Orchidectomy Without Vaginoplasty at WIH International Hospital

At WIH International Hospital in Bangkok, led by Dr. Chettasak (Dr. Chet’s NPI), we provide comprehensive gender-affirming surgical options tailored to individual needs. While many transgender women choose full gender-affirming surgery (GAS) with vaginoplasty, others prefer orchidectomy without vaginoplasty.

This procedure is recognized by the WPATH Standards of Care (SOC-8) as a valid form of gender-affirming surgical treatment. For some patients, orchidectomy is the final step of gender affirmation; for others, it is an interim stage before future vaginoplasty.

Why Patients Choose Orchidectomy Without Vaginoplasty

Patients usually fall into three main groups depending on their long-term surgical goals:

Those planning vaginoplasty soon

o These patients already intend to undergo full gender-affirming surgery in the near future.
o They request orchidectomy earlier to avoid or reduce the use of androgen blockers, which may cause side effects such as liver inflammation or cardiovascular risks.
o By removing the testicles, testosterone levels drop significantly (around 95%reduction), eliminating the need for long-term anti-androgen medication.

Those without a clear timeline, but still expecting GAS in the future

o Some patients are younger or undecided about the timing of vaginoplasty.
o They undergo orchidectomy first to relieve dysphoria or simplify hormone therapy.
o However, if vaginoplasty is delayed for more than 1–2 years, the scrotal skin may shrink, limiting the option of skin-graft vaginoplasty and potentially requiring more complex procedures such as colon vaginoplasty or peritoneal vaginoplasty (PPV).

Those who do not plan further genital surgery

o Some transgender women are comfortable retaining their penis but want to permanently remove the testicles.
o For this group, orchidectomy alone provides lasting relief from gender dysphoria and is considered their final step of gender affirmation, consistent with WPATH SOC-8 guidelines.

Why Patients Choose Orchidectomy Without Vaginoplasty

Patients usually fall into three main groups depending on their long-term surgical goals:

Those planning vaginoplasty soon

o These patients already intend to undergo full gender-affirming surgery in the near future.
o They request orchidectomy earlier to avoid or reduce the use of androgen blockers, which may cause side effects such as liver inflammation or cardiovascular risks.
o By removing the testicles, testosterone levels drop significantly (around 95%reduction), eliminating the need for long-term anti-androgen medication.

Those without a clear timeline, but still expecting GAS in the future

o Some patients are younger or undecided about the timing of vaginoplasty.
o They undergo orchidectomy first to relieve dysphoria or simplify hormone therapy.
o However, if vaginoplasty is delayed for more than 1–2 years, the scrotal skin may shrink, limiting the option of skin-graft vaginoplasty and potentially requiring more complex procedures such as colon vaginoplasty or peritoneal vaginoplasty (PPV).

Those who do not plan further genital surgery

o Some transgender women are comfortable retaining their penis but want to permanently remove the testicles.
o For this group, orchidectomy alone provides lasting relief from gender dysphoria and is considered their final step of gender affirmation, consistent with WPATH SOC-8 guidelines.

Why Patients Choose Orchidectomy Without Vaginoplasty

Patients usually fall into three main groups depending on their long-term surgical goals:

Those planning vaginoplasty soon

o These patients already intend to undergo full gender-affirming surgery in the near future.
o They request orchidectomy earlier to avoid or reduce the use of androgen blockers, which may cause side effects such as liver inflammation or cardiovascular risks.
o By removing the testicles, testosterone levels drop significantly (around 95%reduction), eliminating the need for long-term anti-androgen medication.

Those without a clear timeline, but still expecting GAS in the future

o Some patients are younger or undecided about the timing of vaginoplasty.
o They undergo orchidectomy first to relieve dysphoria or simplify hormone therapy.
o However, if vaginoplasty is delayed for more than 1–2 years, the scrotal skin may shrink, limiting the option of skin-graft vaginoplasty and potentially requiring more complex procedures such as colon vaginoplasty or peritoneal vaginoplasty (PPV).

