Castration in the UK: Procedure, Risks, and Decision‑Making

Castration (bilateral orchiectomy) is a major, irreversible surgical procedure. In the UK, it requires thorough medical and psychological assessment.

Pathway

1. GP/urologist consultation: discuss indications, alternatives, risks.
2. Psychological evaluation (often mandatory).
3. Pre‑operative workup: bloods, imaging, consent.
4. Surgery under general anaesthesia (~30–60 min); scrotal or inguinal approach.
5. Hospital stay 1–2 days; follow‑up for wound care, hormone monitoring.

Risks

• Bleeding, infection, pain, nerve injury, scarring
• Permanent infertility, erectile dysfunction
• Hormonal changes: testosterone loss → hot flashes, bone loss, mood changes, metabolic effects

Testosterone Replacement

Long‑term TRT is usually required unless contraindicated. Decision must be informed, voluntary, and supported by a multidisciplinary team.