Background <p>Gender-affirming orchiectomy is well described; however, a subset of patients may also seek scrotectomy to alleviate dysphoria related to the scrotum. Techniques and outcomes of gender-affirming orchiectomy and scrotectomy (GAOS) have not been described to date.</p> Methods <p>We retrospectively reviewed all patients who had undergone GAOS from 2021 to 2024 at our institution. The World Professional Association for Transgender Health criteria for surgical treatment were met preoperatively, and patients understood vaginoplasty was not recommended post-scrotectomy. Two approaches were offered: excision of a majority of scrotal tissue and primary closure of the perineal wound, or excision of all rugated skin with mons and groin (Y-flap) advancement. Patient-reported outcomes questionnaires from the PROMIS^® Sexual Function and Satisfaction Measures, version 2.0, along with questions specific to post-scrotectomy anatomy, were sent postoperatively.</p> Results <p>Eight patients, median age 31 years, underwent GAOS with a preoperative hormone duration of 26.5 months. All patients reported dysphoria related to the scrotum and testes, and wished to preserve the phallus. Five elected for primary closure, three for Y-flap perineoplasty. At median 97-day follow-up, all reported satisfaction and dysphoria relief. One patient with Y-flap experienced wound dehiscence requiring operative revision. Four reported sexual activity with the ability to achieve erection and orgasm.</p> Conclusions <p>GAOS is a well-tolerated procedure that can address dysphoria related to the scrotum and testes. Longer-term study of this emerging procedure is warranted.</p>