The removal of one testicle, known as a unilateral orchiectomy, often raises concerns about future health and vitality. The human body, however, possesses a remarkable ability to adapt to the loss of one paired organ. While the procedure results in physical changes, the remaining systems frequently compensate effectively to maintain normal function. This compensation primarily involves the remaining testicle and the hormonal feedback loops controlled by the brain.
Maintaining Normal Hormone Levels
The primary concern regarding testicle removal is the potential for low testosterone, often tied to sexual health. The body manages this through compensatory hypertrophy, where the remaining healthy testicle increases its functional output to maintain hormonal balance. This requires the remaining Leydig cells to produce more testosterone.
The pituitary gland regulates this process by monitoring hormone levels. When testosterone dips after surgery, the pituitary releases higher amounts of luteinizing hormone (LH). This increased LH stimulates the remaining testicle to boost production, often returning levels to the normal range. The remaining testicle may even become modestly larger (10% to 25%) due to this increased workload.
For most individuals with a healthy remaining testicle, systemic testosterone levels stay within the typical range, making hormone replacement therapy (HRT) unnecessary. However, the risk of developing a clinically significant deficiency increases, especially in the first year. Post-operative monitoring is recommended, particularly if the orchiectomy was due to testicular cancer, as the underlying condition may have already affected hormone production.
Fertility and Reproductive Capacity
Fertility is distinct from hormone production, relating to the generation of viable sperm. Since sperm production occurs in both testicles, removing one effectively halves the capacity. The remaining testicle can compensate by increasing its output, similar to its response for testosterone.
Despite this compensation, unilateral orchiectomy can reduce semen quality for many men. Studies show deterioration in sperm concentration and total sperm count in up to 85% of patients. A small percentage may develop azoospermia (complete absence of sperm). However, this reduction does not necessarily mean infertility, and many men successfully achieve natural conception afterward.
The underlying reason for the orchiectomy is important, as conditions like testicular cancer can negatively impact the remaining testicle before surgery. For men planning future fatherhood, a post-procedure semen analysis assesses fertility status. Pre-operative sperm banking is often discussed if further treatments like chemotherapy or radiation might compound the effect on sperm production.
Physical Appearance and Emotional Adjustment
The most visible side effect of a unilateral orchiectomy is the change in the scrotum’s physical appearance, leaving an empty space. This change can lead to concerns about body image, self-esteem, and masculinity. These psychological adjustments are highly individual and may include feelings of loss or shame, which can be more common among younger men.
A testicular prosthesis, or implant, is available to address the aesthetic change. It can be placed during the orchiectomy or a later procedure. Modern prostheses are typically made of biocompatible silicone, designed to mimic the shape, weight, and feel of a natural testicle. The implant’s primary purpose is cosmetic: filling the empty space to improve appearance and alleviate psychological distress.
Many patients are unaware of the prosthesis option, and only a small percentage ultimately receive one. Regardless of whether an implant is chosen, open communication with partners and medical professionals about body image and emotional health is necessary for recovery. Counseling can provide a supportive environment for adjusting to the physical and emotional changes following surgery.