Orchiectomy
(also: bottom surgery, castration, lower surgery, orchi, orchidectomy)
Table of Contents
Introduction
Dating back to the 2nd millennium BCE, castration has been around for a long time. The practice of the removal of one's testicles originated to create eunuchs (people who were typically servants or slaves in royal courts and harems). While societal roles have changed since medieval times, castration (now renamed orchiectomy) is still around in the medical field. Orchis are still performed as medical treatment for various reasons including the following; testicular cancer, post vasectomy pain syndrome, testicular torsion, prostate cancer, for the community of modern-day individuals who still willingly identify as male eunuchs, and for transgender women who suffer from gender dysphoria.
This page will be focusing on the role that orchiectomies play in the transition of many transgender women as a treatment for gender dysphoria. However, if you are interested in the history of this procedure, and the other ways in which it is still performed, see the external links at the bottom of this page for further research.
Many transgender women (and some nonbinary people) will seek out orchidectomies as a method of obtaining gender euphoria and decreasing the production of testosterone in their bodies. Some women simply have an orchiectomy without any other lower surgeries. If she chooses to do so, a scrotectomy (the removal of the scrotum) will also be performed to avoid the elevated risk of bleeding issues/hematomas that comes alongside an empty sack. If she chooses to have additional gender-affirming surgeries alongside orchi; such as vaginoplasty, then a scrotectomy is not advised to be performed (as that extra skin would be used for optimal vaginoplasty results).
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General Information
An orchiectomy can reduce the overall need for hormones. A simple orchi can involve the removal of one or both testicles, while a bilateral orchi always involves removing both. Discuss with your surgeon what feels right for you.
This surgery is an outpatient procedure that lasts for around 30-60 minutes. It may be performed under either local or general anesthesia. During the procedure, the penis is taped to the abdomen so that it is out of the way. Incisions are made (see below for variations). The undesired testicle(s) are cut out from the surrounding tissues and vessels and removed through the incision. Clamps are placed to prevent blood from gushing out of the spermatic cords. The area is washed with saline solution, then the incision is sewn shut.
Full recovery from an orchiectomy can take 2 weeks to 2 months. For the first week, there are some things you'll want to do such as keeping the incision area dry and covered in gauze. Wash the area gently with mild soap once you are able to bathe. Follow your doctor's instructions in regards to wearing scrotal support or taking any perscribed pain medications, stool softeners, creams, or ointments. Use ice to reduce swelling. Do not have sex until fully healed.
If you are post-op, notify your doctor if you experience pain, redness, pus, or bleeding around the incision. Notify your doctor if you have a fever over 100°F (37.8°C), are unable to urinate, or have a large purple spot (hematoma).
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Different Types of Orchi
Bilateral
Both testicles are removed.
This may be performed as treatment for prostate cancer or breast cancer.
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Radical Inguinal
One or both testicles are removed through a small cut in the lower part of the abdominal area, as opposed to the scrotum.
This may be done to test testicular tissue for cancer.
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Simple
One or both testicles are removed through a small cut made in the scrotum.
This may be done to lower testosterone production, treat prostate cancer, or treat breast cancer.
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Subcapsular
The tissues around the testicles are removed from the scrotum. This keeps the scrotum intact so that there is no outward sign that anything has been removed.
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Anatomy
External Links
Blogs/Vlogs/Forums/Etc
- elilla: 11/11/2020: What’s it like to be a post-orchiectomy non-op trans woman (https://wordsmith.social/elilla/whats-it-like-to-be-a-post-orchiectomy-non-op-trans-woman)
- Reddit - r/neutered (https://www.reddit.com/r/neutered/)
- Sherry Lanina: 04/29/2006: Orchiectomy For Transsexuals (https://sherrylanina.tripod.com/orchiectomytrans.htm)
- YouTube Video: Dee Hunnybuns: 06/16/2021: My Orchiectomy Regret | TRANSGENDER
