Testicle removal, known medically as orchiectomy, is one of the most well-established surgical procedures in urology, and recovery from the operation itself tends to be straightforward. Most people experience moderate pain and limited activity for roughly the first five days, with symptoms dropping off quickly after that. But the surgery’s effects reach well beyond the incision site. Whether you are losing one testicle or both, and whether the reason is cancer, prostate treatment, or gender-affirming care, understanding what comes next involves hormones, fertility, body image, and some longer-term health considerations that deserve honest discussion.
The First Week of Recovery
The surgery is typically done through a small incision in the groin rather than through the scrotum, especially when cancer is the reason. It is usually an outpatient procedure, meaning you go home the same day. A study tracking patient-reported symptoms day by day after radical orchiectomy found that pain and limited activity were the only symptoms most patients rated as moderate or severe, and even those dropped to mild or absent after postoperative day five. Serious complications were essentially absent: no complications above the mildest grade occurred in the 30 days after surgery.1PubMed Central. Convalescence after radical orchiectomy: Detailing surgical recovery with a novel electronic patient reported outcome (ePRO) platform
Expect some swelling and bruising in the scrotum and groin area for a week or two. You will likely be told to wear supportive underwear, avoid heavy lifting for a few weeks, and ease back into exercise gradually. Most people return to desk work within a week and more physical jobs within two to four weeks. Showering is usually fine within a day or two; baths and swimming pools wait until the wound is fully closed.
What Happens to Your Hormones
This is the question that matters most for understanding life after the operation, and the answer depends entirely on whether one testicle or both were removed.
If you lose one testicle, the remaining one picks up much of the slack. Research in primates shows that within hours of removing one testicle, circulating testosterone drops roughly in half, as you would expect. But within about four days the remaining testicle partially compensates, bringing testosterone back to about two-thirds of its previous level even without any increase in the brain’s hormonal signals telling it to work harder.2Endocrinology. In the Adult Male Rhesus Monkey (Macaca mulatta), Unilateral Orchidectomy in the Face of Unchanging Gonadotropin Stimulation Results in Partial Compensation of Testosterone Secretion by the Remaining Testis In humans, the compensation appears even more complete over time. A study of testicular cancer patients who had one testicle removed and then received no further treatment found no significant changes in testosterone or related hormones during follow-up.3PubMed. Longitudinal Changes in Serum Levels of Testosterone and Luteinizing Hormone in Testicular Cancer Patients after Orchiectomy Alone or Bleomycin, Etoposide, and Cisplatin In practical terms, most men with one remaining healthy testicle do not need hormone replacement and maintain normal testosterone levels.
Bilateral removal is a different story. Losing both testicles eliminates your body’s primary testosterone source almost entirely. Without replacement therapy, you will experience symptoms of very low testosterone: fatigue, loss of muscle mass, reduced sex drive, hot flashes, mood changes, and over time, thinning bones. Testosterone replacement becomes a lifelong necessity. The standard approach has been intramuscular injections, but a study of bilaterally orchiectomized cancer patients found that roughly a third had below-normal testosterone levels on their replacement regimen, especially when injections were spaced three weeks or more apart.4PubMed. Androgen replacement and quality of life in patients treated for bilateral testicular cancer The takeaway: if you have had both testicles removed, do not assume the first prescription is the final answer. Blood levels should be monitored and the schedule adjusted until your testosterone is genuinely in the normal range, not just being delivered.
Fertility After Orchiectomy
Losing one testicle does not necessarily end your ability to father children, but it can reduce sperm quantity and quality. A study that collected sperm samples both before and after orchiectomy found that overall sperm concentration and motility were lower after surgery. Two men became completely azoospermic, meaning no sperm at all. Yet the picture was not uniformly negative: thirteen individuals in the same study actually showed improved sperm output after the diseased testicle was removed.5Journal of Clinical Urology. Routine sperm banking for testicular cancer patients should be performed both before and after orchidectomy This makes sense when you consider that a cancerous or otherwise damaged testicle may have been dragging down overall fertility before it was removed.
Sperm banking before surgery is strongly recommended, and that same research suggests banking after surgery as well, since the remaining testicle may still produce viable sperm. If both testicles are removed, natural conception is no longer possible, and stored sperm or donor sperm would be the paths forward. Fertility counseling before surgery is considered part of the standard of care, especially for younger patients.6Europe PMC. Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer
Sexual Function and Erectile Health
Erections are controlled by nerves and blood vessels that are not directly severed during a standard orchiectomy, so in theory the surgery alone should not cause erectile problems. In practice, however, a systematic review and meta-analysis found that about 35% of testicular cancer survivors experience some degree of erectile difficulty.7PubMed Central. Erectile dysfunction among testicular cancer survivors: A systematic review and meta-analysis That is a higher rate than in the general population of similar-age men, and it reflects a tangle of causes: hormonal shifts, psychological stress, anxiety about body image, and sometimes the additional impact of chemotherapy or radiation given after surgery.