Those who do not plan further genital surgery

o Some transgender women are comfortable retaining their penis but want to permanently remove the testicles.
o For this group, orchidectomy alone provides lasting relief from gender dysphoria and is considered their final step of gender affirmation, consistent with WPATH SOC-8 guidelines.

Important Considerations

Irreversible procedure:

Once performed, orchidectomy cannot be reversed.

Permanent loss of fertility

Patients will no longer be able to produce sperm or have biological children unless sperm is cryopreserved before surgery.

Scrotal skin shrinkage risk

If orchidectomy is done long before vaginoplasty (over 1–2 years), the scrotal skin may shrink and thin. This can make skin-graft vaginoplastyimpossible, requiring more complex surgical options.

Detailed Surgical Procedure

At WIH International Hospital, orchidectomy is performed with meticulous technique to ensure both safety and the preservation of future surgical options:

Anesthesia:

The procedure is performed under either general anesthesia or twilight sedation (intravenous sedation with local anesthesia), managed by our anesthesiology team for maximum safety, comfort, and smooth recovery.

Incision:

The preferred incision is made at the midline of the scrotum, providing excellent exposure, minimal visible scarring, and optimal preservation of surrounding tissues.

Removal of testicle and spermatic cord:

spermatic cord, and the stump is ligated as close as possible to the external inguinal ring to prevent residual androgen activity.

Spermatic cord contents:

The cord contains the vas deferens, the testicular vessels (artery and pampiniform plexus of veins), and nerves. Careful dissection is performed to avoid injury to surrounding structures.

Concurrent pathology removal:

If abnormalities such as varicocele (dilated veins) or lipoma of the cord are found, these can be safely removed during the same surgery.

Pain prevention:

A cautery cut is routinely used when dividing the cord, reducing the risk of neuropathic pain caused by neuroma formation.

Scrotal skin preservation:

In every case, the scrotal skin is preserved carefully for potential future use in gender-affirming surgery, such as skin-graft vaginoplasty.

Post-operative care:

A pressure dressing is applied to the scrotal area immediately after surgery. This helps minimize bleeding and prevents prolonged swelling, ensuring smoother recovery.

Orchidectomy vs. Historical Castration

Modern orchidectomyis a safe, ethical, and medically supervised procedure recognized by WPATH as gender-affirming care. In contrast, historical castration of eunuchs in ancient China involved the removal of both penis and testicles without anesthesia, often leading to extreme pain, urinary complications, and lifelong hormonal consequences.

While eunuchs endured social isolation and regret, today’s orchidectomy provides relief from gender dysphoria, improved health, and enhanced quality of life. The key difference lies in purpose, safety, and patient consent, reflecting how far medicine and human rights have advanced.

👉 Learn more in our WIH Educational Blog on Historical Castration.

Conclusion

Orchidectomy without vaginoplasty is a safe and recognized gender-affirming surgical option. For many, it is the final step of gender affirmation, while for others, it serves as an interim stage before full GAS.

At WIH International Hospital, under the expertise of Dr. Chettasak, all procedures follow WPATH SOC-8 guidelines to ensure safe, ethical, and affirming care for every patient.

Why Choose WIH International Hospital

  • Chettasak Tulayaphanich — 30+ years of expertise in MTF gender-affirming surgery
  • World-renowned NPI technique ensuring natural aesthetics and preserved sensation
  • State-of-the-art facilities and comprehensive post-operative care
  • Personalized consultations tailored to each patient’s needs

At WIH, we believe that gender-affirming surgery is about more than just physical transformation — it’s about aligning your body with your identity, so you can live confidently as your authentic self.

WIH Hospital

Book your consultation

Ready to learn more, or need support with your dilation routine? Contact Dr. Chettasak’s team at WIH International Hospital.

WhatsApp: +66 95 650 3892
info@wihhospital.com