Orchiectomies at UCSF are performed by Dr. James F. Smith, MD, MS.  Orchiectomy (testicle removal) is an outpatient (no hospital overnight stay required), low-risk procedure typically done under general anesthesia in the UCSF operating rooms. Dr. Smith typically makes a small incision in the scrotum along the median raphe (line in the midline of the scrotum), an approach that does not affect future bottom surgery choices. It is common to see a small of amount of bruising and swelling and experience mild discomfort. Rare risks include skin infection and a large bruise (hematoma).  The recovery process is brief, and most patients are able to resume work and most daily activities within a few days.

In preparation for surgery, it is strongly recommended that you work with your hormone prescribing provider to achieve testosterone levels in the female range.  Because your testosterone level will be in or below the female range after orchiectomy, it is important that you experience what this will feel like in advance.  Mild testosterone replacement is an option for those who experience symptoms of low testosterone after orchiectomy; discuss this with your hormone prescriber or schedule a hormone therapy consultation at UCSF.  If your testosterone level is not suppressed into the female range before surgery, you may experience a sudden drop in testosterone level after orchiectomy, which can cause side effects such as mood swings or low energy.


At UCSF, we want you to have the best possible result from your surgery with the greatest satisfaction. UCSF criteria for surgery are based on the World Professional Association for Transgender Health SOC (Standards of Care) 7th Edition, and are required by most insurance companies. Prior to scheduling your initial consultation, please send the following:

  • Your insurance card and identification

  • A completed UCSF Gender Affirming Health Program Surgery Patient Packet
  • Medical Clearance Letter from your medical provider indicating that you are medically cleared and prepared for surgery, and capable of providing consent for surgery. In some cases, you may be asked to have a medical consultation at UCSF prior to scheduling your consult with the surgeon.  The letter should follow this format.
  • Documentation by your medical provider of current and consistent feminizing hormone therapy for a minimum of 12 months. It is strongly recommended that your testosterone levels are verified in the female range prior to surgery, to avoid the effects of a rapid drop in testosterone levels after surgery, and also to insure you are familiar with what it feels like to have low testosterone levels
  • Undergo a behavioral health assessment and obtain referral documentation in line with WPATH guidelines. More detail on this process and the requirements can be found here.

Referral letters and documentation should be faxed or e-mailed to:

UCSF Gender Affirming Health Program
415-353-3399 fax
[email protected]

Please include your legal name, chosen name (if different), and date of birth with all communication.