Orchiectomy for Transgender Women: What to Expect

An orchiectomy (or “orchidectomy”) is a surgery that removes one or both testicles. For many transgender women and transfeminine people, a bilateral orchiectomy (removing both) can be a meaningful, gender-affirming stepsometimes as a stand-alone procedure and sometimes as part of a larger surgical plan (like vaginoplasty).

If you’re considering it, you probably have two big questions: What will it actually be like? and How will it change my hormones, recovery, and daily life? This guide walks through the process in plain Englishbecause medical jargon is already exhausting, and you didn’t ask to earn a second degree in “Forms & Waiting Rooms.”

Quick note: This article is educational, not personal medical advice. Policies and requirements vary by surgeon, clinic, state, and insurance planso your care team is the final authority on what applies to you.

What an Orchiectomy Does (and Doesn’t) Do

The main goal: lower testosterone at the source

Testicles produce most of the body’s testosterone. After bilateral orchiectomy, the body no longer makes significant amounts of testosterone from the testes. For many trans women, that can mean:

• Less need (or no need) for certain anti-androgen medications
• Potentially lower doses of estrogen to achieve target hormone levels
• Relief from dysphoria related to having testes

What it won’t do by itself

Orchiectomy alone doesn’t create external genital changes like a vulva or vaginal canal. It also doesn’t automatically cause instant feminizationbecause your overall results still depend on your hormone regimen, genetics, age, and time.

Who Typically Seeks a Gender-Affirming Orchiectomy?

People consider orchiectomy for different reasons. Here are common scenarios:

• Medication side effects: Some people want to reduce or stop anti-androgens (for example, if they cause unwanted side effects or interact with other health conditions).
• Affirmation and comfort: For some, removing the testes significantly eases dysphoria and improves day-to-day comfort.
• A “bridge” step: Some people choose orchiectomy as a smaller, simpler surgery before any future genital reconstructionor instead of it.
• Cost and recovery considerations: It’s often shorter and less complex than other genital surgeries.

Eligibility, Assessments, and Common Requirements

Many U.S. programs follow professional guidelines (like WPATH Standards of Care) and also have their own clinic policies. Requirements vary, but commonly include:

Informed consent and readiness documentation

You’ll usually have consultations to confirm you understand the procedure’s benefits, risks, and permanent effects (especially fertility). Many surgeons and insurers ask for one or more referral letters from qualified mental health professionals.

Age and legal consent

In the U.S., many surgical programs provide gender-affirming genital surgeries only for patients who are legally adults. Some centers publish explicit “18+” policies. If you’re under 18, you may be able to start by meeting with a specialized gender clinic to discuss options, timelines, and supportive care.

Hormone therapy history (sometimes required, sometimes flexible)

Some surgeons or insurers expect a period of hormone therapy before surgery (often described as “12 months,” when clinically appropriate). Others focus more on individualized assessmentespecially if hormones aren’t desired or aren’t medically recommended for a particular patient. The key point: there’s no single universal rule, and your surgeon/insurer may have specific checkboxes.

Orchiectomy vs. Vaginoplasty vs. Scrotectomy

Orchiectomy

Removes the testes. Usually preserves most scrotal tissue unless otherwise planned.

Scrotectomy

Removes scrotal skin. This can matter if you want vaginoplasty later, because scrotal skin may be useful in certain surgical techniques. If there’s any chance you’ll pursue vaginoplasty in the future, discuss tissue-preservation with your surgeon before scheduling anything.

Vaginoplasty (or vulvoplasty)

A set of procedures that create external feminine genitalia (and sometimes a vaginal canal). Orchiectomy may be done at the same time as vaginoplasty, depending on the technique and surgeon.

How to Prepare: Before Surgery

Preparation is usually straightforward, but the details matter. Your surgical team typically provides a checklist. Common items include:

Medical review and labs

• Health history review (including medications, allergies, and past anesthesia reactions)
• Basic labs and sometimes a pre-op physical exam
• Clear instructions about which medications to pause (especially blood thinners) and when

Nicotine, alcohol, and general healing readiness

If you smoke or vape nicotine, your surgeon may strongly recommend stopping beforehand because nicotine can impair wound healing. Follow your clinic’s guidance closelythis is one of those “small habit, big impact” situations.

