What Is a Bilateral Orchiectomy?

A bilateral orchiectomy is a surgery to remove both testicles (testes). As part of a gender transition, it is chosen to help a person's body better match their gender identity. By removing the body's main source of testosterone, the procedure produces a lasting drop in testosterone levels.

This is an educational overview to help you understand the surgery, its role in gender-affirming care, what recovery looks like, and the risks and alternatives — so you can decide, together with your care team, whether it is right for you.

A Newer Use, With Care

The use of bilateral orchiectomy for gender transition and affirmation is relatively new, so the full short- and long-term effects continue to be studied. Our team will talk through what is known and unknown so your decision is fully informed.

How It Supports Gender Transition

Removing the testicles eliminates the body's primary source of testosterone. For many people, this brings meaningful benefits:

  • A large, lasting decrease in testosterone, which often allows you to reduce the dose of feminizing hormones (or anti-androgens) you take.
  • Relief from gender dysphoria for many people, as physical appearance moves closer to gender identity.
  • One permanent step that removes the ongoing need for testosterone-blocking medication.

The Procedure & Recovery

During a bilateral orchiectomy, the surgeon makes an incision in the middle of the scrotum, removes both testes, and then closes the incision, often with sutures. It is an outpatient surgery, so you can go home the same day.

What Happens

  • Anesthesia: the procedure may be done with local anesthesia, IV sedation, or general anesthesia
  • Incision: a single incision in the middle of the scrotum
  • Removal: both testes are removed
  • Closure: the incision is closed, usually with sutures
  • Medications: your surgeon will likely prescribe pain medication and antibiotics to prevent infection

At-a-Glance

  • Duration: about 1 to 2 hours
  • Anesthesia: local, IV sedation, or general
  • Hospital stay: outpatient — home the same day
  • Physical recovery: a few days to about a week

Important Things to Discuss Before Surgery

A few decisions are best made before the day of surgery. Talk these through with your surgeon, and let them know about any future surgeries you may plan.

Preserving Scrotal Skin for Future Vaginoplasty

If your transition will eventually include a vaginoplasty (the surgical construction of a vagina using skin grafts), the scrotal tissue may be preserved to help create the vaginal lining instead of being removed. Because this affects how the orchiectomy is performed, discuss it with your doctor before proceeding.

Fertility and Permanent Sterilization

This surgery results in total and permanent sterilization — afterward you will not be able to father a child. If you may want biological children in the future, consider fertility preservation through sperm banking before surgery.

Pausing Hormones Around Surgery

You will need to stop taking hormones for a few weeks before and after surgery to lower the risk of blood clots. Your care team will give you specific timing instructions.

Risks & Possible Complications

As with any surgery, there are risks. These include, but are not limited to:

Surgical & Anesthesia Risks

  • Bleeding at the surgical site until the wound heals
  • Infection, which may need antibiotics
  • Anesthesia problems, such as nausea, sore throat, or allergic reaction
  • Allergic reaction, ranging from a mild rash to a severe, emergency reaction
  • Blood clots, which can travel to the lungs — a medical emergency
  • Nerve injury, causing numbness or pain near the surgical site
  • Injury to surrounding organs near the scrotum

Healing & Longer-Term Effects

  • Delayed healing, which may require more treatment
  • Scar tissue and possible skin discoloration
  • Unsatisfactory result — appearance may differ from what you expected, and more surgery may be needed
  • Permanent infertility (sterilization)
  • Decreased libido and energy
  • Lower bone density / osteoporosis over time from reduced hormone levels, which can lead to fractures

If any complication occurs, you may need additional treatment or a longer recovery. Keeping your hormone plan on track after surgery — under your care team's guidance — helps protect your bone health.

Other Choices

Orchiectomy is not the only way to feminize the body or to live in alignment with your gender identity. Depending on your goals and health, alternatives may include continuing feminizing hormone therapy and anti-androgen medication without surgery, or other gender-affirming procedures.

Your doctor will help you understand which options may be best for you. How well any treatment works depends on your specific situation, so this is a decision to make together.

Behavioral Health Assessment

Because this surgery is permanent, we require at least one behavioral-health assessment letter from a qualified mental health provider before scheduling. This is consistent with the WPATH (World Professional Association for Transgender Health) Standards of Care, which help confirm that you understand the nature, permanence, and outcomes of the procedure and are ready to proceed.

If you don't yet have a behavioral-health provider, our team can provide referrals to qualified behavioral-health professionals experienced in gender-affirming care. We're happy to help you take this step.

Frequently Asked Questions

Will I still need to take hormones after surgery?

Most people continue feminizing hormone therapy after orchiectomy, but because your body's testosterone is greatly reduced, you may be able to lower your dose and stop anti-androgen medication. Your care team will adjust your plan and monitor your hormone and bone health.

Can I still have a vaginoplasty later?

Yes — but tell your surgeon before the orchiectomy if a vaginoplasty may be in your future. The scrotal skin can often be preserved to help build the vaginal lining, which changes how the orchiectomy is performed.

Is the surgery reversible?

No. Removal of the testicles is permanent and causes permanent sterilization. If you may want biological children, consider sperm banking before surgery.

How long is recovery?

The procedure takes about 1 to 2 hours and you go home the same day. Physical recovery usually takes a few days to about a week, with pain medication and antibiotics as prescribed.

Compassionate, Affirming Surgical Care

Our team provides gender-affirming bilateral orchiectomy in a respectful, supportive setting. We'll review your goals, explain the procedure and recovery, help coordinate behavioral-health referrals, and answer every question along the way.

  • ✅ Outpatient surgery — typically home the same day
  • ✅ Options discussed in advance, including scrotal-skin preservation
  • ✅ Guidance on fertility preservation and hormone timing
  • ✅ Referrals to qualified behavioral-health providers
Schedule Your Consultation

When you're ready to schedule, or for questions about coverage, call 678-344-8900 to speak with our team