Orchiectomy

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Orchiectomy, or orchidectomy is the term for the surgical procedure to remove one or more of the testes in a biological male. This causes sterilization (unable to reproduce) and greatly reduces the production of testosterone.

Its more popular term, "castration", should not be confused with penectomy, which is the whole or partial removal of the penis, nor with vasectomy, which is a procedure to sterilize a male by removal of part of the vasa deferentia, the tubes which connect the testicles to the prostate.

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Indications

The primary reason for an orchiectomy is as a treatment for testicular cancer. If only one testicle is found to be cancerous then only that one is removed. The reason for complete (radical) removal, in the cases of cancer treatment, is that testicular cancers frequently spread from the spermatic cord into the lymph nodes near the kidneys. Some patients elect to have a prosthetic testicle inserted into their scrotum afterwards. Even if both testicles are removed, male sexual function can be restored and maintained through the use of testosterone injections or patches.

Some trans women and some anatomic males with non-binary gender identity undergo orchiectomy as part of medical transition. Orchiectomy can be done before or in place of sex reassignment surgery for people who either can't afford complete genital reassignment, or chose to not have it. Those who are planning reassignment surgery in the future, should consult with the chosen surgeon before proceeding with orchiectomy, as some will prefer their patients have not had prior orchiectomy. Marci Bowers claims the financial point where orchiectomy breaks even compared to anti-androgen drugs to be approximately three years.

It is often indicated when antiandrogenic drugs such as spironolactone or cyproterone acetate cause unwanted or even dangerous side effects (such as kidney damage in the case of spironolactone or liver damage in the case of cyproterone acetate). Because estrogen can interact with clotting disorders causing DVTs, the dosage of estrogen required after an orchiectomy can be lowered to what a cisgender woman would be given to relieve symptoms of menopause if breast development is to the person's satisfaction.

Rarely some men seek this procedure in order to remove what they consider uncomfortable, uncontrollable or dysfunctional sexual urges. Others may seek it in order to fulfill a fetish or fantasy. The most common reason for control of sexuality is as part of rehabilitation for sex offenders.

The Procedure

This procedure cannot and should not be done outside of a doctor's care. Those who have done self-cutting of this extreme nature have generally regretted the outcomes or have had a difficult SRS due to scar tissue. Choosing to have this done by non-medically trained persons can also result in major health problems due to blood loss, excessive scar tissue formation or life threatening infections.

Typically done under local anesthesia, the scrotum is cut along the raphe (center line) to minimize the appearance of scars. The layers of muscle and fasciae are incised and the testis is extracted. The spermatic cord is tied off with two triple square knots using non-dissolving sutures and cut with an electrosurgical device. Operating time is generally 30 minutes in an outpatient setting with a checkup the next morning.

Alternatively, the inguinal (groin area) may be used to access the spermatic cords from a higher location that is possible from simple traction or to avoid scarring on the scrotum which may interfere with future reassignment surgery. A 6 cm incision is made above the pubic bone on the side corresponding to the testicle to be removed. The testicle is then pulled up through the inguinal canal, the spermatic cord is clamped off in two places and cut with an electrosurgical device. Operating time ranges from 30 minuets to a maximum of 90 minuets depending on choice of anesthesia used.

After the cord and testicle have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged. The procedure is usually finished in less than an hour, an hour to an hour and a half for a bilateral procedure.

Recovery time is typically a week or less with complete recovery in two weeks. Light activity may be resumed in about 3 to 4 days after the procedure. Common complications include bruising on or around the scrotum, spotting of blood, and localized pain, usually lasting only several days. Sexual activity may resume after two weeks or as indicated by the physician who performed the procedure.

Medical consequences

A subject of castration who is altered before the onset of puberty will retain a high voice, non-muscular build, and small genitals. They may well be taller than average, as the production of sex hormones in puberty—particularly estrogen, derived from testosterone via aromatization—stops long bone growth. The person may not develop pubic hair and will have a small sex drive or none at all. Castrations after the onset of puberty will typically reduce the sex drive considerably or eliminate it altogether. Also castrated people are automatically sterile, because the testes (for males) and ovaries (for females) produce sex cells needed for sexual reproduction. Once removed the subject is infertile. The voice does not change. Some castrates report mood changes, such as depression or a more serene outlook on life. Body strength and muscle mass can decrease somewhat. Body hair sometimes may decrease. Castration prevents male pattern baldness if it is done before hair is lost; however, castration will not restore hair growth after hair has already been lost due to male pattern baldness.[1] Castration eliminates the risk of testicular cancer.

Historically, eunuchs who additionally underwent a penectomy reportedly suffered from urinary incontinence associated with the removal of the penis, and they had their own specialist doctors.[2]

Without Hormone Replacement Therapy (HRT), typical symptoms (similar to those experienced by menopausal women) include hot flashes; gradual bone-density loss, resulting in osteopenia or osteoporosis; potential weight gain or redistribution of body fat to the hips/chest. Replacement of testosterone in the form of gel, patches, or injections can largely reverse these effects, although breast enlargement has also been reported as a possible side effect of testosterone usage.[3]

See also

References

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*Some information provided in whole or in part by http://en.wikipedia.org/

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