If you notice changes in your erections or libido after orchiectomy, it is worth getting your testosterone checked. Low testosterone is a treatable cause, and addressing it can improve both desire and function. Psychological factors also play a real role and should not be brushed off as “just in your head.” For many men, the combination of cancer diagnosis, body changes, and sexual anxiety creates a feedback loop that responds well to counseling, either alone or alongside medical treatment.
Body Image, Grief, and Psychological Impact
The emotional side of losing a testicle is often underestimated by the medical system. A large population-based study of testicular cancer survivors found that about a third of men missed their removed testicle, and roughly a quarter experienced feelings of uneasiness or shame about their body because of the loss.8PubMed. Feelings of loss and uneasiness or shame after removal of a testicle by orchidectomy: a population-based long-term follow-up of testicular cancer survivors These feelings were not fleeting; the study specifically captured long-lasting responses. A separate systematic review reported that roughly one in five testicular cancer survivors experiences significant anxiety, one in seven experiences distress, and one in ten experiences depression, all at rates exceeding the general population.9PubMed Central. Mental health after orchiectomy: Systematic review and strategic management
One finding from the body-image research stands out: men who were never offered a prosthesis reported feelings of loss and shame at about twice the rate of men who were offered one but declined it.8PubMed. Feelings of loss and uneasiness or shame after removal of a testicle by orchidectomy: a population-based long-term follow-up of testicular cancer survivors The act of being given a choice seems to matter psychologically, even when the choice is “no thanks.” If your surgeon does not bring up the option of a prosthesis, it is worth asking.
Testicular Prostheses
A testicular prosthesis is a silicone implant placed in the scrotum to restore the appearance and feel of a testicle. They come in various sizes, and the procedure can be done at the same time as the orchiectomy or later. Satisfaction rates are consistently high. One study found that 96% of patients were satisfied with their implant, though about a quarter described it as feeling “too firm” compared to a natural testicle.10PubMed Central. Testicular prostheses – impact on quality of life and sexual function A broader review of the literature across multiple studies confirmed that overall satisfaction with testicular prostheses is reported as high, and that patients should be offered the option either at the time of removal or afterward based on their preference.11Sexual Medicine Reviews. Testicular prostheses: a historical and current review of the literature
Timing may matter for how you feel about the decision down the road. Research comparing men who received a prosthesis at the same time as their orchiectomy with those who did not found that the prosthesis group reported less regret, greater confidence that their decision was correct, and were more willing to repeat the same choice. Men without a prosthesis were more likely to say they still missed their removed testicle and felt ashamed about their body image. Having a prosthesis was independently associated with lower decision regret.12PubMed. Decision Regret About Testicular Prosthesis After Radical Orchiectomy: Real-life Data to Improve Preoperative Patient Counseling None of this means a prosthesis is right for everyone, but the evidence suggests that getting one at the time of surgery tends to leave people more satisfied than getting one later or not at all.
Bone Health After Bilateral Removal
Testosterone plays a direct role in maintaining bone density, which makes long-term bone loss a real concern after bilateral orchiectomy. A study of men who had both testicles removed as treatment for prostate cancer found that bone mineral density declined progressively over the years following surgery. Osteoporotic fractures occurred in about 14% of the orchiectomy group versus roughly 1% of prostate cancer patients who did not have orchiectomy, and the cumulative fracture rate seven years out was 28% in the surgical group.13PubMed. Osteoporosis after orchiectomy for prostate cancer
These numbers come from a population where the orchiectomy was performed specifically to eliminate testosterone as a cancer treatment, and many of these men were older. The risk is lower for younger men on well-managed testosterone replacement. But the data make it clear that if you have had both testicles removed, bone density monitoring with periodic scans is not optional, especially as you age. Weight-bearing exercise, adequate calcium and vitamin D intake, and consistent testosterone replacement all contribute to keeping bones intact.
