After a vasectomy you only need your testicles for hormonal purposes. You're done from a fertility perspective unless you have a reversal - and patency is a crap shoot in the long term.
HRT for men isn't like it is for women. You can be successfully treated and live a normal life, more men are doing it than your think. Men being men just don't talk about it as much. Once you get your delivery method and dosing worked out you should be good to go.
So you really don't even need them for hormones if you are willing to accept the baggage of HRT.
I used to be worried about losing them. After becoming that '1-2% of men that develop severe pain after vasectomy' the AUA talks about I was still worried about losing them. Then waiting failed. So did antibiotics, anti inflammatory, anti depressant, and gabapentin. Then denervation failed.
Then I was like ok, there is really only one thing left to try.
At this point I don't understand why men are so protective of their nuts. Having one removed didn't change who I am, certainly not as much as pvps does. Having it removed gave me some of my life back.
I've talked with a lot of guys who's had orchiectomies for various reasons from cancer to pain to even just a desire to have them removed. Generally they are living normal lives.
I think too many urologists got in trouble for treating chronic 'orchalgia' with orchiectomy without looking for other causes of referred pain. I posted the playbook in another topic that you should run through to validate the pain isn't secondary to another cause. Who would want to get their nuts removed only to find out it was referred pain from their kidneys? I think the cause of our pain is pretty obvious for us.
Then you have the urologists who do scrotal removals for pain - because that's what they do for torsion. Torsion is acute pain. With chronic pain and mechanical injury it has been shown that inguinal removal has a much higher success rate.
So to recap, you have urologists who don't know much about the distinction between treating chronic orchalgia and pvps, who sometimes don't do their homework on ruling out possible causes of pain, who perform a surgery in a way that has been shown to be less successful in resolving pvps pain - because they do it that was for a totally different type of pain.
Just like anything else dealing with pvps it's frustrating.
I guess what I'm getting at is our nuts are already fucked up. You can say with a high degree of certainty they will probably remain that way as long as they are there. Removing them might fix the issue. Is so great. If not, well you've done everything you can.
What I'm more worried about is the excessive treatment with nerve blocks, denervation, neurectomy, etc causing damage that can't be un-done. How many guys have you read about here who've had denervation who have had no improvement, or worse yet new issues or more pain? Granted we're some of worst cases but you'd think there would be more success with the treatment here and on other sites.
It sounds good - keep your testicle and lose the pain. It's covered by insurance. You remain infertile. This is just my observation but it seems like the 'marketing' of the procedure is out of line with the results. Kind of like a vasectomy.
What about the guys who had a little pain that they wanted gone but now have a new bucket of issues? If a cord block gave them relief and there were no caused of referred pain an orchiectomy would have probably cleared things up. But because we are so focused on keeping our nuts we don't consider that. So they have denervation and get a new set of symptoms. How do you address those? Would an orchiectomy even be an option at this point or are they due to an issue from the nerves being cut?
Then there is the issue if it were a more commonly talked about treatment for pvps that alone would scare off most men from having a vasectomy. "No, no there are no real problems. But you might lose your nuts". I see the take rate dropping a lot after that.
I think if you get to the point where your pain requires surgery you should be offered reversal, denervation, or orchiectomy. They all are valid treatment options with their own situations they work better for and come with their own sets of baggage and risks.
And if you get to the point where you could lose everything - ask yourself honestly are your nuts worth it?