orchidectomy

Orchidectomy, also called orchiectomy, is the surgical removal of one or both testicles. It is performed for medical reasons such as cancer treatment, hormonal therapy, or as part of gender-affirming surgery. When only one testicle is removed, the procedure is a unilateral orchidectomy; when both are removed, it is a bilateral orchidectomy.

Common indications include treatment of testicular cancer, where removal of the affected testis is essential to reduce tumor burden and prevent spread. It is also used as a method of androgen deprivation therapy for prostate cancer, since eliminating most testosterone production can slow or control disease. In addition, orchidectomy may be part of gender-affirming surgery for some transgender women and for select non-binary individuals. It may also be performed for severe testicular injury or chronic pain where other treatments have failed.

The procedure is typically done under general anesthesia. An incision is usually made in the groin (inguinal approach) for suspected cancer to avoid tumor seeding; a scrotal approach may be used in nonmalignant cases, though it is less common when cancer cannot be ruled out. The testis is detached from the spermatic cord and removed, and the incision is closed. Recovery is often by short hospital stay or outpatient basis, with pain controlled by medication and scrotal support advised during healing.

Effects include a rapid fall in testosterone levels to castration levels after bilateral removal, resulting in infertility and potential changes in sexual function and mood. Hormone replacement is not routinely required for non-gender-affirming cases, but may be discussed if clinically indicated. Possible risks include infection, bleeding, injury to surrounding structures, and chronic pain or swelling in the scrotum.