Bilateral orchidectomy for gender affirmation

Here is a visual and schematic representation of the bilateral orchidectomy for gender affirmation.

Bilateral orchidectomy permanently ends the testicular production of testosterone, often allows anti-androgen treatment to stop, and can on its own be the final genital procedure. Its limits: removing both testicles is irreversible, it causes permanent infertility, and it creates neither a vulva nor a vagina. The other options are to continue feminising hormone therapy, with or without an anti-androgen, not to operate, or to choose a vulvoplasty or vaginoplasty when it fits the plan.

Before bilateral orchidectomy, Dr Manon Belhoste and the anaesthetist give instructions on fasting and hygiene, which must be followed without exception. All medicines, hormone treatments and supplements must be declared. Hormone therapy, anticoagulants and antiplatelet drugs must not be stopped on your own: the medical team decides any adjustments. Stopping smoking and all nicotine is required to reduce the risk of healing problems, and any infection, fever, skin lesion or new health problem must be reported before the procedure. Any sperm banking wanted must be completed before surgery, as earlier feminising hormone therapy may have reduced sperm production and collection is not guaranteed. Any future plan for a vulvoplasty or vaginoplasty must be reported before surgery.

After bilateral orchidectomy, oedema (swelling), bruising, discomfort and tenderness of the scrotum are common in the first few days, and gentle walking is encouraged from the start. Baths and swimming are avoided for 6 weeks. Cycling, motorbike riding and horse riding are stopped for several weeks, and sexual activity waits until healing is complete. Libido, spontaneous erections and the volume of ejaculate may decrease or change. Orgasm can remain possible.

Testicular testosterone production becomes permanently very low. Anti-androgens can often be stopped, and the oestrogen dose sometimes reduced, only on the advice of the doctor who manages hormone therapy. Long-term endocrine follow-up remains necessary, particularly for bone health.

A previous orchidectomy does not prevent a later vaginoplasty or vulvoplasty. Some teams use scrotal skin during vaginoplasty, so the approach preserves these tissues as far as possible.

The price of bilateral orchidectomy includes Dr Manon Belhoste's fees, follow-up consultations after the operation, anaesthesia and clinic fees at Polyclinique La Phocéanne or Clinique Phénicia.