Although the operation is relatively simple, many men find it psychologically devastating to lose their testicles — and for this reason alone decide against it. Another factor to consider is that, unlike medication options, orchiectomy is permanent. Some men continue to choose this option, however, because it remains the most efficient way to reduce testosterone levels, and it eliminates expenditures on medications and multiple visits for monitoring side effects that would be needed to achieve the same results. The option of orchiectomy is also sometimes recommended for elderly men who cannot readily visit a doctor for an injected medication, or who cannot risk the cardiovascular side effects of diethylstilbestrol (DES).
If the patient elects to proceed with the insertion he/she is laid on the side. The fleshiest part of the upper outer quadrant of the buttocks is located and cleansed. This is usually midway between the iliac crest and the greater trocanter. A 10cc syringe of Lidocaine is used with 2cc of N/S using a inch 25 gauge needle to infiltrate an area parallel to the table. A very small shallow puncture is made at the point of infiltration. A female trochar or male trochar is inserted through the puncture site and quickly angled parallel to the table anteriorly along the path of the local anesthesia to the hub of the trochar. The stylus is removed and the appropriate size pellets are placed in the trochar and inserted with the plunger.