An orchiectomy is surgery to remove the testicles. For trans women and transfeminine people, it is a gender-affirming option that stops the body producing testosterone, which often reduces or removes the need for testosterone-blocking medication and can lower ongoing hormone doses. It is a relatively simple, quick procedure compared with vaginoplasty, and some people choose it as a standalone step, either because they do not want vaginoplasty or are not ready for it. One crucial point: if you may want vaginoplasty in future, discuss it first, because the scrotal skin an orchiectomy removes is used to build the vaginal canal, so the timing and technique matter. It is permanent and causes sterility, so fertility preservation is considered beforehand.
What an orchiectomy is
An orchiectomy is the surgical removal of the testicles. In a gender-affirming context, it is chosen by trans women and transfeminine people because the testicles are the body’s main producers of testosterone, so removing them stops that production. Compared with the larger genital reconstructions, it is a comparatively minor and quick operation, which is part of why it appeals to some people as a first or standalone step.
A gender-affirming orchiectomy usually means a bilateral orchiectomy, removing both testicles. It does not, on its own, create a vulva or vaginal canal, that is what vaginoplasty does, so it is important to be clear about what it does and does not change. What it does is end testosterone production and remove the testicles, which for many people is a meaningful step in itself. This guide covers who chooses it, how it affects hormones and fertility, and, importantly, how it relates to vaginoplasty if that is something you might want in future.
Why trans women choose it
People choose an orchiectomy for several reasons, and often more than one at once. A common one is to stop testosterone production directly, which frequently means reducing or stopping testosterone-blocking medication such as anti-androgens, and sometimes lowering oestrogen doses, since there is no longer testosterone to counteract. For people who find their blockers have side effects or who simply want to simplify their medication, this is a real benefit worth discussing with a hormone provider.
Another reason is that it is simpler and quicker than vaginoplasty, with a faster recovery and lower cost, so it can be a more accessible step. Some people choose it because they do not want vaginoplasty, and an orchiectomy meets their goals without a larger surgery. Others choose it as an interim step while waiting for or deciding about vaginoplasty. And for some, removing the testicles is affirming in itself. All of these are valid; the right reason is your own, and it is worth talking through with clinicians so the decision, and its timing, fits your wider plans.
Types of orchiectomy
There are a couple of variations worth knowing, though your surgeon will advise what suits you. A simple orchiectomy removes the testicles through a small incision, and is the usual approach for gender-affirming purposes. Surgeons differ in exactly how they do this and where they place the incision, and some techniques are chosen specifically with a possible future vaginoplasty in mind, to preserve the scrotal skin.
This is the key variable: whether the surgery is done in a way that preserves the scrotal tissue for later use, or not. Because that tissue is central to vaginoplasty, a surgeon who knows you may want vaginoplasty later can take care to preserve it, whereas an orchiectomy done without that in mind may make a future vaginoplasty more complex. This is exactly why the conversation about your longer-term plans, covered next, matters so much before you have the procedure.
Orchiectomy and future vaginoplasty
This is the single most important thing to understand before an orchiectomy, and it is easy to miss. In most vaginoplasty techniques, the scrotal skin is used to help build the vaginal canal and the vulva. An orchiectomy removes the testicles from within the scrotum, and depending on how it is done, it can affect the amount and quality of scrotal skin available for a future vaginoplasty.
Because of this, if there is any chance you might want vaginoplasty in future, it is essential to tell your surgeon before the orchiectomy, so the procedure can be planned to preserve tissue, or so you can make an informed choice about timing. Some surgeons and people prefer to have vaginoplasty first, or the two together, precisely to avoid compromising the tissue. None of this means an orchiectomy rules out later vaginoplasty, many people do have vaginoplasty after an orchiectomy, but it can make it more involved if tissue was not preserved. The practical message is simple: decide about this deliberately, with a surgeon who knows your full plans, rather than having an orchiectomy in isolation and discovering the implications later. This is one of the things we make sure is discussed up front.
