Orchiectomy

Orchiectomy

The purpose of orchiectomy in gender affirmation surgery is to decrease the amount of testosterone level so that the use of androgen antagonists is no longer required. Moreover, this procedure could also reduce estrogen use. Some patients undergo orchiectomy to aid genital tucking. In terms of cancer prevention, orchiectomy is found to help prevent testicular, prostate, and male breast cancer. However, side effects of orchiectomy include erectile dysfunction, reduced sexual arousal, and permanent loss of fertility. Furthermore, patients who undergo orchiectomy before vaginoplasty may have a significant retraction of the scrotal skin. If they undergo gender affirmation surgery later, the surgical procedure would be more difficult. In those cases, alternative options for neovaginal lining, such as the colon or peritoneal tissue, may be required.

Orchiectomy should be deferred in transgender women who plan to undergo male-to-female GAS in the future. Instead, they should suppress androgen production with androgen antagonists under the care of an endocrinologist. However, patients who definitively do not want male-to-female GAS and still require high doses of estrogen may confer with their physician for an orchiectomy to reduce the probability of future complications that arise from long-term estrogen usage.

Male-to-female GAS orchiectomy

1. 1. Must have a diagnosis of gender dysphoria, certified by two psychiatrists.
2. 2. Aged 20 (Patients aged over 18 but less than 20 must also provide parental consent).
3. 3. Must have sufficient understanding of the surgery and competence to sign the consent.
4. 4. No comorbid conditions preventing surgery or anesthesia.
5. 5. Individuals with a concomitant psychiatric disorder must be treated until the symptoms are well controlled prior to surgical intervention.
6. 6. Must have taken feminizing hormone therapy for at least 12 months (unless there are contraindications that prevent individuals from using hormonal therapy)

Refer: Gender Affirmation Surgery - The Thai Handbook of Transgender Healthcare Services, Center of Excellence in Transgender Health, Chulalongkorn University