Introduction and Hypothesis <p>Access to gender-affirming care has improved for transgender individuals, yet significant barriers to surgical interventions persist. Bilateral orchiectomy is a straightforward, same-day procedure that plays a crucial role in gender affirming care. This article and accompanying video outline the indications for this procedure and provide a step-by-step demonstration of the surgical technique.</p> Methods <p>We describe the surgical steps of gender-affirming bilateral orchiectomy, highlighting its similarities to vaginal gynecologic procedures. We also discuss indications for gender-affirming bilateral orchiectomy, review testicular anatomy and its parallels to ovarian anatomy, surgical technique, and postoperative care.</p> Results <p>The senior author, a board-certified urogynecologist, has performed over 100 bilateral orchiectomies with excellent outcomes. Given the political and systemic challenges transgender patients face in accessing surgical care, this video underscores the role of urogynecologists and gynecologists in providing this essential service.</p> Conclusions <p>This video illustrates indications and technique for bilateral orchiectomy in gender-affirming care, emphasizing its overlap with vaginal surgical skills. Increased exposure to this procedure may encourage urogynecologists and gynecologists to incorporate it into their practice with minimal additional training.</p>