What it is

Orchiectomy is surgical removal of one or both testicles. In gender medicine it is performed on trans-identified males ("trans women") as a standalone procedure or as a step toward vaginoplasty. The word the user may be reaching for is sometimes spelled "gonadectomy" — but the specific term for testicle removal is orchiectomy, and that is what this page covers.

Orchiectomy is the simplest of the genital gender-affirming surgeries. Mean operating time in the largest cohort study was 15 minutes. It is done under local or general anaesthesia, usually as day surgery. It is also performed for entirely non-gender reasons — testicular cancer, torsion, trauma — which is why a body of surgical outcome data exists independent of gender medicine.

Why trans-identified people get it

The motivations recorded in the research divide roughly as follows (from van der Sluis et al. 2025, n=119):

• Standalone procedure — 29% did not want vaginoplasty or vulvoplasty at all, citing absence of genital dysphoria about the penis. They wanted the testicles gone and nothing else changed.
• Bridge to future vaginoplasty — 39% saw it as a preceding step to possible later surgery.
• Unable to access vaginoplasty — 16% actually wanted vaginoplasty or vulvoplasty but did not meet institutional BMI (body mass index) requirements. In this group, orchiectomy was a substitute forced by a barrier, not a first choice.
• To stop anti-androgens — a common practical reason: spironolactone has side effects, and removing the testicles eliminates the need for it.

Only 15% (18/119) banked sperm before surgery.

What the research shows

Complications

The surgical complication profile is genuinely low. This is a simple, well-tolerated operation. The harder questions are not about wound healing.

Regret

Zero regret in a 119-person retrospective chart review is a real finding, but it is not the same as zero regret existing. It means no one told their surgeon. The study's own limitations section acknowledges this.

Detrans perspectives

Detransitioners who had orchiectomy describe consequences that the surgical literature does not measure: loss of sexual function, hormonal dependence, and the psychological weight of permanent castration.

I had an orchi 20 years ago for one reason: I was tired of cumming and being a slave to arousal, masturbation, and morning erections. What you will see is continuing decline in fluid, penis size, and ability to get or maintain an erection to where maybe every few months there will be enough fluid to have a small orgasm... ADVICE TO ALL: Orchi is the end of having any reliable erection, penetration maybe have some for 1-2 more years. Don't get one unless you are ready to never have intercourse or masturbation again.

—Mindless_Low_1047, detrans male

Penis loses length, girth, sensation, and reliability. This was made even worse by quitting estrogen. This was improved by starting testosterone. Penis also becomes more easily caught in clothes and thighs, due to lack of support from the missing parts, which makes sitting painful or awkward. My doctor promised me nothing would be different, and nearly everything was. My doctor lied and put their activism before my health and happiness.

—joliphotia, detrans male

Happiness isn't about how you look... I regret my orchiectomy. I still take e since I need to take some kind of hormone for my bones. Was castration worth smooth skin and some boobs? No definitely not. Do I like the aesthetic effects of estrogen? Sure... Does it make me happy? No honestly I don't really think about it. If anything all I've done is made it harder than before to live a normal life as a well socialized adult.

—ICircumventPermabans, questioning own gender transition

Any problems with anti androgens can be solved with an orchiectomy! It's true you won't have to take antiandrogens again, but then you're in a worse situation. Having gonads helps regulate your hormones properly, let alone fertility or sexual function. I just don't feel normal anymore, and I wish I could take it back...

—10231570600, detrans male

Yeah. People always say they would spend their life wondering what if. I experienced it and now I'm thinking what if I didn't have my balls chopped off and spend 4 years being extremely sensitive to criticism and having no energy. But at least I tried I guess. Sucks either way.

—nansnssvqgakdbdh, detrans male

Some detransitioners frame it in terms of what the surgery does to a person's future before they have had time to live it:

You wont be able to have kids. Your body is never going to work right again. Completely change how you see sex. You're more prone to medical issues and you'll be dependent on hormones for the rest of your life. You will never be the same again.

—jackolantern717, detrans female

Keep in mind that the removal of your testicles will almost eliminate your libido, so if this is AT ALL sex-motivated, think very hard about whether you'll still want this after the sexual/fetishistic appeal goes away.

—detransdyke, detrans female

And some offer practical hope to those who have already had it:

Scrotoplasty and testosterone therapy are available for trans men so they're available for you too. You'll be able to restore your genitals to near their previous appearance and get your testosterone back in time if that's what you choose. It sucks but you just made an error in medical treatment, it happens to lots of people for all kind of procedures, it's not shameful or a reflection on you as a person.

—cherrytea0, detrans male

One detransitioner reports a positive outcome, which is worth including for balance:

If you're more of a bottom I can tell you gay guys don't really care. I had an orchiectomy and I'm in a loving long term relationship. Real relationships (not sexual encounters) have more to do with having a good personality not what is between your legs.

