An orchiectomy is a surgical procedure to remove one or both testicles. It’s most commonly performed to treat testicular cancer, but it also plays a role in managing advanced prostate cancer and is one option in gender-affirming surgery. The procedure itself is relatively quick, typically done under general anesthesia, with most people going home the same day.
Why an Orchiectomy Is Performed
The most common reason is testicular cancer. When imaging and blood work suggest a solid mass in the testicle, surgical removal is the gold standard for both diagnosis and initial treatment. The removed testicle is examined under a microscope to confirm the type and stage of cancer. For early-stage testicular cancer, the surgery alone is curative in over 80% of seminoma cases and about 70% of non-seminoma cases.
For advanced prostate cancer, removing both testicles dramatically lowers testosterone, which fuels prostate cancer growth. Normal testosterone levels sit around 500 to 600 ng/dL. After bilateral orchiectomy, about 75% of patients see their levels drop below 20 ng/dL. However, injectable medications that suppress testosterone have largely replaced this approach, so it’s now far less common for prostate cancer than it once was.
Other reasons include severe testicular trauma, torsion (a twisted testicle that has lost blood supply), chronic infection or abscess, and an atrophic (shrunken, nonfunctioning) testicle. Orchiectomy is also performed as a gender-affirming procedure for transgender women and some nonbinary individuals. In that context, current guidelines call for documentation of persistent gender dysphoria, the capacity to consent, being at the age of majority, and two mental health assessment letters.
Types of Orchiectomy
Simple Orchiectomy
A simple orchiectomy is performed through a small incision in the scrotum. It’s used when there is no suspicion of cancer, for example, to remove a testicle damaged by trauma or torsion, to treat a painful or infected testicle, or as part of gender-affirming care. The approach is more direct and the procedure tends to be shorter.
Radical Inguinal Orchiectomy
When cancer is suspected, surgeons use a different approach entirely. Instead of cutting through the scrotum, they make an incision in the groin (the inguinal area) and remove the testicle along with the spermatic cord, which contains blood vessels and lymphatic channels. This route prevents cancer cells from potentially spreading into scrotal tissue or lymph pathways. The cord is tied off at the level of the internal inguinal ring to ensure full oncological control. A scrotal approach is never used when malignancy is a possibility.
Subcapsular Orchiectomy
In a subcapsular orchiectomy, the surgeon removes the inner tissue of the testicle but leaves the outer shell (the tunica) in place. This was historically used for prostate cancer patients who wanted to preserve the outward appearance of the scrotum. It’s rarely performed today.
What Recovery Looks Like
Most orchiectomies are outpatient procedures, meaning you go home the same day. Expect soreness, swelling, and bruising around the surgical site for the first week or two. Ice packs and over-the-counter pain relief are usually enough to manage discomfort, though your surgeon may prescribe something stronger for the first few days.
For the first three to four weeks, you’ll need to avoid heavy lifting, running, sports, and sexual activity. Light walking is generally fine and encouraged to prevent blood clots. Most people return to desk work within one to two weeks and resume full physical activity after four weeks, depending on how they feel and their surgeon’s guidance.
Hormonal Effects After Surgery
If only one testicle is removed, the remaining one usually compensates by producing enough testosterone on its own. That said, the impact isn’t trivial. Research tracking men after unilateral orchiectomy found that about 21% already had clinically significant testosterone deficiency before surgery. One month after, that number rose to roughly 39%, and by one year it reached nearly 50%. Over long-term follow-up, 10% to 15% of men who had a single testicle removed will eventually need testosterone replacement therapy.
If both testicles are removed, your body stops producing testosterone almost entirely. This leads to noticeable changes: reduced muscle mass, lower energy, hot flashes, decreased sex drive, mood changes, and loss of bone density over time. Testosterone replacement therapy (patches, gels, or injections) is standard for anyone who has had both testicles removed, unless the goal of surgery was specifically to lower testosterone, as in prostate cancer treatment or gender-affirming care.
Fertility Considerations
Removing one testicle doesn’t necessarily mean you can’t father children, since the remaining testicle can still produce sperm. But fertility can be affected, especially if chemotherapy or radiation follows surgery. The American Urological Association recommends that patients be counseled about infertility risks before any definitive treatment and offered sperm banking when appropriate. This is especially important for anyone with an abnormal contralateral testicle, known subfertility, or who may need additional cancer treatment after surgery. Sperm banking should happen before the orchiectomy when possible, since some men already have reduced sperm quality at the time of a cancer diagnosis.
Bilateral orchiectomy eliminates sperm production permanently. For anyone who wants biological children in the future, banking sperm beforehand is the only option.
Testicular Prostheses
A testicular implant can be placed either during the orchiectomy or in a separate procedure afterward. The most widely used version is a silicone shell filled with sterile saline solution by the surgeon before insertion. The implant is sized to match the remaining testicle as closely as possible, and in children, it may need to be replaced with a larger one as they grow. The FDA notes that testicular implants are not considered lifetime devices, so replacement may eventually be needed, but many last for decades without issues. The decision is entirely cosmetic and personal; the implant has no hormonal or reproductive function.
Risks and Complications
Orchiectomy is considered a low-risk surgery, but no procedure is without potential complications. The most common issues are bleeding or hematoma (a collection of blood under the skin), wound infection, and lingering pain at the incision site. Nerve damage during surgery can occasionally cause numbness or chronic discomfort in the groin or scrotum. For radical inguinal orchiectomy specifically, there is a small risk of injury to structures in the inguinal canal, including the nerve that provides sensation to the inner thigh.
Most complications are minor and resolve on their own or with simple treatment. Serious complications like deep infection or significant blood loss are rare.