Metabolic Changes and Weight
The loss of testosterone affects metabolism in ways that go beyond the scale. A randomized study comparing orchiectomy to drug-based testosterone suppression found that men in the orchiectomy group gained more fat mass (about 2 kg) and total body weight (about 3.3 kg) over 48 weeks than men receiving medication. The increases in fat were correlated with rising insulin resistance, and changes in cholesterol, fat mass, and insulin sensitivity began showing up as early as 12 to 24 weeks after testosterone was removed.14PubMed. Metabolic consequences of gonadotropin-releasing hormone agonists vs orchiectomy: a randomized clinical study In extreme cases, the metabolic fallout can be severe: one case report documented rapid onset of visceral fat buildup, fatty liver disease, and worsened diabetes within eight months of bilateral orchiectomy.15PubMed Central. Severe Visceral Obesity, Fatty Liver and Diabetes after Orchiectomy for Prostate Cancer
For men who lose one testicle and maintain normal testosterone, these metabolic shifts are unlikely to be significant. The concern is primarily for those on long-term androgen deprivation, whether through bilateral removal or medication. Cardiovascular risk also rises modestly: one analysis found a 16% higher risk of cardiovascular disease in men who had surgical orchiectomy compared to same-age men without prostate cancer, with the risk especially concentrated in the first six months for those who already had a cardiovascular history.16Oxford Academic (JNCI: Journal of the National Cancer Institute). Androgen Deprivation Therapy–Linked Cardiovascular Disease Risk: Still Unresolved
Breast Tissue Growth
Gynecomastia, the development of breast tissue in men, can occur after orchiectomy because the balance between estrogen and testosterone shifts. Even in men with one remaining testicle, if testosterone drops low enough relative to circulating estrogens, breast tissue can grow. The underlying mechanism is the altered ratio between the two hormones rather than the absolute level of either one alone.17PubMed Central. Gynecomastia: Clinical evaluation and management This is more common in the setting of bilateral removal or androgen deprivation therapy for prostate cancer than after unilateral orchiectomy for testicular cancer. If breast tenderness or enlargement develops, it is worth bringing up with your doctor early, because treatment options are more effective when addressed before the tissue becomes firmly established.
Cancer Surveillance After Orchiectomy
If your orchiectomy was for testicular cancer, removal of the testicle is both diagnostic and therapeutic, but it is not the end of the story. Even in early-stage disease where no further treatment is needed, regular follow-up is essential because a minority of patients will have a relapse. A large study of clinical stage I patients managed with surveillance after orchiectomy found that most recurrences were detected by imaging scans and tumor marker blood tests.18PubMed. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance Surveillance schedules vary by tumor type and stage, but typically involve periodic CT scans, blood draws for tumor markers, and physical exams over five to ten years.
Emerging blood-based tests may eventually make surveillance less reliant on repeated imaging. A circulating microRNA called miR-371a-3p has shown promising accuracy for detecting relapse, with one study reporting 83% sensitivity and 96% specificity for identifying recurrences.19PubMed Central. Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review This is not yet standard practice, but it signals that follow-up protocols are likely to evolve.
Gender-Affirming Orchiectomy
For transgender women and some nonbinary individuals, bilateral orchiectomy serves a different purpose: eliminating the body’s testosterone production as part of gender-affirming care. The outcomes in this context are distinct from cancer treatment. A study of patients undergoing gender-affirming bilateral orchiectomy found that all patients who had been taking spironolactone, an anti-androgen medication with notable side effects, were able to stop it entirely after surgery. About 80% of those on progesterone could discontinue it, and roughly 40% of patients on estradiol were able to reduce their dose to about half of what they had been taking.20PubMed Central. Endocrine, gender dysphoria, and sexual function benefits of gender-affirming bilateral orchiectomy: patient outcomes and surgical technique A separate study found that nearly all patients reported decreased genital-associated gender dysphoria after surgery, and all patients who had been tucking reported relief from tucking-related discomfort.21The Journal of Sexual Medicine. Medical, Gender Dysphoria, and Quality-of-Life Benefits of Pre-Vaginoplasty Bilateral Orchiectomy Complication rates were essentially zero in both studies, making this one of the lower-risk gender-affirming surgical options.
Testis-Sparing Surgery as an Alternative
Not every testicular mass requires removal of the entire testicle. Organ-sparing surgery, where only the tumor is excised while the rest of the testicle is preserved, has become a legitimate option in selected cases. A systematic review found that testis-sparing surgery is safe and effective for small, nonpalpable tumors under two centimeters, with good results for both cancer control and preservation of hormonal function. It is especially valuable for men who have a tumor in their only remaining testicle or who have tumors in both, where full removal would mean losing all testicular tissue.22PubMed Central. Outcomes of organ-sparing surgery for adult testicular tumors: A systematic review of the literature This is not appropriate for every case, and a frozen-section biopsy during surgery is typically used to confirm whether the tissue is benign or malignant before deciding how much to remove. But if your imaging shows a small lesion and your surgeon has not mentioned the possibility of sparing the testicle, it is a reasonable question to raise.