Orchiectomy is a gender-affirming, lower body surgery that removes of the gonads (testes) and spermatic cord. It can be done with or without scrotectomy (removal of scrotal sac).

The goal is to be able to take a lower dose of estrogen-based medications, reducing their risks and unwanted side effects and to eliminate the need for testosterone blockers. This surgery is done by a urologist. Some people have an orchiectomy and later have a vaginoplasty, although often they are done in a single procedure. If scrotectomy (removal of scrotal tissue) is performed, this will remove tissue that often is used to create the vaginal lining during vaginoplasty and additional skin grafts (e.g. from the upper thighs) may be required. Some people only ever have an orchiectomy. 

Referral & Consult

Referral & consultation process

1Find out if a surgical recommendation is needed

Many urologists do not require a surgical recommendation. It is helpful for your referring provider to call the office in advance to find out if the urologist requires a surgical recommendation.

2Complete surgical care planning (if needed)

If the urologist requires a surgical recommendation, you will need to meet with a clinician for surgical care planning. This can be done by a clinician who meets the qualifications and competencies outlined in the WPATH Standards of Care 8 - this can include your primary care provider

3Review referral options

Visit the surgery referral page for steps required in the referral options for orchiectomy.

4Speak to your surgeon

You may want to ask your surgeon about:

  • The different surgical techniques available
  • The advantages and disadvantages of each technique
  • The limitations of a procedure to achieve "ideal" results
  • Whether they have before-and-after photographs of their own patients, including those of both successful and unsuccessful outcomes
  • The risks and possible complications of the various techniques
  • The surgeon's own complication rates for each procedure


The procedure

The basic steps in an orchiectomy are:

  1. An incision is made in the middle of the external genitals (scrotum).
  2. The gonads (testes) are removed through the incision.
  3. The incision is closed with sutures and covered with surgical dressing.
  4. You will probably be admitted to hospital and sent home on the same day.

Preparing for surgery

While you wait for your referral to be processed, you should keep your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule consultation and surgery appointments.

You may also want to visit the Preparing for Surgery page to help you create a plan for success after surgery.


All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It's important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Post surgery

Post-operative care

You will likely receive painkillers and antibiotics to reduce the chance of infection.

As part of the healing process, you should expect:

  • Some discomfort
  • Some bruising and swelling around the surgical site.
  • Bleeding is possible, but rare.


The number of check-ups following surgery needed varies from person to person. Your surgeon may wish to see you once following your surgery to ensure you are healing as expected. You can also see your primary care provider about any concerns in the post-operative period.

When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about pain, bleeding, urination, bowel movements, fever and how you are feeling physically and emotionally.

Recovery time

Recovery time (the time it will take you to get back to your usual activities varies from person to person, so always follow the advice of your own surgeon. Generally speaking, people are often fully mobile within a day or two and return to work within a few days to a week. This depends on how you feel and what kind of work you do. Some activities, such as driving, heavy lifting, exercise, sex and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities.

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