A bilateral orchiectomy (orchi) is a surgery that removes both testes.
Your surgeon will answer your questions about surgery and provide you more information about the risks associated with orchiectomy during your consultation.
How do I prepare for an orchiectomy while I am waiting for a consultation?
While you wait for your consultation, there are several things you might need to do to prepare for an orchiectomy.
Estrogen
We recommend that patients start estrogen for gender-affirming hormone therapy if appropriate to their gender goals. Some insurance providers may encourage patients to take estrogen for 12 continuous months before an orchiectomy.
If you are not certain that you want to take estrogen for gender-affirming hormone therapy, and would prefer to maintain your testosterone levels after an orchiectomy or explore other options, you should speak with your endocrinologist about the options available to you.
Nicotine cessation
We require you to abstain from nicotine consumption, including tobacco and e-nicotine products, for at least 6 weeks prior to surgery and 6 weeks after surgery. This is because nicotine constricts the blood vessels and decreases blood flow to body tissues. Nicotine users may have a higher risk of complications, including delayed healing of wounds and skin graft failure.
Some patients may choose to work with their primary care provider and the Koop Tobacco Treatment Center at Dartmouth Hitchcock Medical Center to receive support in quitting nicotine products to help them prepare for surgery.
Diabetes management
For individuals who are diabetic or are at-risk for diabetes, it is important to have A1C levels checked and confirmed before you have surgery. We ask that you have an A1C of 7% or lower prior to surgery. Having uncontrolled blood glucose levels can lead to higher rates of infection and there are risks associated with poor healing of the surgical site.
Body mass index (BMI)
We recognize that bodies come in all sorts of shapes and sizes and that weight is not the ultimate deciding factor for overall health. Generally speaking, a BMI of 35 or less is desirable for optimal surgical recovery. Having a BMI above 35 can lead to higher rates of complications, specifically with regard to blood clotting and tissue healing.
Some patients may choose to work with their primary care provider and the Weight and Wellness Program to address weight and related conditions to help them prepare for surgery. However, each person is unique and BMI is not always a reliable indicator of overall health.
WPATH letters of surgical readiness
Many insurance providers will require you to provide 2 letters from mental health providers as per the World Professional Association for Transgender Health’s (WPATH's) seventh edition of their Standards of Care guidelines.
- They may want one of the letters to come from a provider who you have an established and ongoing relationship with. This provider is usually a therapist or psychiatrist who you have regular appointments with.
- A second letter is often required from a provider who has screened you for your eligibility for surgery, but that you do not continue to see on a regular basis.
It is important for you to contact your insurance provider to confirm what their requirements are for covering gender-affirming genital surgery.