- YouTube Video: Institute for Cancer Genetics and Informatics: 04/30/2020: Bilateral orchiectomy; surgical removal of both testicles
- YouTube Video: SorceressEna: 06/17/2020: 1 Year Later - Orchiectomy MtF Surgery Update
- YouTube Video: UCLA Health: 05/22/2018: Gender Affirming Orchiectomy | Mark S. Litwin, MD | UCLAMDChat
- YouTube Video: Urology Times: 03/23/2017: Simple orchiectomy for transgender patients
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Studies/Journals/Etc
- BJUI: 10/29/2003: From mutilation to medication: the history of orchidectomy (https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1046/j.1464-410X.1997.00304.x) - GLASS, J.M. and WATKIN, N.A. (1997), From mutilation to medication: the history of orchidectomy. British Journal of Urology, 80: 373-378. https://doi.org/10.1046/j.1464-410X.1997.00304.x
- PubMed: 11/18/2015: A Rare Case of Male‐to‐Eunuch Gender Dysphoria (https://pmc.ncbi.nlm.nih.gov/articles/PMC4721041/) - Hermann, Maria, and Andreas Thorstenson. “A Rare Case of Male-to-Eunuch Gender Dysphoria.” Sexual medicine vol. 3,4 331-3. 18 Nov. 2015, doi:10.1002/sm2.81
- PubMed: 05/11/2014: The hidden world of self-castration and testicular self-injury (https://www.ncbi.nlm.nih.gov/pubmed/24709968) - Johnson, Thomas W, and Michael S Irwig. “The hidden world of self-castration and testicular self-injury.” Nature reviews. Urology vol. 11,5 (2014): 297-300. doi:10.1038/nrurol.2014.84
- PubMed: 08/02/2014: Voluntary genital ablations: contrasting the cutters and their clients (https://pubmed.ncbi.nlm.nih.gov/25356309/) - Jackowich, Robyn A et al. “Voluntary genital ablations: contrasting the cutters and their clients.” Sexual medicine vol. 2,3 (2014): 121-32. doi:10.1002/sm2.33
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Eunuch Resources
- Trans Language Primer - Eunuch (https://translanguageprimer.com/eunuch/)
- Wikipedia - Eunuch (https://en.wikipedia.org/wiki/Eunuch)
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Testicle Cancer Resources
These are links to articles and such that are primarily discussing this procedure in the context of cancer treatment.
- Healthline: Tim Jewell: 08/28/2018: What to Expect from an Orchiectomy (https://www.healthline.com/health/mens-health/orchiectomy)
- Urologists - Orchiectomy (https://www.urologists.org/article/procedures/orchiectomy)
- VeryWellHealth: Sherry Christiansen: 11/26/2023: An Overview of an Orchiectomy (https://www.verywellhealth.com/orchiectomy-overview-4580446)
- Wikipedia - Prostate Cancer (https://en.m.wikipedia.org/wiki/Prostate_cancer)
Additional Resources
- Align Surgical - Orchiectomy (https://alignsurgical.com/orchiectomy/)
- Healthline: Aditi Pai: 09/29/2018: What You Should Know About Orchiectomy for Transgender Women (https://www.healthline.com/health/orchiectomy-for-transgender-women)
- liebertpub: 01/16/2019: Testicular Seminoma in a Transgender Woman: A Case Report (https://www.liebertpub.com/doi/10.1089/lgbt.2018.0173)
- MTFsurgery - Orchiectomy Surgery (https://www.mtfsurgery.net/orchiectomy.htm)
- Rainbow Health Ontario - Gender Affirming Surgery - Orchiectomy - A summary for health care providers (https://www.rainbowhealthontario.ca/wp-content/uploads/2024/09/Surgical-summary-Orchiectomy.pdf)
- Reconstructive Surgical Arts - Orchiectomy (https://rsa-docs.com/orchiectomy)
- Reconstructive Surgical Arts - The Complete Guide to Orchiectomy and Scrotectomy: Procedure, Recovery, and Risks (https://rsa-docs.com/blog/the-complete-guide-to-orchiectomy-and-scrotectomy-procedure-recovery-and-risks)
- TransHub - Orchiectomy (https://www.transhub.org.au/orchiectomy)
- Trans Language Primer - Orchiectomy / Castration (https://translanguageprimer.com/orchiectomy/)
- Urologic Clinics - Orchiectomy as Bridge or Alternative to Vaginoplasty (https://www.urologic.theclinics.com/article/S0094-0143(19)30052-7/abstract) - TY - JOUR T1 - Orchiectomy as Bridge or Alternative to Vaginoplasty AU - Hehemann, Marah C. AU - Walsh, Thomas J. Y1 - 2019/11/01 PY - 2019 N1 - doi: 10.1016/j.ucl.2019.07.005 DO - 10.1016/j.ucl.2019.07.005 T2 - Urologic Clinics JF - Urologic Clinics SP - 505 EP - 510 VL - 46 IS - 4 PB - Elsevier SN - 0094-0143 M3 - doi: 10.1016/j.ucl.2019.07.005 UR - https://doi.org/10.1016/j.ucl.2019.07.005 Y2 - 2025/04/23 ER -
- Wikipedia - Orchiectomy (https://en.wikipedia.org/wiki/Orchiectomy)
- Women's College Hospital - Orchiectomy Guidebook (https://pensarecool.neocities.org/thetransgenderdictionary/o/orchiectomy_guidebook.pdf)
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See also the pages for; estrogen, penectomy, and vaginoplasty.
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