The Transgender Dictionary

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Orchiectomy

(also: bottom surgery, castration, lower surgery, orchi, orchidectomy)

Table of Contents

Introduction

Dating back to the 2nd millennium BCE, castration has been around for a long time. The practice of the removal of one's testicles originated to create eunuchs (people who were typically servants or slaves in royal courts and harems). While societal roles have changed since medieval times, castration (now renamed orchiectomy) is still around in the medical field. Orchis are still performed as medical treatment for various reasons including the following; testicular cancer, post vasectomy pain syndrome, testicular torsion, prostate cancer, for the community of modern-day individuals who still willingly identify as male eunuchs, and for transgender women who suffer from gender dysphoria.

This page will be focusing on the role that orchiectomies play in the transition of many transgender women as a treatment for gender dysphoria. However, if you are interested in the history of this procedure, and the other ways in which it is still performed, see the external links at the bottom of this page for further research.

Many transgender women (and some nonbinary people) will seek out orchidectomies as a method of obtaining gender euphoria and decreasing the production of testosterone in their bodies. Some women simply have an orchiectomy without any other lower surgeries. If she chooses to do so, a scrotectomy (the removal of the scrotum) will also be performed to avoid the elevated risk of bleeding issues/hematomas that comes alongside an empty sack. If she chooses to have additional gender-affirming surgeries alongside orchi; such as vaginoplasty, then a scrotectomy is not advised to be performed (as that extra skin would be used for optimal vaginoplasty results).

General Information

An orchiectomy can reduce the overall need for hormones. A simple orchi can involve the removal of one or both testicles, while a bilateral orchi always involves removing both. Discuss with your surgeon what feels right for you.

This surgery is an outpatient procedure that lasts for around 30-60 minutes. It may be performed under either local or general anesthesia. During the procedure, the penis is taped to the abdomen so that it is out of the way. Incisions are made (see below for variations). The undesired testicle(s) are cut out from the surrounding tissues and vessels and removed through the incision. Clamps are placed to prevent blood from gushing out of the spermatic cords. The area is washed with saline solution, then the incision is sewn shut.

Full recovery from an orchiectomy can take 2 weeks to 2 months. For the first week, there are some things you'll want to do such as keeping the incision area dry and covered in gauze. Wash the area gently with mild soap once you are able to bathe. Follow your doctor's instructions in regards to wearing scrotal support or taking any perscribed pain medications, stool softeners, creams, or ointments. Use ice to reduce swelling. Do not have sex until fully healed.

If you are post-op, notify your doctor if you experience pain, redness, pus, or bleeding around the incision. Notify your doctor if you have a fever over 100°F (37.8°C), are unable to urinate, or have a large purple spot (hematoma).

Different Types of Orchi

Bilateral

Both testicles are removed.

This may be performed as treatment for prostate cancer or breast cancer.

Radical Inguinal

One or both testicles are removed through a small cut in the lower part of the abdominal area, as opposed to the scrotum.

This may be done to test testicular tissue for cancer.

Simple

One or both testicles are removed through a small cut made in the scrotum.

This may be done to lower testosterone production, treat prostate cancer, or treat breast cancer.

Subcapsular

The tissues around the testicles are removed from the scrotum. This keeps the scrotum intact so that there is no outward sign that anything has been removed.

Anatomy

This page has been discussing the removal of the testicles, but what are they anyway? This section will explain this part of the reproductive system (and nearby internal parts). For informational purposes, this section will be discussing this part of the anatomy under the assumption that no alterations have been made. For additional information on the rest of the reproductive system associated with the testicles (and such), see penis page.

Bulbourethral Glands/Cowper Glands

Pea-sized structures on the sides of the urethra, just below the prostate. These glands produce a transparent, slippery liquid that neutralizes any remaining acids in the urine. The liquid empties into the urethra.

Ejaculatory Ducts

Each testicle has a vas deferens that joins with seminal vesicle ducts to form ejaculatory ducts. The ejaculatory ducts move through the prostate, where they collect fluid to add to semen. The ejaculatory ducts empty into the urethra.

Epididymis

A long, coiled tube that rests on the back of each testicle. The epididymis carries and stores sperm. The epididymis brings sperm to maturity.

Scrotum

The scrotum is the loose, pouch-like sac of skin that hangs behind the penis. The scrotum contains nerves, blood vessels, and holds the testicles.

The scrotum protects the testicles, and provides a sort of a "climate control" system. For normal sperm development, the testes must be at a slightly cooler temperature than the rest of the body (between 97°F and 99°F or 36°C and 37°C). Special muscles in the wall of the scrotum allow it to contract (tighten) to bring the testicles closer to the body for warmth and protection. These same muscles will relax away from the body to cool down the testicles.

Seminal Vesicles

Sac-like pouches near the bladder attatched to the vas deferens. The seminal vesicles produce 80% of ejaculatory fluid, including fructose (an energy source that helps the sperm move).

Testicles/Testes

Typically coming as a pair, these oval-shaped organs are located inside the left and right of the scrotum. They are roughly the size of a pair of olives. The spermatic cord holds the testicles in place and supplies them with blood.

Within each testicle are the seminiferous tubules (coild mass of tubes), which produce sperm cells through a process called spermatogenesis. Sperm are immature when they initially leave the testicles, before they enter the epididymis.

Cryptorchidism/Undescended Testicles

This is an intersex variation where one or both of the testes do not descend from a person's abdomen into their scrotum. Bilateral cryptorchidism is when both testes are undescended. Unilateral cryptochidism is when only one of the testes does not descend.

Intersex variations associated with undescended testicles include 17-beta HSD, CAIS, PAIS, Bladder Exstrophy, Cloacal Exstrphy, De la Chapelle Syndrome, Fraser Syndrome, Jacob's Syndrome, Kallmann Syndrome, LCH, and XXYY Syndrome.

Vas Deferens

A long, muscular tube that travels from the epididymis and into the pelvic cavity (just behind the urinary bladder). The vas deferens transports sperm to the urethra in preperation for ejaculation.