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Bilateral orchidectomy: what changes when both testicles are removed | CION Cancer Clinics
When both testicles are removed, the body stops making almost all of its testosterone and stops making sperm. Without treatment that affects sex drive, erections, energy, muscle, bones and mood, and natural fatherhood ends. After testicular cancer, testosterone is usually replaced. After prostate cancer, it is kept low on purpose. This page explains what changes, the alternatives, and what to ask first. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What happens when both testicles are removed?
- How does life change without testosterone?
- How does it differ for testicular and prostate cancer?
- What should happen before and after the operation?
- Are there alternatives, and who might they suit?
- What do men and families often fear about this operation?
- What do the terms around this operation mean?
- Common questions about bilateral orchidectomy
The short answer
What happens when both testicles are removed?
When both testicles are removed, the body stops making almost all of its testosterone and stops making sperm. Without treatment, that brings changes to energy, sex drive, erections, muscle, bones and mood, and natural fatherhood is no longer possible.
Why it is done
There are two quite different reasons. In testicular cancer, it is needed when both testicles contain cancer, or when cancer appears in the remaining one years later. In advanced prostate cancer, it is done on purpose to lower testosterone, because testosterone feeds that cancer.
The reason changes the plan afterwards
After testicular cancer, most men are offered testosterone replacement, so that the body's normal hormone level is restored. After orchidectomy for prostate cancer, testosterone is kept low deliberately, and replacement is not given, because it would help the cancer grow.
What this page cannot tell you
Whether this operation is right for you, or which alternatives fit your situation, is a decision for you and your treating team. This page explains what changes, so that you can ask the right questions before agreeing.
If you might want children, ask about sperm banking before the operation. Afterwards it is no longer possible.What changes
How does life change without testosterone?
These effects are what low testosterone does. Replacement, where it is allowed, reverses most of them.
Sex drive and erections
Interest in sex usually falls sharply, and erections become weaker or stop. Many couples find it helps to talk about this openly before surgery.
Hot flushes and sweats
Sudden waves of heat and sweating, similar to menopause, are common in the first months. Medicines can ease them if they are troublesome.
Energy, mood and memory
Tiredness, low mood, irritability and poorer concentration are reported. Tell your doctor if your mood drops. It is treatable.
Body shape
Muscle thins, fat builds around the belly, and some men notice breast tenderness or swelling.
What helps
- Regular walking and light weights
- Enough protein in meals
Bones and heart
Over years, bones can thin and become easier to break, and blood sugar and cholesterol may rise. Your team may suggest bone scans and regular checks.
Not sure whether this applies to you?
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How does it differ for testicular and prostate cancer?
Testicular cancer in both
Advanced prostate cancer
Done to remove the cancer itself
Done to lower testosterone that feeds the cancer
Often a younger man, sometimes unmarried
Usually an older man
Testosterone replacement is usually offered
Testosterone is kept low on purpose
Sperm banking is a pressing question
Fertility is less often the main concern
Sometimes part of a testicle can be kept
Hormone injections are an alternative to surgery
Preparing and afterwards
What should happen before and after the operation?
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A full conversation first
Ask why both testicles need removing, whether any alternative exists, and how testosterone will be managed afterwards. Bring your wife or a family member if you want them involved.
-
Sperm banking, if wanted
Samples need to be stored before surgery. If you are unwell or pressed for time, ask the team how quickly this can be arranged.
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Baseline blood tests
Hormone levels, tumour markers, blood sugar and cholesterol give a starting point to compare against later.
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The operation
Usually a short operation. For testicular cancer, each side is removed through a groin cut. For prostate cancer, it is often done through the scrotum, sometimes leaving the outer covering so the scrotum looks fuller.
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Replacement and long-term checks
After testicular cancer, testosterone as a gel or injection is usually started under your doctor's guidance. Levels, bones and heart health are then checked regularly for life.
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Before you agree
Are there alternatives, and who might they suit?
Alternatives exist in some situations, and they are worth asking about. Which one fits depends on the cancer and on what matters most to you.
For testicular cancer in a remaining testicle
When the tumour is small, some specialist centres may consider removing only the tumour and keeping part of the testicle, so some hormone production continues. This partial approach does not suit larger tumours, and often needs radiotherapy to the remaining tissue, which can still affect hormones and fertility. Ask whether you might be suitable.
