Orchidectomy, also spelled orchiectomy, is the surgical removal of one or both testicles. It is performed for a range of medical reasons, from testicular cancer and advanced prostate cancer to testicular torsion, trauma, and gender-affirming care. The procedure itself is usually straightforward, but the reasons behind it, the techniques involved, and the aftereffects vary widely depending on why it is being done and how much tissue is removed.
Testicular Cancer and Radical Inguinal Orchidectomy
The most well-known context for orchidectomy is testicular cancer. When imaging and clinical findings suggest a malignant tumor, radical inguinal orchidectomy is the standard first step. This involves making an incision in the groin rather than the scrotum, removing the entire affected testicle along with its spermatic cord, and tying off the cord at the level of the internal inguinal ring. The operation both confirms the diagnosis and stages the tumor, and for the majority of men with early-stage disease, it is curative on its own.1PubMed Central. Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer American Urological Association guidelines reinforce that radical orchiectomy remains the treatment of choice when the clinical picture points to malignancy and the other testicle is normal.2Journal of Urology. Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline
The reason surgeons go through the groin is oncologic control. Dividing the spermatic cord high up prevents tumor cells from seeding along the cord and makes a cleaner field if later lymph node surgery is needed. Some researchers have explored whether cutting the cord lower could reduce operative morbidity without compromising outcomes. A study of nearly 200 patients found that about one in ten had tumor spread into the spermatic cord. Among those with spread close to the upper cut line, all were already metastatic and went on to receive chemotherapy regardless of surgical technique, suggesting that a lower-cord approach might not change clinical outcomes in practice.3SpringerLink / World Journal of Urology. Low-cord orchidectomy for testicular cancer: what would be different? The high-cord technique remains standard for now, but this kind of evidence is nudging urologists to reconsider how aggressive the approach needs to be for every patient.
When Only Part of the Testicle Needs to Go
Not every testicular mass turns out to be cancer. Small lesions sometimes prove benign at the time of surgery, which has led to growing interest in testis-sparing surgery, also called partial orchidectomy. During this approach, the surgeon removes only the mass itself, often using intraoperative frozen-section analysis to check the tissue under a microscope before deciding whether the entire testicle must come out. One experienced center reported that about a third of the small masses they operated on were benign, meaning radical removal could have been avoided.4PubMed. Partial orchiectomy: The Princess Margaret cancer centre experience
Partial orchidectomy has clear appeal for men who have tumors in both testicles, tumors in a solitary remaining testicle, or very small lesions. A review of the current evidence found that organ-sparing surgery offers adequate cancer control with low recurrence rates. Hormone-producing function of the testicle is preserved in roughly eight to nine out of ten patients, and about half go on to father children.5PubMed Central. Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective Patient selection is important: frozen-section evaluation during the operation helps surgeons distinguish benign from malignant tissue in real time, guiding whether to proceed with the limited resection or convert to a full orchidectomy.6PubMed Central. Testis sparing surgery for small testicular masses and frozen section assessment
Orchidectomy for Advanced Prostate Cancer
Bilateral orchidectomy, the removal of both testicles, has a completely different rationale when performed for prostate cancer. Because prostate tumors are driven by testosterone, eliminating the body’s main source of that hormone can slow or shrink the cancer. This is surgical castration, and it has been used for decades as a form of androgen deprivation therapy. The alternative is medical castration using injectable drugs that suppress testosterone production chemically.
Both approaches achieve similar testosterone suppression in the short term, but the comparison gets more nuanced over time. In one study of men with advanced prostate cancer, rates of cancer-marker control were similar during the first year. After that, surgical castration pulled ahead among patients with a poor prognosis, showing better tumor-marker suppression, longer progression-free survival, and better overall survival.7PubMed Central. A comparison of androgen deprivation therapy versus surgical castration for patients with advanced prostatic carcinoma A large population-based study of over 3,200 men with metastatic prostate cancer found that those who had bilateral orchidectomy had lower risks of fractures, peripheral artery disease, and cardiac complications compared to those receiving drug-based suppression.8JAMA Oncology. Comparison of Gonadotropin-Releasing Hormone Agonists and Orchiectomy: Effects of Androgen-Deprivation Therapy Despite these advantages, surgical castration has fallen out of favor in many countries because men understandably prefer an injection to an irreversible operation, and drug-based therapy can be paused if side effects become intolerable.
