Orchidectomy

What is orchidectomy?

Surgical removal of the testes (testicles) usually causing permanent reduction in testosterone levels.

It's also known as Orchiectomy or Orchi.

What does orchidectomy do?

Fertility
Causes permanent infertility
Body hair
Reduces and thins
Muscles
Weakens and makes smaller
Lower body
Makes it easier to tuck, shrinks genitals, reduces erections
Face
Softens skin, lessens acne

Who can have orchidectomy?

You must have had 12 continuous months living as your gender identity
You must have had 12 continuous months of HRT, unless you’re unable to
You must have capacity to consent for this treatment
If you have significant medical conditions, these need to be “reasonably well-controlled”
Under 18s cannot have this but can be referred at 17
You typically need a BMI of less than 30

How long does orchidectomy last?

The effects are permanent and cannot be reversed.

What should I be aware of?

Orchidectomy results in permanent destruction of the testes and is irreversible. After orchidectomy you will be infertile and unable to have children unless you have previously carried out gamete storage (i.e. sperm banking).

After orchidectomy, you will need to take at least one sex hormone (oestrogen and/or testosterone) in order to prevent medical problems like osteoporosis.

Orchidectomy may not be suitable for people who are interested in later obtaining a vaginoplasty as it can make the vaginoplasty more difficult - check with your surgeon if you are unsure.

Orchidectomy may cause erectile dysfunction in people with penises. If this is not desired, it can be treated with sildenafil, tadalafil or vardenafil.

How do I get an orchidectomy?

You will normally need to meet the following conditions:

persistent and well-documented gender dysphoria
capacity to make fully informed decisions and to consent to treatment
if significant medical or mental health concerns are present, they must be reasonably well controlled
two medical opinions, usually at least one from a gender clinic, that surgery is appropriate
12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless the patient has medical contraindications or is otherwise unable to take hormones)
at least 12 months’ living continuously in a gender role that is congruent with the gender identity 1.

The NHS gender pathway does not normally fund orchidectomy surgery. However, you can ask your gender service to write a letter to your GP asking them to refer you for an orchidectomy, or you can arrange for one privately.

NGICNS maintains a list of NHS surgery providers providing various gender-related surgeries. At the moment, all of these surgeons are based in England, so you will have to travel if you live in another part of the UK. If you have decided to pay for your own surgery, rather than using NHS funding, there are additional options available to you. For more information about these private surgery options read our private surgery page.

Where can I learn more?

You can also read more about orchidectomy in this booklet from Parkside Hospital who are a UK provider of orchidectomy surgery.

How do I get ready for surgery?

Doing some preparation in advance can help make sure everything goes smoothly during your hospital stay and recovery. To help you avoid forgetting to do or buy something we have created a Getting ready for gender surgeries page.

Where can I ask questions about surgery?

When you and your clinical team agree that you are ready for surgery on the NHS, the NHS Gender Dysphoria National Referral Support Services (GDNRSS) will process your referral to your chosen surgical provider. They have a Single Point of Access support line that you can call for information about your referral, the status of your chosen provider and practical information such as travel and parking, who can accompany you, what to take with you and where to report when you get there.

You can also book a virtual consultation with one of the GDNRSS Clinical Nurse Advisors who can provide information on:

Surgical techniques used by various providers and surgeon teams
Typical recovery times following surgery
Potential post-surgical complications
Surgical eligibility criteria, where providers have these in place
Waiting times for surgical providers
Supporting patients to change provider

You can contact the service by calling 01522 85 77 99 or by email. The service is open Monday to Friday from 9am until 5pm. You can find out more about the service in this booklet.

How much will it cost?

The cost of an orchidectomy performed in the UK is currently around £3000-4000 (last updated October 2020).

If you have a formal diagnosis, the NHS will usually provide funding for orchidectomy.

Outside of Scotland, orchidectomy is usually only funded as part of vaginoplasty, clitoroplasty or labiaplasty.

If you're receiving certain benefits, or are on a low income, you may be able to get help with the cost of travel for NHS treatment. Further information about help with travel costs can be found:

References

1.
Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link

Acknowledgements

This page is illustrated using a photograph by Павел Сорокин available at Pexels.

Errors and omissions

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