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Orchiectomy and Scrotectomy

Medically reviewed by Nicole M, RN on October 3, 2024.

An orchiectomy is the surgical removal of the testicles whereas a scrotectomy is the surgical removal of the scrotal sack tissue. These are often some of the first surgical procedures that a patient undergoes as a part of their medical transition.

Our transgender and gender non-conforming patients often solicit these procedures to simplify their gender affirming hormone replacement therapy (HRT) regime. Removing the testicles means that a patient will no longer need to take testosterone blockers. Likewise, an orchiectomy can allow the body to produce more estrogen on its own. This means that a patient might be able to take less estradiol externally, which can reduce health risks like blood clotting.

Many transfeminine and non-binary patients undergo an orchiectomy to prepare for a later vaginoplasty or vulvoplasty. Keep in mind that an orchiectomy can be done at the same time as a vaginoplasty/vulvaplasty. Patients that are interested in a vaginoplasty or vulvaplasty (sometimes written as “vulvoplasty”) are recommended not to undergo a scrotectomy in order to maintain their scrotal sack so that the skin can be used later to construct the vulva.

Since an orchiectomy is essentially a sterilization procedure, we encourage our patients to consider their fertility preservation and other reproductive health options prior to undergoing surgery.

What is an orchiectomy?

An orchiectomy is one of the quickest and most inexpensive gender affirming surgeries. It is performed in less than an hour while a patient is under general anesthesia.

Patients of varying gender identities undergo orchiectomies for medical reasons, such as chronic pain or to simplify their HRT.  Since the testicles are the main source of testosterone, you will likely no longer need to take anti-androgen medications or testosterone blockers after surgery. Likewise, many orchiectomy patients find that their bodies can produce more estrogen naturally; as a result, they may be able to take less estradiol. It is important to work with your hormone provider before and after surgery to ensure that your medications are adjusted adequately.

An orchiectomy is often undergone by a patient months or years prior to a vaginoplasty or vulvaplasty. Dr. Ley does not require that this procedure be performed beforehand as it can be done simultaneously. If you would like to get an orchiectomy before your vaginoplasty/vulvaplasty, we recommend that our patients schedule it out for at least 8-12 weeks prior.

The procedure itself involves a midline scrotal incision that is used to cut the spermatic cord and remove the testicles. The cord is allowed to retract up and the incision is closed with dissolvable sutures. The testicles are then sent for analysis by the pathology department to check for any abnormalities.

Recovery for this procedure is fairly light. Patients are expected to deal with pain, bruising and discomfort for a short amount of time after the surgery.

What is a scrotectomy?

A scrotectomy is an irreversible procedure that removes the scrotal sack tissue, creating a smooth area of skin where the scrotum once was. This can be done at the same time as an orchiectomy if you desire, but is not a requirement. If you do not have a scrotectomy at the time of your orchiectomy, then you will have an empty scrotal sack.  When a scrotectomy is performed, the scrotal skin is completely removed. There may be a small amount of skin left around the base of the penis in order to prevent tethering, especially with erections.

For patients that are interested in a vaginoplasty or vulvaplasty (i.e., a “zero-depth vaginoplasty”) we recommend that you do not undergo a scrotectomy. This is because scrotal tissue is often used in the construction of the vulva.