Bilateral orchidectomy is performed either as a standalone procedure or as part of staged gender-affirming surgery (GAS) in gender-diverse individuals (1). Evidence on postoperative sexual function in this population remains limited. We hypothesised that male-to-female transgender individuals undergoing androgen deprivation may retain satisfactory erectile function—contrary to common assumptions and in contrast to outcomes seen in prostate cancer patients, where erectile dysfunction is typically profound. This study aimed to compare sexual function before and after gender-affirming bilateral orchidectomy.

This prospective study included 23 consecutive gender-diverse patients undergoing gender-affirming bilateral orchidectomy at a single centre. Preoperative data included demographics, gender identity, gender affirming hormone therapy (GAHT) duration and type, perceived importance of sexual function, motivation for surgery, and International Index of Erectile Function (IIEF) scores. Patients were reassessed at 3 months postoperatively with repeat IIEF scoring.

Twenty-three patients were enrolled; one was lost to follow-up. Most participants identified as “she/her,” with one identifying as “they/them.” Around 55% were aged 30–40 years. All patients had received GAHT for ≥1 year, with 59% treated for >2 years. Therapies included oestrogen (100%, n=22), GnRH agonists (45.5%, n=10), progesterone (31.8%, n=7), finasteride (13.6%, n=3), cyproterone acetate (9.1%, n=2), and spironolactone (4.5%, n=1). Median preoperative IIEF score was 52 (range 10–70), unchanged postoperatively at 52 (range 19–74). Subjectively, 63.6% reported no change, 31.8% reported improved sexual function, and one patient did not respond. Overall patient satisfaction rate after receiving gender reaffirming bilateral orchidectomy was 90.9%.

Despite prolonged GAHT, erectile function was largely preserved, challenging the assumption that androgen deprivation results in universal erectile dysfunction. No measurable decline in sexual function was observed following orchidectomy as evidenced in Figure 1. While IIEF was used due to a lack of validated tools for gender-diverse populations, its relevance is limited, as erectile function may contribute to gender dysphoria. Findings should therefore be interpreted cautiously. Notably, 31.8% of patients were taking progesterone despite lack of recommendation in World Professional Association for Transgender Health Standards of Care Version 8 (2).

Male-to-female transgender individuals may retain satisfactory erectile function despite prolonged GAHT. Additionally, gender-affirming bilateral orchidectomy does not appear to adversely affect sexual function in this population. There is a clear need for validated, population-specific sexual function measures and for evidence-based guidance on adjunctive therapies such as progesterone.

Victor R, Yuan N, Lee G, Garcia M. Medical, Gender Dysphoria, and Quality-of-Life Benefits of Pre-Vaginoplasty Bilateral Orchiectomy. J Sex Med. 2022;19(4, Supplement 1):S77–8. doi:https://doi.org/10.1016/j.jsxm.2022.01.413
Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022;23(S1):S1–259. doi:10.1080/26895269.2022.2100644

Continence 19S (2026) 102781
DOI: 10.1016/j.cont.2026.102781