An orchiectomy is a surgical procedure involving the removal of one or both testicles, the organs housed within the scrotum responsible for producing sperm and testosterone. Removing one testicle is a unilateral orchiectomy, while removing both is a bilateral orchiectomy. This procedure is typically performed in a surgical center or hospital under general anesthesia and is often an outpatient operation.
Indications and Variations
The reasons for seeking an orchiectomy fall into two categories: medical necessity and gender affirmation. For medical necessity, the procedure addresses serious health conditions like testicular cancer, severe trauma, or infection. In cases of suspected testicular cancer, a radical inguinal orchiectomy is performed through a groin incision to remove the testicle, tumor, and entire spermatic cord. This technique prevents the potential spread of cancer cells.
An orchiectomy also suppresses hormones for cancers fueled by androgens, such as advanced prostate or male breast cancer. For gender affirmation, a simple orchiectomy is performed, often for transgender women and non-binary people. This approach uses a scrotal incision to remove the testicles and a short segment of the spermatic cord. The goal is to significantly reduce the body’s natural testosterone production, potentially reducing the need for testosterone-blocking medications.
Navigating Prerequisites and Consultations
The process of obtaining an orchiectomy begins with finding a qualified urologist or surgeon experienced in the specific procedure required. Securing a referral from a primary care provider is often necessary, particularly for insurance coverage.
Medical Necessity Requirements
For cases driven by medical necessity, pre-screening involves diagnostic tests to confirm the condition, such as an ultrasound and blood work to check tumor markers. These results guide the surgeon’s decision on the procedure type. A radical orchiectomy is often chosen to avoid a conventional biopsy, which risks spreading cancer cells.
Gender Affirmation Requirements
The path for gender affirmation requires specific psychological evaluations to meet established standards of care, such as those set by WPATH. Patients must receive a diagnosis of persistent gender dysphoria and demonstrate the capacity to provide fully informed consent for the irreversible surgical changes. Referrals from licensed mental health professionals are standard, often requiring one or two letters of support. These evaluations confirm the patient understands the procedure’s permanence and that any significant mental health concerns are well-controlled. Some guidelines suggest a minimum period of continuous Hormone Replacement Therapy (HRT), often 12 months, before genital surgery.
Surgical Procedure and Immediate Recovery
The orchiectomy procedure is quick, typically taking 30 to 60 minutes under general anesthesia. The incision location depends on the procedure type: the groin for a radical orchiectomy or the scrotum for a simple one. After isolating and removing the necessary structures, the surgeon closes the site with stitches. Patients are monitored in recovery and usually discharged the same day, but must arrange for transportation home.
In the immediate post-operative period, mild to moderate pain, swelling, and bruising in the scrotal area are expected. Pain is managed with medication, and swelling can be minimized by resting and applying ice packs. Patients should wear supportive undergarments for the initial 48 hours. Activity restrictions prohibit heavy lifting, strenuous exercise, and sexual activity for several weeks. While light daily routines can resume within a few days, full recovery typically takes two to three weeks.
Financial Planning and Post-Surgical Care
The cost of an orchiectomy varies significantly based on the facility, surgeon, and whether the procedure is medically necessary or elective. Insurance coverage is complex and depends heavily on the indication. Cancer treatment is generally covered as a medical necessity, but coverage for gender affirmation surgery is determined by the specific policy’s provisions for gender-affirming care.
For those undergoing a bilateral orchiectomy, long-term management of hormone levels is a permanent consideration. Since the primary source of testosterone is removed, patients require long-term Hormone Replacement Therapy (HRT) to maintain health and prevent complications like loss of muscle mass or decreased bone density.
For transgender women, an orchiectomy often allows for a reduction in the dosage of feminizing hormones, as the body no longer requires a testosterone blocker. Regular monitoring of hormone levels through blood work is required to ensure proper dosage and manage long-term health risks. The cost of ongoing medical management and prescriptions should be factored into the overall financial plan.