The surgical procedure involving the removal of both testicles is known as a bilateral orchiectomy. This intervention is often performed as a treatment for advanced prostate cancer or as a component of gender-affirming care. Since the testicles are the body’s primary source of certain hormones, their removal results in profound physiological changes. Understanding these changes is important for individuals considering or undergoing this irreversible procedure.
The Immediate Hormonal Shift
The most immediate consequence of a bilateral orchiectomy is the abrupt cessation of hormone production. The testicles typically produce over 90% of circulating testosterone, and their removal causes serum levels to drop rapidly. Testosterone levels fall to castrate levels (less than 50 ng/dL), often within hours following the surgery.
This sudden hormonal deficiency triggers an immediate reaction in the pituitary gland, which is part of the brain’s endocrine control center. The pituitary gland increases the secretion of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) in an attempt to stimulate the now-absent gonads. This increase in LH and FSH levels signals that the normal hormonal feedback loop has been interrupted. The patient effectively enters a state of surgical hypogonadism, which drives subsequent physical and metabolic changes.
Physical and Metabolic Consequences
The long-term absence of adequate hormone levels leads to predictable changes in body composition and metabolism. A significant consequence is a decrease in lean muscle mass paired with an increase in body fat, particularly visceral fat accumulation around the internal organs. This shift in body composition can contribute to an increase in overall body weight, reported to be around a 2.9% increase within the first year after the procedure.
The lack of hormonal support also has a profound impact on bone health, substantially increasing the risk of developing osteoporosis and fragility fractures. Hormone-sensitive bone cells become less active, leading to a progressive loss of bone mineral density over time. Furthermore, the metabolic profile often becomes less favorable, increasing the risk for disorders like metabolic syndrome and Type 2 diabetes. This includes measurable increases in fasting serum insulin and glucose levels, alongside adverse changes in lipid panels, such as elevated total cholesterol and low-density lipoprotein (LDL) cholesterol. Patients may also experience vasomotor symptoms, commonly known as hot flashes and sweating, associated with sudden hormone withdrawal.
Impact on Sexuality and Reproduction
The surgical removal of both testicles causes complete and permanent sterility because the testicles are the site of all sperm production. The ability to conceive a child naturally is lost forever. Individuals who wish to preserve the option of biological parenthood must complete sperm banking before the procedure, as the procedure is irreversible.
The procedure severely affects sexual function due to the drastic reduction in hormone levels. The loss of the primary hormone source results in a significant decrease in libido, or sex drive. Furthermore, the ability to achieve or maintain an erection is often impaired, a condition known as erectile dysfunction. These sexual health changes are a direct consequence of the resulting hypogonadal state and the hormone’s role in regulating sexual desire and physical response.
Life After Removal: Management and Support
Mitigating the physical and psychological consequences of a bilateral orchiectomy requires active management, most commonly through Hormone Replacement Therapy (HRT). HRT is the standard treatment used to re-establish physiological hormone levels and counteract metabolic and physical effects. This therapeutic approach helps restore muscle mass, maintain bone density, and improve both libido and erectile function.
The replacement hormones can be administered through various methods, including injections, topical gels, or transdermal patches, with the specific choice depending on patient preference and medical necessity. Regular monitoring of serum hormone levels is required to ensure the dose is correctly calibrated to maintain health and manage symptoms. Psychological support is often necessary to help individuals navigate emotional adjustments, concerns about body image, and the impact on intimate relationships.