Logistics: set yourself up for an easy first week

• Ride home: If you have sedation or general anesthesia, you’ll need someone to take you home.
• Home base: Clean sheets, loose underwear or a scrotal support if recommended, and easy meals.
• Work/school planning: Many people return to desk-type activities within days, but give yourself breathing room.

The Day of Surgery: What Happens

Orchiectomy is often an outpatient procedure, meaning you go home the same day. Exact technique varies, but many gender-affirming orchiectomies are performed through a small incision in the scrotal area.

Anesthesia options

Depending on the surgeon, setting, and your medical history, anesthesia may be local with sedation or general anesthesia. Your anesthesia team will explain what to expect, including common short-term effects like grogginess, mild nausea, or a sore throat after general anesthesia.

Procedure basics (no scary movie details)

In simple terms: the surgeon removes the testes and closes the incision with sutures. You’ll leave with aftercare instructions, and sometimes with a dressing and/or supportive garment.

Recovery Timeline: What It Usually Looks Like

Recovery experiences vary, but many people find orchiectomy recovery manageable compared with more extensive surgeries. Here’s a common timeline:

First 24–72 hours

• Swelling and soreness: Normal. Often helped by prescribed or over-the-counter pain medication.
• Support helps: A scrotal supporter or snug (not tight) supportive underwear may reduce discomfort.
• Ice packs: Many post-op instructions recommend icing in short sessions to reduce swelling.
• Rest: You’ll likely spend a lot of time doing the ancient healing practice of “lying down and watching shows you don’t even like.”

First 1–2 weeks

• Activity limits: Avoid heavy lifting, strenuous exercise, and anything your surgeon says could stress the incision.
• Incision care: Follow your clinic’s instructions for showering, keeping the area clean, and watching for infection.
• Back to routine: Many people return to school or desk work within a few days to a week, depending on pain and energy.

Weeks 3–8 (full healing window varies)

• Gradual return to exercise: Typically with clearance from your surgeon.
• Scar settling: The incision area usually softens and becomes less noticeable over time.
• Hormone adjustments: This period often includes follow-ups with your prescribing clinician to fine-tune medications.

Risks and Complications: What to Watch For

Every surgery has risks, even when it’s common and generally safe. Typical risks discussed for orchiectomy include:

• Bleeding or hematoma (a collection of blood that can increase swelling)
• Infection
• Delayed wound healing
• Scarring or changes in sensation
• Anesthesia-related side effects (nausea, vomiting, dizziness)

Call your surgeon or seek urgent care if you have:

• Fever, chills, or worsening redness
• Increasing pain not controlled by medication
• Drainage that looks like pus or has a strong odor
• Rapidly increasing swelling, or swelling that feels tight and severe
• Any symptom your discharge instructions highlight as urgent

Hormones After Orchiectomy: What Changes?

This is a big one. Orchiectomy changes your baseline hormone production, so your medication plan usually changes too.

Anti-androgens may be reduced or stopped

Because the testes are a main source of testosterone, many people no longer need medications aimed at blocking or lowering testosterone after bilateral orchiectomy. That can reduce side effects (for example, those associated with certain anti-androgens). However, medication decisions should be made with your clinician based on labs, symptoms, and your overall goals.

Estrogen often continues (and is important for bone health)

After gonad removal, your body still needs an appropriate sex-steroid hormone level for long-term healthespecially to protect bone density. Most transgender women continue estrogen therapy after orchiectomy, sometimes at a lower dose than before. The goal is usually to maintain hormone levels in a typical range for your affirmed gender, using a regimen that fits your medical risk profile.

Monitoring still matters

Expect follow-up labs and appointments. Your clinician may monitor estradiol levels, overall metabolic markers, and other labs depending on your medication route and medical history.

Fertility and Family Planning: The Permanent Part

Bilateral orchiectomy permanently removes the ability to produce sperm from the testes. If having genetically related children might matter to you now or later, talk to a clinician about fertility preservation (such as sperm cryopreservation) before surgery. Even if you feel 99% sure today, it’s worth having a calm, informed conversationfuture-you deserves options.

Long-Term Health After Orchiectomy

Bone density and overall wellness

With lower endogenous sex hormone production, long-term hormone management matters for bone health. Your clinician may recommend lifestyle supports (like strength training when cleared, calcium/vitamin D if appropriate, and regular preventive care) along with medical monitoring.

