The testicles are a part of the male reproductive system. They are covered with a piece of skin called the scrotum and secrete major reproductive and sex hormones including testosterone. In the medical and surgical gender affirmation process, one of the main steps is to reduce testosterone levels and achieve more feminine features. Surgical castration is the removal of both testicles to prevent male reproductive hormone production. The scrotum can be used as a skin graft to build the vagina in trans women, so, removing the scrotal skin is not recommended in these patients. Bilateral Orchiectomy surgery will start with a 2.5-cm incision in the middle of the scrotum and end with cutting the spermatic cod and removing the testicles. The procedure under general anesthesia takes a maximum of 1 hour, and it can be carried out in the same section with vaginoplasty. The recovery period for bilateral orchiectomy is a few days to a week. It should be kept in mind that bilateral orchiectomy is surgical castration, and it will completely eliminate the patient’s fertility.