Does orchiectomy (removal of a testicle) affect testosterone levels?

Impact of Orchiectomy on Testosterone Levels

Unilateral orchiectomy (removal of one testicle) generally does not significantly affect serum testosterone levels in most men, as the remaining testicle can compensate through increased production. 1

Effects of Unilateral Orchiectomy on Hormone Levels

• In patients with normal human chorionic gonadotropin (hCG) levels, unilateral orchiectomy may lead to increased follicle-stimulating hormone (FSH) and decreased inhibin B levels, while serum testosterone typically remains within normal range 1

• The body maintains testosterone homeostasis through compensatory mechanisms:

  • Luteinizing hormone (LH) levels increase after orchiectomy, stimulating the remaining testicle to produce more testosterone 2
  • This compensatory increase in LH helps maintain normal testosterone production despite the loss of one testis 3

• Short-term hormonal changes after unilateral orchiectomy may include:

  • Temporary decrease in sperm concentration and total sperm count 2
  • Increased FSH and LH levels 2, 4
  • Decreased inhibin B levels 2

Special Considerations

• Patients with testicular cancer may have pre-existing hormonal abnormalities:

  • 12-16% of long-term testicular cancer survivors may be classified as hypogonadal by laboratory standards 1
  • Patients with testicular cancer can have Leydig cell dysfunction even in the contralateral (unaffected) testicle 1
  • Elevated estradiol levels are found in approximately 40% of patients with recently diagnosed testicular cancer, which correlates with higher risk of testosterone deficiency after treatment 3

• Bilateral orchiectomy (removal of both testicles) results in:

  • Rapid decline in testosterone to castrate levels within 3-12 hours (mean 8.6 hours) 5
  • Permanent testosterone deficiency requiring hormone replacement therapy 1
  • The biological half-life of serum testosterone after bilateral orchiectomy is approximately 30-60 minutes (mean 45 minutes) 5

Clinical Implications

• Monitoring recommendations after unilateral orchiectomy:

  • Serum testosterone levels should be evaluated during management of testicular cancer patients due to higher risk of hypogonadism 1
  • The risk of hypogonadism is greatest at 6-12 months after treatment, with potential improvement in Leydig cell function over time 1
  • It is reasonable to delay initiation of testosterone therapy until the patient shows continuous signs or symptoms of testosterone deficiency 1

• Testosterone replacement therapy is indicated for patients with symptoms of deficiency after orchiectomy 6

  • Primary hypogonadism due to orchidectomy is an FDA-approved indication for testosterone replacement therapy 6

• Fertility considerations:

  • Semen quality may deteriorate after orchiectomy compared to pre-treatment values 2
  • In some patients, the most appropriate time for cryopreservation of semen is before orchiectomy 2
  • Liberal use of semen cryopreservation before orchiectomy is recommended for most patients with testicular cancer 1

Conclusion for Clinical Practice

• For patients undergoing unilateral orchiectomy:
  • Regular monitoring of testosterone levels is recommended, especially in the first year after surgery 1
  • Patients should be informed that while most men maintain normal testosterone levels after unilateral orchiectomy, a subset may develop hypogonadism requiring treatment 1, 3
  • Fertility preservation should be discussed before surgery when possible 1