Subcapsular Orchidectomy and Cosmetic Considerations
When orchidectomy is done for prostate cancer, some surgeons offer a subcapsular technique. Instead of removing the entire testicle, the surgeon shells out the testosterone-producing tissue from inside, leaving the outer capsule and a portion of the tissue in place. The result is a smaller but still present scrotal structure, which can matter psychologically. A systematic review and meta-analysis found that subcapsular orchidectomy was associated with higher treatment satisfaction compared to total orchidectomy. However, it left residual testosterone and prostate-specific antigen levels slightly higher, which means oncologists need to weigh cosmetic and quality-of-life benefits against the completeness of hormonal suppression.9PubMed. Subcapsular versus total orchiectomy in advanced prostate cancer: A systematic review and meta-analysis of clinical and patient-reported outcomes Another study found that men who had the subcapsular procedure with pseudotesticles reported feeling less emasculated, experienced less sexual bother, and had better sexual function scores.10PubMed Central. Cosmetic Appeal, HRQoL, and Effectiveness of Simple and Pseudotesticular Techniques of Orchidectomy in Prostate Cancer
Gender-Affirming Orchidectomy
Orchidectomy is also performed as part of gender-affirming care for transgender women and nonbinary individuals. In this context, removing the testicles eliminates the body’s primary testosterone source, which can reduce or eliminate the need for anti-androgen medications. A study of patients who underwent gender-affirming bilateral orchidectomy found that all patients were able to discontinue spironolactone, a commonly prescribed testosterone blocker, and had significant reductions in estradiol and progesterone doses as well.11Sexual Medicine. Endocrine, gender dysphoria, and sexual function benefits of gender-affirming bilateral orchiectomy: patient outcomes and surgical technique
A large cohort study with middle- to long-term follow-up reported that about 86% of patients had an uncomplicated recovery. The most common complications were abscesses and bleeding events. Having a BMI above 35 was the main risk factor for infectious complications. Importantly, no cases of regret were recorded. Some patients later went on to have vaginoplasty or vulvoplasty, while others were content with orchidectomy alone as their final procedure.12PubMed Central. Gender-affirming orchiectomy in transgender and non-binary individuals: A large cohort study with middle- to long-term follow-up Complication rates for gender-affirming orchidectomy appear comparable to those performed for other reasons such as testicular torsion or pain, based on a national surgical quality database analysis.13PubMed. Outcomes of Orchiectomy for Gender-affirming Surgery: A National Surgical Quality Improvement Program Study
Testicular Torsion and Trauma
Orchidectomy sometimes happens under emergency conditions. Testicular torsion, where the spermatic cord twists and cuts off blood flow, is a urologic emergency most common in adolescents and young men. When caught early, the testicle can often be untwisted and surgically fixed in place. But the clock matters: a study of torsion cases found that the average duration of symptoms before surgery was roughly 15 hours in patients whose testicles could be saved, compared to 42 hours in those who needed orchidectomy.14PubMed. Testicular torsion: orchiectomy or orchiopexy? When the tissue has clearly died, the decision becomes more straightforward: a survey of European pediatric surgeons found that when facing a necrotic testicle, about a third perform orchidectomy immediately, while most others first puncture the tissue to assess viability before deciding.15PubMed. A Survey of Preoperative, Perioperative, and Postoperative Management Practices for Testicular Torsion in Pediatric Patients among European Surgeons
Severe blunt or penetrating trauma to the scrotum can also lead to orchidectomy. The guiding principle is to salvage the testicle whenever possible, but when the organ is too extensively damaged to repair, or when leaving it risks serious infection, removal becomes necessary.16PubMed Central. Orchiectomy after testicular trauma in a 45-year-old man: A case report Imaging, typically with ultrasound, helps guide this decision by showing whether blood flow to the testicle is intact and how disrupted the tissue architecture is.
Fertility After Orchidectomy
Losing one testicle does not mean losing the ability to have children. The remaining testicle typically compensates hormonally and continues producing sperm. But semen quality does decline after surgery. A study comparing semen samples collected before and after orchidectomy for testicular cancer found that all major parameters were significantly worse after the operation: median total sperm count dropped from about 57 million to 13 million, progressive motility fell from 40% to 25%, and the rate of azoospermia (having no sperm at all) tripled.17PubMed Central. Preoperative semen quality is superior to the quality shortly after orchiectomy in patients with testicular germ cell tumour – a retrospective study from two centres in Germany
The picture has an interesting wrinkle, though. Another study found that while sperm count and motility were worse after surgery, DNA fragmentation in the sperm actually improved once the tumor was removed, suggesting the cancer itself had been damaging sperm quality at a molecular level.18PubMed Central. Semen Cryopreservation in Testicular Cancer: Before or After Orchidectomy? This finding complicates the usual advice, but most experts still recommend banking sperm before surgery when possible. Among patients offered preoperative cryopreservation, roughly two-thirds accept. Of those who later try to conceive, most manage to do so naturally; in one cohort, only one out of five men who achieved a pregnancy needed to use banked sperm to do it.19European Urology Open Science. Impact of unilateral orchidectomy on fertility and the utilization of preoperative sperm cryopreservation
Testicular Prostheses and Body Image
The psychological impact of losing a testicle is often underestimated in clinical settings. For many men, especially younger ones, the change to their anatomy affects self-image, confidence in intimate situations, and general well-being. Testicular prostheses, silicone implants placed in the scrotum to restore the appearance and feel of a testicle, are one way to address this.
Satisfaction rates with prostheses are generally high. In one survey, about 83% of men rated their prosthesis as good or excellent, and roughly 88% said they would have it implanted again.20PubMed. Satisfaction With Testicular Prosthesis After Radical Orchiectomy The most common complaints are that the implant feels too firm (about 44% thought so) and that the positioning is not quite right (about 20%). These numbers echo findings from other surveys, where about 60% of recipients felt the implant was too firm.21PubMed Central. Patient Attitudes Toward Testicular Prosthesis Placement After Orchiectomy Despite these specific gripes, the overall sense is that having a prosthesis beats not having one.