For prostate cancer
Hormone injections or tablets, such as leuprolide, goserelin or degarelix, lower testosterone without surgery. They can be stopped or changed, but need repeated visits and cost more over time. Surgery is a single step that cannot be reversed. Some men prefer one, some the other.
Who the operation may not suit
A man who strongly wants to keep the choice of reversing hormone treatment, or who is unsure about losing natural fertility, should say so before anything is decided.
Never start, stop or change hormone medicines on your own. Your doctor sets the plan.Commonly believed
What do men and families often fear about this operation?
"He will no longer be a man."
Identity, love and his role in the family do not live in the testicles. With testosterone replacement after testicular cancer, most physical changes are reversed. Counselling helps many men with the feelings this operation brings.
"His voice will change and his beard will fall out."
In an adult man the voice does not rise. Body and facial hair may slowly thin without testosterone, but this is gradual and replacement usually prevents it.
"Testosterone replacement will bring the cancer back."
After testicular cancer, replacement does not feed the cancer and is standard care. After prostate cancer it is different, which is why the reason for surgery matters so much.
"We can hide it and he can still marry and have children."
Natural fatherhood is not possible afterwards. Banked sperm may make children possible with fertility treatment. Honest conversations, supported by a counsellor if you want, usually go better than secrecy.
Words you will meet
What do the terms around this operation mean?
- Bilateral orchidectomy
- Removal of both testicles.
- Subcapsular orchidectomy
- The inside of each testicle is removed but the outer covering stays, used mainly for prostate cancer.
- Testosterone replacement
- Giving the hormone as a gel or injection to restore normal levels.
- Androgen deprivation
- Lowering male hormones on purpose to slow prostate cancer, by surgery or medicine.
- Partial orchidectomy
- Removing only the tumour and keeping some healthy testicle, in selected small tumours.
Questions we are asked
Common questions about bilateral orchidectomy
Can I still have sex after both testicles are removed?
Without testosterone, desire and erections usually fall. With replacement after testicular cancer, many men regain a satisfying sex life. Orgasm is still possible, though there is little or no semen. Erection medicines can help some men. Talk to your doctor openly about it.
Will I need testosterone for the rest of my life?
After testicular cancer, yes, in most cases, because the body cannot make it again. It is given as a gel or injection, and your doctor adjusts the plan using blood tests. After prostate cancer, testosterone is not replaced, because keeping it low is the purpose.
Can I have children after this operation?
Not naturally, because sperm are no longer made. If sperm were banked before surgery, fertility treatment may make a pregnancy possible. If you have not banked sperm and surgery is being planned, ask the team straight away whether there is still time.
Can a prosthesis be placed so the scrotum looks normal?
Testicular implants exist but are not easily available everywhere in India. For prostate cancer, a subcapsular approach keeps some fullness. Ask your surgeon what is possible at your centre before the operation, because it is easier to plan at the same time.
Is surgery or injections better for prostate cancer?
Neither is better for everyone. Both lower testosterone. Surgery is a single step that cannot be undone. Injections need repeated visits, can be paused or changed, and cost more over time. Your team will explain the trade-offs so you can choose what suits you.
How do we protect his bones afterwards?
Regular walking, weight-bearing exercise, enough calcium from food and time outdoors all help. Your doctor may arrange a bone density scan and may suggest medicines to strengthen bones. Do not start supplements on your own without asking.
My father feels ashamed. How can the family help?
Let him talk when he wants to, and do not make it a topic for relatives. Go with him to appointments if he agrees. Many men find it easier to speak with a counsellor or doctor than with family. Ask the team about counselling support.
Is the operation covered by Aarogyasri or insurance?
Cancer surgery is often covered under Aarogyasri, CGHS, ECHS, EHS and many cashless insurance policies, but long-term testosterone or hormone medicines may be covered differently. Call the helpline with your details and we will check your cover.
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Sources
- Cancer Research UK — Testicular cancer
- Macmillan Cancer Support — Testicular cancer
- American Cancer Society — Hormone therapy for prostate cancer
- NHS — Prostate cancer: treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Testosterone After OrchidectomyHow hormone levels are checked and replacedOrchidectomy for Prostate Cancer (Hormone Control)When removal is done to lower testosteroneSperm Banking Before OrchidectomyStoring sperm while it is still possibleTesticular Prosthesis: Is It Available in India?Options for appearance after surgery
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