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Urology/Bilateral orchiectomy

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Question
QUESTION: Hello Doctor, two quick questions:

- Is a man still able to ejaculate after having both testicles removed?

- Is testosterone replacement therapy effective at helping a man maintain normal testosterone levels in the absence of testicles?

I am asking because I am soon having an operation to remove both due to chronic bilateral pain. Thanks Doctor.

ANSWER: Taylor

These are questions you need to ask your surgeon.

Ejaculation still works after bilateral orchiectomy especially if testosterone replacement is used. The semen will have no sperm, but this will not be noticeable.

Replacement therapy can restore testosterone levels in the blood to normal.

---------- FOLLOW-UP ----------

QUESTION: Thank you Doctor, this eases my mind a lot.

Also, let me take a moment to thank you for the service you provide here. I assume that you do not get paid for the answers you provide here, and that you do this because you care about people who need help. What you're doing here is invaluable and greatly appreciated, and speaks to the fact that you are not only a great Doctor, but also a great and compassionate human being.

ANSWER: Taylor

You are right in that we are not paid anything to answer questions on this site. Thanks for your comments.

---------- FOLLOW-UP ----------

QUESTION: No problem Doctor. Just an update, I saw a urologist today who I thought would be willing to perform the procedure for me, but unfortunately I was informed that he would not perform the procedure strictly due to pain. He said he would only do it if I had cancer or injury. I have been unsuccessful in finding a urologist who will remobe my testicles because they have all said that this surgery is not done for pain. But I have suffered bilateral pain for years. I am 100% sure that it is coming from the testicles, and not from any nerve sources. So I have a tough question for you, and I apologize for putting you on the spot:

Would you be willing to do this for me? I realize there is a risk of phantom pain, but I am willing to accept that risk in exchange for the possibility of being pain free again. I could fly to you and self pay if necessary. Also, if you are willing to do it for me, how much would the surgery cost?

Sorry to put you on the spot. I'm just ready to end this nightmare and I hope you would be kind ebough to help me. Thank you.

Answer
Taylor:

I would personally not do such a surgery.  It is not my allowed for me to solicit patients on this site, particularly not for a surgery that is highly controversial.

I would suggest that you consult pain therapy and see if there is an alternative pain control solution such as spermatic cord injection of local anesthetic.

It might not be unreasonable to consider removal of just one testicle if all other means of pain control have failed.  If the pain is not relieved at least on that side, then at least you avoid having both testicles removed without benefit to your pain.  If successful, then you can make the case of having the other testicle removed for pain control.

You may want to try checking with a tertiary care University program to see if they have anything else to offer.  

Urology

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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