How it changes hormones
Removing the testicles removes the body’s main source of testosterone, so the hormonal picture changes, and your hormone provider will adjust your regimen accordingly. The most common change is reducing or stopping testosterone-blockers, since there is no longer significant testosterone to block, which many people welcome as a simplification. Oestrogen is still needed, because your body now produces very little of its own sex hormones, so ongoing oestrogen therapy continues, sometimes at an adjusted dose.
This is a benefit for many people: fewer medications and, for some, a more stable hormonal state. It also means, however, that oestrogen becomes essential rather than optional, because after an orchiectomy your body relies on it, and stopping hormones entirely would leave you without adequate sex hormones, which has health implications for bones and more. So an orchiectomy is a commitment to ongoing oestrogen therapy. Your hormone provider will guide the specifics, and it is worth coordinating the surgery with them so your regimen is adjusted safely afterwards.
Fertility and permanence
An orchiectomy is permanent and causes sterility, because removing the testicles ends the body’s ability to produce sperm. This is irreversible, so it is essential to consider fertility before the procedure. Anyone who might want biological children in future is usually advised to explore fertility preservation, such as sperm banking, beforehand, since it is not possible afterwards.
This deserves genuine thought rather than being rushed past, even if children do not feel relevant to you now, because feelings can change and the option closes permanently. Many people are entirely settled in not wanting biological children and proceed without preservation, which is a valid choice made with full information. The point is simply that it is a one-way decision on fertility, so it should be a considered one. A good surgeon and hormone provider will raise this with you, and we make sure it is part of the conversation before anything is arranged.
The procedure
A gender-affirming orchiectomy is a relatively short, straightforward operation. It can be done under general anaesthetic or, in some cases, regional or local anaesthetic with sedation, depending on the surgeon and your preference. The surgeon makes a small incision, removes both testicles, and closes the incision. Where the plan is to preserve scrotal skin for a possible future vaginoplasty, the surgeon takes care to do so.
Because it is a minor procedure compared with the larger genital surgeries, it is often done as a day case or with a short stay, and you go home the same day or after a night. It is still real surgery with real preparation and aftercare, but the scale is much smaller than vaginoplasty, which is reflected in the shorter operation, quicker recovery and lower cost. Your surgeon will explain exactly how they perform it and what to expect for your case.
Recovery
Recovery from an orchiectomy is relatively quick, which is one of its practical advantages. This is a general guide; your surgeon’s instructions always come first.
- First few days. Swelling, bruising and soreness in the area, managed with medication and supported by wearing snug underwear as advised. Rest and limited activity are important.
- First one to two weeks. Discomfort settles and many people return to desk work within this window, avoiding heavy lifting and strenuous activity.
- Weeks two to four. Most normal activity resumes as comfort allows, with your surgeon’s guidance on exercise and any restrictions.
- Hormone adjustment. Alongside physical recovery, your hormone provider adjusts your medication now that testosterone production has stopped.
Because it is a smaller operation, the recovery footprint is modest, though everyone heals at their own pace. If you have travelled for it, a shorter stay than the major surgeries is usually needed, and we can confirm a realistic timeline with your surgeon.
Orchiectomy in Thailand
Orchiectomy is offered at our partner hospitals in Thailand, either as a standalone procedure or as part of a wider plan. We are a facilitator, not a hospital: we coordinate the surgery your chosen partner hospital provides, with recovery-suitable accommodation, transfers, interpreting and aftercare, handled by one team that speaks your language, and, importantly, we make sure your longer-term plans, especially around any future vaginoplasty, are discussed with the surgeon up front.
Because it is a smaller procedure, it is one of the more accessible feminizing surgeries in terms of cost and recovery. You can see indicative guide prices on our pricing page, and read our guide to how MTF bottom surgery works if you are weighing orchiectomy against vaginoplasty. Prices and plans are indicative and confirmed only after the surgeon reviews your case.