Surgical Removal of Testicles: Varieties, Risks, Procedural Details, and Additional Information
In the realm of gender affirmation, orchiectomy – the surgical removal of one or both testicles – plays a significant role for transgender women. This article aims to provide a comprehensive overview of the procedure, its implications, and the recovery process.
Orchiectomy is a common procedure, with most patients making a full recovery within 1 to 4 weeks post-surgery. The specific recovery time can vary depending on the complexity of the surgery [3][4][5].
For transgender women undergoing bilateral orchiectomy, it's essential to note that this procedure leads to lifelong hormone replacement therapy due to the loss of natural testosterone production [2][3].
While complications are relatively rare, they can include surgical risks such as bleeding, infection, scarring, and nerve damage. Approximately 86% of orchiectomy patients experience no complications, but hemorrhage and abscesses are among the more common issues [2].
Long-term effects differ based on whether the orchiectomy is unilateral or bilateral. Unilateral orchiectomy typically preserves hormonal and sexual function, while bilateral orchiectomy leads to irreversible infertility, a significant decline in libido, potential physical changes such as muscle loss and fatigue, hot flashes, mood disorders, and decreased bone density [2][3].
Psychological adjustment varies, with many transgender patients feeling relief post-surgery, but some may experience body image or emotional challenges, especially if testicular implants are not used. Psychological support is crucial during recovery and adjustment [2].
Before the procedure, a physical examination is conducted, including giving blood and stool samples. The individual will receive either a general or local anaesthetic before the surgery. During the procedure, the surgeon will tape the penis to the abdomen, sterilize the incision site, and make an incision either on the scrotum or on the lower abdomen [6].
For those wishing to undergo orchiectomy as part of their male-to-female transition, a medical clearance letter from their primary doctor is required. Depending on the type of orchiectomy, the surgeon may also remove the spermatic cord or the tissue surrounding the testicles, along with any tumors [6].
Orchiectomy is not only used in gender affirmation but also in treating testicular, prostate, and breast cancer in males. A study found that orchiectomy and hormone therapy achieve treatment results for metastatic prostate cancer [7].
After the procedure, the surgeon will sterilize the wound and close the incision with sutures. Detailed recovery instructions may include wearing a scrotal support strap, using ice packs, keeping the incision clean and dry, taking nonsteroidal anti-inflammatory drugs for pain and swelling, avoiding strenuous physical activity, and returning for a follow-up [6].
Subcapsular orchiectomy, a testis-sparing procedure, only removes the tissue surrounding the testicles. This method has been found to have fewer instances of post-traumatic stress disorder (PTSD) and phantom testis syndrome compared to total orchiectomy [8].
In the event of complications, potential side effects associated with orchiectomy include loss of muscle mass, hot flashes, fatigue, decreased sexual interest, gynecomastia, and loss of fertility [6].
It's important for individuals undergoing orchiectomy to provide a healthcare professional with a list of all medications and supplements they are currently taking, any known or suspected allergies to anaesthetics or other medications, and whether or not they want to have a prosthetic testicle implanted during the operation [6].
In conclusion, for transgender individuals undergoing orchiectomy as part of gender affirmation, it's crucial to be aware of the recovery timeline, potential complications, the need for lifelong hormone replacement therapy, and the long-term effects on health and well-being. Psychological care and fertility counseling are important components of comprehensive care [2].
- Alongside its role in gender affirmation, orchiectomy is Used in treating male cancers such as prostate, breast, and testicular cancer.
- The recovery time for orchiectomy varies, with most patients making a full recovery within 1 to 4 weeks post-surgery, but this can depend on the complexity of the surgery.
- Transgender women undergoing bilateral orchiectomy must prepare for lifelong hormone replacement therapy due to the loss of natural testosterone production.
- Complications from orchiectomy are relatively rare, but potential issues can include surgical risks, such as bleeding, infection, scarring, and nerve damage.
- The long-term effects of orchiectomy differ based on whether it's unilateral or bilateral. Bilateral orchiectomy can lead to irreversible infertility, decreased bone density, and significant declines in libido.
- Before undergoing orchiectomy, individuals should provide a list of medications and supplements, allergies, and preferences for prosthetic testicle implants to their healthcare provider for a safe and smooth procedure.
