Infotrans

Bilateral Orchiectomy

Who can undergo the surgery?

According to the recommendations reported in the bibliography section, people who match the following criteria can undergo bilateral orchiectomy surgery:

  • Gender incongruence is marked and sustained;
  • Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care;
  • Demonstrates capacity to consent for the specific gender-affirming surgical intervention;
  • Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options;
  • Other possible causes of apparent gender incongruence have been identified and excluded;
  • Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed;
  • Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).

In Italy, the following criteria have also to be matched:

When the necessary criteria for carrying out the surgery are met (see above), the person concerned must:

  • identify a specialized clinical center (Infotrans.it offers a list of public or public-private partnership structures, present on the national territory, able to provide this type of services in the "Service Map" section)
  • schedule a urological consultation

It is not necessary to stop hormone therapy. In general, if one is taking any prescription medication, this should be discussed with the health provider. It may be necessary to stop taking it even several days before the surgery. Drug therapy may be resumed at the doctor's discretion.

Bilateral orchiectomy is a surgery that consists in the removal of both testes and helps to stop the production of androgens (male sex hormones). Each testis is extracted from its envelope (scrotum) in association with the epididymis and funicles (sacs and canals that contain spermatozoa). The testes will be sent to the laboratory for histological analysis to rule out the presence of a testicular cancer. This surgery is often part of penile and scrotal inversion vaginoplasty or colon vaginoplasty, but it can also be done independently. The intervention irreversibly precludes the ability to reproduce.
The surgical procedure lasts about an hour and takes place under general or spinal anesthesia.

The surgical procedure is performed on a day hospital basis or short hospital stay, depending on the characteristics of the person and post-operative recovery.

In the 2-3 weeks following the surgery it is recommended to avoid:

  • weight lifting
  • take hot baths
  • take a sauna

The person will need to be seen or returned to the hospital if:

  • has a fever
  • has severe pain
  • notices that the wound starts bleeding or shows a light discharge. 

Like any surgery, there is a risk of bleeding, infections and adverse reactions to anesthesia.

National Health Service (NHS): no cost.
Private practice: at the discretion of the provider.

Coleman E,  Radix AE, Bouman W,  et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022; Sep 6;23(Suppl 1):S1-S259.
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. Erratum in: J Clin Endocrinol Metab. 2018; 103(2): 699. J Clin Endocrinol Metab. 2018; 103(7): 2758-2759.