Preventive screenings (including prostate)

Orchiectomy doesn’t remove the prostate. Even after some gender-affirming surgeries that include orchiectomy, the prostate remains. That means you should still discuss age-appropriate prostate screening with your clinician, based on your risk factors and current guidelines.

Mental health and “post-op emotions”

Many people feel relief after surgery, but it’s also normal to feel unexpectedly emotional, tired, or mentally “weird” during recovery. Anesthesia, pain meds, stress, and disrupted sleep can all contribute. If you have anxiety or depression, consider lining up support ahead of timelike a trusted friend, therapist, or support group.

Questions to Ask Your Surgeon (Bring This List)

• Am I a good candidate for stand-alone orchiectomy based on my goals and medical history?
• Which surgical approach do you use, and where is the incision typically placed?
• What anesthesia will I have?
• What does your typical recovery timeline look like, and what activity limits do you require?
• How should I manage my hormones before and after surgery?
• If I might want vaginoplasty later, how do you preserve tissue options now?
• What complications should I watch for, and how do I reach your team after hours?
• How does billing work with my insurance, and what documentation is required?

Bottom Line

A gender-affirming orchiectomy is often a relatively brief outpatient surgery with a recovery measured in days to weeksnot monthsthough everyone heals differently. The biggest long-term impacts tend to be hormone management (often simpler afterward), fertility permanence, and the emotional relief many people describe when their body aligns more closely with their identity.

If you’re considering orchiectomy, your best next step is a consultation with a surgeon experienced in gender-affirming care and a clinician who manages gender-affirming hormone therapy. With the right team and a plan that fits your body and goals, “what to expect” becomes much less mysteriousand a lot more doable.

Experiences: What People Commonly Say It Feels Like (Realistic, Not Glossy)

People’s experiences after orchiectomy are personal, and no two recoveries are identicalbut patterns show up again and again in the stories patients share with clinics, support groups, and trusted friends. Here are some of the most common themes, described in a realistic way (not a “miracle transformation in 24 hours” way).

1) The relief can be quietand that’s still huge

Many people expect a big, cinematic wave of emotion. Sometimes that happens. But just as often, the feeling is surprisingly simple: a quiet, steady sense of relief. One day you notice you’re not thinking about your genitals as much. Or you realize that getting dressed feels less tense. Or you catch yourself walking around the house without that background “buzz” of dysphoria. It can feel almost anticlimacticuntil you realize that “anticlimactic” is kind of the dream when you’re talking about peace in your own body.

2) The first week is mostly about comfort logistics

People often say the toughest part isn’t dramatic painit’s the awkwardness: finding the most comfortable sitting position, remembering not to lift heavy things, and figuring out the perfect balance of support and softness in underwear. The MVP items tend to be boring: ice packs, supportive garments (if recommended), loose pants, and a cozy spot where you can rest without constantly getting up. Many also describe a “low battery” feeling from anesthesia and disrupted sleep, even if the incision itself isn’t terrible.

3) Hormone changes can feel subtle at first

A common misconception is that orchiectomy instantly changes everything about mood, energy, or appearance. In reality, many people notice the biggest differences once their clinician adjusts medicationsespecially if they stop an anti-androgen that caused side effects. Some describe fewer bathroom trips, less lightheadedness, or more stable day-to-day energy after medication changes. Others feel no major difference except relief and simpler hormone management. Both experiences are normal.

4) Recovery can be emotionally “wavy”

A lot of people report emotional ups and downs in the first couple of weeks: feeling proud and relieved one day, then impatient or oddly fragile the next. That doesn’t mean something is wrong. Surgery is a stressor, routines get disrupted, and the body is healing. People often say it helps to plan small comfortsfavorite snacks, low-effort entertainment, gentle check-ins with supportive friendsso your recovery isn’t only medical, but also human.

5) The best stories include planningnot just bravery

The smoothest recoveries tend to come from practical planning, not “toughing it out.” People who arrange a ride, prep meals, clear their schedule, ask questions, and follow aftercare instructions usually describe fewer stressful surprises. In other words: you don’t need to be fearless. You just need a plan. And if you’re nervous, that’s not a sign you’re unreadyit’s a sign you understand this matters.