Gender-affirming orchiectomy in transgender and non-binary individuals: A large cohort study with middle- to long-term follow-up

Introduction: Some transgender individuals opt for gender-affirming orchiectomy. Data on postoperative outcomes in the transgender population are scarce. Methods: All individuals who underwent gender-affirming orchiectomy between 01-2010 and 01-2024 were retrospectively identified at two centers that provide surgical transgender care. Individual demographics, motivations, intra- and postoperative complications, reoperations and postoperative regret were recorded. Surgical risk factors were identified using logistic regression analysis. Results: A total of 119 individuals were retrospectively identified with a median clinical follow-up of 2.3 years (range 0.3–9.4). A total of 109 identified as transgender woman, eight as non-binary and two as agender. 18 (15%) individuals opted for sperm cryopreservation before surgery. The postoperative course was without complications in 102 (86%) individuals. Complications comprised hemorrhage (n = 5, 4%, Clavien-Dindo 3b) and abscess formation (n = 7, 6%, Clavien-Dindo 2), (n = 1), 3a (n = 3) and 3b (n = 3))). In the follow-up time, seven individuals underwent vaginoplasty, two vulvoplasty and two were on the waiting list for vaginoplasty. There were no cases of regret. A BMI >35 was identified as risk factor for infectious complications (p =.045, OR 9.8, 95% CI 1.0–99.3). Discussion: Gender-affirming orchiectomy is a simple and safe procedure. It can be performed as standalone gender-affirming surgical procedure, or as bridge to another gender-affirming procedure.