—MilwaukeeMaker, detrans male

Trans perspectives

Trans-identified people who are satisfied with orchiectomy describe it in strongly positive terms, and their reasons are often practical:

Getting an orchi and scrotectomy didn't affect my levels one bit and pretty much made my dysphoria go away. Second-best decision i ever made in my entire life (the best was starting HRT). Penis still works as before, can get erect with a bit of outside help, pretty much no visible scar. 10/10, would recommend.

—Stinkehund1, mtf

Have an orchidectomy. Getting rid of those horrible twins of evil makes such a difference, clothes fit better, you can cross your legs and walk more comfortably, you no longer need anti androgens, feminisation will accelerate, and you retain your penis if that is important to you.

—Jo-Wolfe, mtf

Nah. I like my ding dong. I'd absolutely remove my balls. I'd have them taken away yesterday if I could. But I don't have complete dysphoria of what lives downstairs. But I couldn't imagine getting SRS and not having complete dysphoria of your genitals. It's an expensive operation that is irreversible. You don't go into it without fully knowing and accepting the outcome.

—CT0292, MTF

Note that even within the trans community, people flag the same irreversible consequences the detransitioners do — permanent sterility, lifelong hormone dependence, and the need to plan scrotal skin preservation if vaginoplasty (often called SRS, for sex reassignment surgery) might be wanted later:

It's a good idea to tell the surgeon if you might want other surgeries later, so they can preserve the scrotal skin. It will make you permanently sterile. Plus, your body needs testosterone or estrogen, so if you do it you're going to need to either start transitioning or take testosterone.

—AmyNotAmiable, MTF

Post-orchi your scrotum may reduce in size. I was told this could be a potential problem for SRS as the scrotal skin needs to be used and having an orchi can both damage the tissue and reduce the elasticity... it's an anticipated problem and one that an SRS surgeon will warn about.

—SovietSeaMammal, MTF

What to think about before deciding

• It is permanent. Testicles do not grow back. Fertility is lost. The surgical literature records low complication rates and low regret — but the regret data comes from retrospective chart reviews of people who stayed in contact with their surgeons.
• You will need exogenous (prescribed) hormones for life. Without testosterone or estrogen, you develop the consequences of having no sex hormone: bone density loss, fatigue, and other effects. This is not optional maintenance; it is a medical requirement.
• Sexual function changes. Detransitioners report loss of erectile reliability, reduced ejaculate, penile atrophy, and reduced sensation. The degree varies, and the surgical literature does not systematically measure long-term sexual outcomes with validated instruments.
• Libido will drop sharply. If part of the motivation is sexual — arousal patterns, fetish, or a desire to stop being driven by libido — ask whether you would still want the surgery once that drive is gone. The surgery removes the drive itself.
• Scrotal skin matters for future surgery. If there is any chance you might want vaginoplasty later, tell the surgeon to preserve scrotal tissue. Post-orchi scrotal shrinkage can complicate penile-inversion techniques.
• Bank sperm if there is any doubt about future fatherhood. Only 15% of the van der Sluis cohort did. Sperm banking before surgery is cheap relative to the permanence of the alternative.
• Why now? If you are scheduled and posting on a detrans forum asking to be talked out of it, that is information. Surgery can wait. A few months or years of delay costs nothing; reversal is not available.

Related pages

• Hysterectomy: Methods, Outcomes, and Detrans Perspectives — the female counterpart procedure
• Vaginoplasty (Male Bottom Surgery)
• Estrogen & Testosterone Blockers in Males
• Detransition: Meaning, Reasons, and Life Afterward
• Study archive · Support directory

References

• van der Sluis, Smit, Schäfer & Bouman (2025). Gender-affirming orchiectomy in transgender and non-binary individuals: A large cohort study with middle- to long-term follow-up. International Journal of Transgender Health 26(2):459–463. source.
• van der Sluis, Steensma & Bouman (2020). Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes. Int J Transgend Health 21(2):176–181. source.
• Saltman et al. (2023). Outcomes of Orchiectomy for Gender-affirming Surgery: A National Surgical Quality Improvement Program Study. Urology 180:98–104. source.
• Endocrine, gender dysphoria, and sexual function benefits of gender-affirming bilateral orchiectomy: patient outcomes and surgical technique (2024). Sexual Medicine 12(4):qfae048. source.
• Zoltin et al. (2025). Orchiectomy and scrotectomy as genital gender-affirming surgery: novel surgical technique and patient-reported outcomes. BMC Urology 25:217. source.
• Bustos et al. (2021). Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plastic and Reconstructive Surgery. PMC8099405.
• Guiding the conversation—types of regret after gender-affirming surgery and their associated etiologies (2021). PMC8105823.
• Cohn, J. (2023). The Detransition Rate Is Unknown. Archives of Sexual Behavior. study page, source.