects and risks

As with all surgery, orchiectomy comes with side effects and risks. A major side effect is infertility, which is permanent and irreversible. If you would like to have biological children in the future then you can bank sperm before your surgery. Other risks include:

• Side effects of low testosterone (higher risk of osteoporosis, less energy, lower sex drive, lower mood)*

• Skin grafts needed for future vaginoplasty (if a scrotectomy is performed)

• Numbness or loss of sensation in the area (often temporary)

• Small stumps of your spermatic cords (which connect the testicles to the body) may remain, which feel like lumps under the skin

Your surgeon should walk you through all of the potential complications with orchiectomy in your consultation appointment.

* If you have a surgery that removes the testicles (orchiectomy or vaginoplasty), it is recommended that you stay on hormones for the rest of your life. This is because they produce sex hormones, and your body needs some form of sex hormone for optimal health.

General surgery risks

There are some general risks that come with most surgeries. They are:

• Bleeding

• Blood clots in your legs or lungs

• Injury to surrounding organs, nerves or blood vessels

• Hematoma (a collection of blood) or seroma (a collection of fluid)

• Infection or abscess

• Wound opening or delayed healing

• Chronic pain

• Scarring

• Feeling dissatisfied with the outcome

• Feelings of regret about surgery

These risks can be higher with certain medications and health conditions, like immune or clotting disorders, or if you smoke. Tell your doctor about any medications and supplements you take, along with any health conditions you have (even if they don’t seem relevant!). 

Anesthetic risks

Orchiectomy is usually done under local or spinal anesthetic, but it can also be done under general anesthetic. General anesthetic has the following risks (most of which are very rare):

• Nausea/vomiting

• Damaged teeth

• Aspiration pneumonia (pneumonia from inhaling liquid like saliva or vomit)

• Respiratory failure (i.e. stopping breathing)

• Heart attack

• Coma

• Death

Ready for surgery?

If you'd like to get orchiectomy and you live in Ontario, your surgeon will require two assessments to confirm you're ready for surgery. If you'd like to apply for OHIP funding to cover your surgery then you also need to submit an application to the Ministry of Health.

For Ontario patients, Foria can provide your assessments and we can also submit and track your funding application for you. See our Surgical Referrals in Ontario article for more information.

If you live in Alberta, your surgeon will require one assessment. This can be done by a family doctor or nurse practitioner, who can then refer you to a surgeon. Referrals are accepted at a surgeon's discretion – if they approve your referral, they will then apply to Alberta Health for funding.

Foria does not currently offer assessments in Alberta, but these services will be available soon. See our Surgical Referrals in Alberta article for more information.

This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Rainbow Health Ontario’s TRS Surgical Summary Sheets.

by Foria Clinical Team

Sep 7, 2023・ minute read

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