Orchiectomy

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.

All patients seeking orchiectomy are required to provide a letter from a licensed mental health provider in referral for surgery.  Due to insurance requirements, in many cases two licensed mental health provider referral letters are required for authorization of coverage for the procedure.  The letters should be sent to us prior to your initial consult with the surgeon.  

The letter should document:​

  • Your identifying characteristics
  • The purpose of the referral is for an orchiectomy
  • Their psychosocial assessment of you, including diagnoses
  • Current social support and plan for support and assistance during recovery from surgery
  • Persistent, well-documented gender dysphoria
  • Capacity to make a fully informed decision and to consent for treatment
  • Age of consent (18) or meeting the WPATH SOC 7th Edition criteria for adolescents
  • Any significant medical or mental health concerns are reasonably well-controlled.
  • Documentation of at least one year of current and consistent estrogen hormone therapy
  • Duration of their relationship with you, including the type of evaluation, counseling, and therapy provided to date.
  • An explanation that criteria for surgery are met, and the clinical rationale for supporting your request for surgery.
  • A statement that you have given informed consent for orchiectomy surgery. The consent process should include an exploration of the goals of surgery, level setting of expectations for the impacts and outcomes of surgery, level of preparation to handle complications, and discussion of alternatives.
  • A statement that your mental health provider is available to contact for care coordination, including their telephone number or email.