A study looking specifically at decision regret makes the case for discussing prostheses early. Men who received a prosthesis at the same time as their cancer surgery reported less regret, less shame about their body image, and less distress about their partner’s perception compared to men who did not get one. Having a prosthesis was independently associated with lower regret in a statistical model. Men without a prosthesis more frequently said they still missed the removed testicle and that their partner had expressed dissatisfaction with their body image.22PubMed. Decision Regret About Testicular Prosthesis After Radical Orchiectomy: Real-life Data to Improve Preoperative Patient Counseling The takeaway for patients and their surgeons: have the conversation about prostheses before the operation, not after.
Phantom Testis Sensations
One of the stranger aftereffects of orchidectomy is phantom testis syndrome, the sensation that the removed testicle is still there. The phenomenon is well documented for amputated limbs, but fewer people know it can happen with a testicle. The reported prevalence varies substantially depending on how the question is asked. An early study of 81 men found that about 12% experienced phantom sensations, most of which were painful and typically faded within 18 months.23PubMed. Phantom sensations after orchiectomy for testicular cancer A larger and more recent survey of 238 men, however, found a much higher rate: 53% reported some kind of phantom experience, with a quarter experiencing phantom pain specifically. Men who had pain in the testicle before surgery were more likely to develop phantom symptoms afterward.24PubMed. Phantom testis syndrome: prevalence, phenomenology and putative mechanisms
The discrepancy between those two numbers likely reflects differences in how actively patients were screened. Many men may not volunteer the information unless specifically asked, either because they find it embarrassing or because they assume it is too unusual to mention. Three patients in the earlier study reported that the phantom sensations affected their sexual life, and one was actually re-operated on because surgeons suspected a second tumor based on his persistent phantom pain. This is a good example of a complication that clinicians should proactively ask about during follow-up rather than waiting for patients to bring it up.
Anesthesia and Pain Control
Orchidectomy for scrotal conditions can be performed under general anesthesia, spinal anesthesia, or regional nerve blocks. For scrotal approaches, an ultrasound-guided spermatic cord block is one option. This technique involves injecting a local anesthetic mixture around each spermatic cord under ultrasound guidance, combined with a small amount of local infiltration at the incision site.25British Journal of Anaesthesia. Ultrasound-guided spermatic cord block for scrotal surgery Regional blocks like this can allow the procedure to be done as outpatient surgery, letting the patient go home the same day. Inguinal orchidectomy for cancer, which involves a deeper dissection through the groin, is more commonly done under general or spinal anesthesia. Recovery timelines are usually measured in weeks rather than months, with most men returning to light activities within a week or two and full activity by about six weeks, though individual recovery varies.
Fertility Preservation for Children and Adolescents
Adult men can bank sperm before an orchidectomy. But what about boys who have not yet gone through puberty? Children facing gonadotoxic cancer treatment or conditions that may require orchidectomy have no mature sperm to freeze. The only experimental option for them is testicular tissue cryopreservation, where a small biopsy of testicular tissue is removed and frozen in the hope that future technology will be able to coax the preserved stem cells into producing mature sperm.26PubMed Central. Testicular Tissue Banking for Fertility Preservation in Young Boys: Which Patients Should Be Included?
This is still genuinely experimental. Clinics around the world are banking tissue, but the techniques to restore fertility from it, whether by transplanting cells back into the body or maturing them in a laboratory, are not yet available for clinical use.27PubMed. Time to therapy and safety of testicular tissue cryopreservation in children undergoing gonadotoxic treatment or hematopoietic stem cell transplant For prepubertal boys, testicular tissue cryopreservation is currently the only option, and researchers are developing next-generation approaches to mature the stored cells into fertilization-capable sperm.28Biology of Reproduction. Male fertility preservation and restoration strategies for patients undergoing gonadotoxic therapies It is a field where the science has outpaced the clinical application, but for families facing the choice, banking tissue now is a bet that the technology will eventually catch up.
The Ethics of Consent and Irreversibility
Because orchidectomy is permanent, questions of informed consent carry extra weight. In the medical setting, this is handled through standard surgical consent processes. But orchidectomy occupies unusual ethical territory because it also exists outside of conventional medicine. A small number of individuals seek castration for reasons unrelated to cancer, prostate disease, or gender identity, sometimes from non-medical practitioners. Research into this phenomenon highlights how the irreversibility of the procedure complicates the legal and ethical framework. Under American criminal law, consent to bodily harm is not generally a valid defense against a battery charge, though cultural attitudes toward body modification have been shifting. When the procedure is performed outside a medical setting, the risks of pain, infection, and life-threatening blood loss are substantial.29Sexual Medicine. Voluntary Genital Ablations: Contrasting the Cutters and Their Clients This fringe phenomenon underscores why access to competent surgical care matters, and why clinicians who encounter patients seeking castration outside standard medical indications should engage rather than dismiss, connecting them with appropriate psychiatric and surgical resources.