An orchiectomy is the surgical removal of one or both testicles. It’s most commonly performed to treat testicular cancer, but it also plays a role in managing advanced prostate cancer and is one option in gender-affirming care for transgender and nonbinary individuals. The surgery is relatively short, typically done under general anesthesia, and most people return to normal activity within three to four weeks.
Why an Orchiectomy Is Performed
The reasons for an orchiectomy fall into a few distinct categories, and the underlying goal shapes which type of surgery is used.
Testicular cancer is the most well-known reason. When imaging or exam findings suggest a solid mass in the testicle, removing the affected testicle is both the primary treatment and the way the diagnosis is confirmed. The entire testicle and spermatic cord are removed through an incision in the groin, not the scrotum, to avoid spreading cancer cells into nearby skin or lymph channels.
Advanced prostate cancer is another major indication. Because prostate cancer cells rely on testosterone to grow, removing both testicles drops testosterone levels by 90% to 95%. This drop happens fast: testosterone typically reaches its lowest level within 3 to 12 hours after surgery. That makes orchiectomy one of the quickest forms of hormone therapy available. Medications that suppress testosterone (sometimes called chemical castration) achieve a similar effect but take longer and require ongoing injections. Unlike surgery, though, medication-based suppression is reversible once treatment stops.
Gender-affirming care accounts for a growing share of orchiectomies. For transgender women and some nonbinary individuals, bilateral orchiectomy eliminates the body’s primary source of testosterone, which means testosterone-blocking medications are no longer needed afterward. It can be performed as a standalone procedure or as a step toward additional surgery. Eligibility criteria from the World Professional Association for Transgender Health include persistent, well-documented gender dysphoria, the ability to give informed consent, at least 12 continuous months of hormone therapy, and any significant mental health concerns being well managed.
Other reasons include removing a testicle damaged beyond repair by trauma, torsion (a twisting that cuts off blood flow), severe infection, or chronic pain that hasn’t responded to other treatments.
Types of Orchiectomy
Radical (inguinal) orchiectomy is the standard approach for known or suspected testicular cancer. The surgeon makes an incision in the groin area, starting about 2 centimeters above the pubic bone and angling toward the hip bone, following the natural skin crease along the inguinal ligament. The incision typically ranges from 3 to 10 centimeters depending on the size of the mass. Through this opening, the spermatic cord is clamped at the level of the internal inguinal ring, the testicle is pushed up from the scrotum into the surgical field, and both the testicle and cord are removed together. Using the groin rather than the scrotum prevents potential contamination of scrotal tissue with cancer cells.
Simple orchiectomy is performed through the scrotum and is used when cancer is not a concern. This is the approach for prostate cancer hormone therapy, gender-affirming surgery, and removal of a nonfunctioning or damaged testicle.
Partial (testis-sparing) orchiectomy removes only the tumor while preserving the rest of the testicle. It uses the same groin incision as a radical orchiectomy, and the removed tissue is immediately analyzed under a microscope while the patient is still in the operating room. This option is generally reserved for specific situations: small masses under 2 centimeters, a patient who has only one functioning testicle, benign-appearing imaging, normal tumor markers, or cases where preserving fertility and hormone production is a priority.
What Happens During Surgery
Orchiectomy is performed under general anesthesia in most cases. Regional anesthesia is possible but rarely used because the procedure is short and manipulating the testicle and cord can trigger reflex responses that are uncomfortable even with numbing.
For a radical orchiectomy, you lie flat on your back while the surgeon makes the groin incision and carefully opens the inguinal canal. A nerve running along the spermatic cord is identified and moved aside to protect it. The cord is then separated from surrounding tissue using blunt dissection, looped with a soft drain to create a tourniquet effect, and clamped near the internal ring. The surgeon applies gentle traction from above while pushing the testicle up from the scrotum below, delivering it into the incision. The cord is then cut between clamps, secured with permanent sutures, and the incision is closed in layers.
A simple orchiectomy follows a more straightforward path directly through the scrotum, making it a shorter procedure with a smaller incision.
Recovery and Activity Restrictions
Most people go home the same day. You’ll likely need to wear a supportive scrotal garment for about 48 hours after surgery to control swelling. Pain is typically manageable with over-the-counter or short-course prescription pain relief.
For the first two weeks, avoid heavy lifting, running, and sexual activity. Full return to sports, vigorous exercise, and heavy lifting generally takes three to four weeks. Swimming and baths are off-limits until your surgeon confirms the incision has healed, which usually takes several weeks.
Hormonal Effects
Removing one testicle usually doesn’t cause noticeable hormonal changes. The remaining testicle compensates by producing enough testosterone to maintain normal levels, sex drive, and overall function.
Removing both testicles is a different story. Testosterone drops to near zero within hours, with a biological half-life of about 45 minutes once the source is gone. This rapid decline produces effects similar to menopause in women: hot flashes, fatigue, mood changes, decreased libido, loss of muscle mass, and over time, reduced bone density. For people with prostate cancer, this hormonal suppression is the therapeutic goal. For transgender individuals, the drop in testosterone is also desired, since it eliminates the need for anti-androgen medications. In either case, ongoing monitoring helps manage side effects, and estrogen or other hormone therapy may be part of the long-term plan.
Fertility Considerations
If you’re having one testicle removed for cancer, the remaining testicle can still produce sperm, though cancer itself and subsequent chemotherapy or radiation can impair sperm quality. Sperm banking before any treatment begins offers the best chance of preserving the ability to have biological children later. This is recommended for all men with cancer before starting treatment, because it’s difficult to predict how therapy will affect any individual’s fertility.
If sperm aren’t frozen before surgery and treatment, the remaining options are more limited and invasive: sperm can sometimes be extracted directly from testicular or epididymal tissue and used with in vitro fertilization. For those who undergo chemotherapy or radiation after orchiectomy, waiting 12 to 18 months after completing treatment is advised before attempting conception naturally or through fertility treatments.
Bilateral orchiectomy, whether for prostate cancer or gender affirmation, results in permanent infertility. Banking sperm beforehand is the only way to preserve the option of biological children.
Testicular Prostheses
A silicone testicular implant can be placed to restore the natural appearance and feel of the scrotum. Implants come in a range of sizes, typically from about 10 to 19 cubic centimeters, and the surgeon selects the right size during the procedure by packing the empty space with gauze to estimate the volume needed. A low inguinal approach for placement is preferred because it carries a lower risk of infection and the implant working its way out. Some people choose to have the prosthesis placed at the time of removal, while others opt for a separate procedure later.
Surgical vs. Medical Castration for Prostate Cancer
For men with advanced prostate cancer, orchiectomy and hormone-suppressing medications achieve the same basic result: dramatically lowering testosterone. The choice between them involves tradeoffs. Orchiectomy is a one-time procedure with no ongoing medication costs or appointments for injections. It works within hours. Hormone-suppressing drugs, on the other hand, are reversible. If treatment goals change or side effects become intolerable, testosterone production can resume after stopping the medication.
One notable difference involves a temporary testosterone spike called a “flare” that occurs when patients first start one class of hormone-suppressing drugs. This brief surge can worsen symptoms before the medication takes full effect. Newer drug formulations avoid this flare entirely. Orchiectomy carries no flare risk, since it removes the testosterone source outright. In practice, most men with prostate cancer today start with medication rather than surgery, but orchiectomy remains a valid and effective option.