Orchiectomy as Part of Transition

Orchiectomy is the surgical removal of the testes. In trans women, the procedure is performed to permanently stop the body’s own testosterone production. It can be performed as a standalone procedure or as part of a vaginoplasty.

What the procedure involves

Orchiectomy is the surgical removal of one or both testicles. In trans women, it is performed bilaterally. The procedure ends testosterone production by the testes — an important endogenous source — thereby reducing the need for anti-androgen medication such as cyproterone or spironolactone.

Indications as part of transition

Trans women often choose orchiectomy because:

• Long-term use of anti-androgens can place strain on the cardiovascular system and liver;
• The procedure is relatively minor compared with vaginoplasty;
• It improves hormonal stability — only estrogen needs to be supplemented;
• For those who do not want or cannot undergo vaginoplasty, it still provides an important endocrine change.

Procedure

The procedure takes approximately 30–60 minutes and can be performed under general or regional anesthesia. Incisions may be made in the scrotum or groin. Recovery generally takes one to two weeks, with restrictions on physical activity. Complications are relatively limited: hematoma, infection, and, in rare cases, chronic pain.

Hormonal effects

Without testicles, the body no longer produces significant amounts of testosterone. Estrogen supplementation becomes necessary for life, not only for feminization but also for bone health. Stopping estrogen after orchiectomy leads to rapid loss of bone density, hot flashes, and other symptoms of hypogonadism.

Irreversibility

Complete and permanent. Sperm production ends; fertility is lost unless sperm has been frozen beforehand. Anyone who detransitions after orchiectomy can receive testosterone externally but will never regain natural testicular function. Information about the long-term implications of the procedure is available at transkompas.nl; transitieschade.nl discusses lifelong dependence on hormones.

Relationship to vaginoplasty

Vaginoplasty generally includes orchiectomy as part of the procedure. Orchiectomy without vaginoplasty is a separate choice: the person opts for the hormonal effects without undergoing complete genital reconstruction. For those who may still want vaginoplasty later, having had an orchiectomy beforehand is not a contraindication.

Fertility and informed consent

Before orchiectomy, sperm cryopreservation must be explicitly discussed and offered. Not all Dutch clinics do this consistently; cases in which patients only later realize that sperm could have been preserved have been documented. For minors of reproductive age, this conversation is particularly urgent.

Reimbursement

In cases of diagnosed gender dysphoria, orchiectomy is covered in the Netherlands through the basic health insurance scheme. Requirements include a statement from treating professionals, and potentially a waiting period and intake assessment. When orchiectomy is chosen without a prior gender diagnosis — for example, because of anti-androgen side effects — reimbursement is less certain.

Effects on hormone treatment

After orchiectomy, anti-androgen medication, such as cyproterone acetate or spironolactone, is generally no longer needed. The estrogen dose can often be reduced. Ongoing hormone replacement remains necessary to support bone health and overall health.

Decision and consequences

The procedure is irreversible. Fertility is permanently lost, which is why sperm preservation is often discussed beforehand. The scrotum can remain intact and may potentially be used later for vaginoplasty.

Risks

General surgical risks apply: postoperative bleeding, infection, and complications from anesthesia. The procedure is relatively minor, and the recovery period is usually short. However, long-term effects on bone density are important if hormone replacement is discontinued.