Several men have been asking me about surgical choices as adults. The range of concerns is everything from curvature repair to erectile implants. I know I have a reputation for being “antisurgery,” and I don’t mind being thought of that way. However, once a surgical option is well considered and the person is fully informed, sometimes surgery is the best choice.

One of you (whom I know about) is facing a decision regarding removal of testicular tissue once those organs have stopped working very well. Many of us who were born with undescended (cryptorchid) testes will face this as we age, because the heating of the testes while they are inside the body (instead of in the relative cool of the testicular sac) causes changes in the cells of the organ. These changes can cause a testis to produce the hormone testosterone differently than a normal testis, and eventually the testis ends up not producing much, if any, testosterone. Once this happens, the organ shrinks, and it can even die inside the person. Sometimes the tissues are naturally absorbed by the body, but sometimes the tissues change and can increase the risk for testicular cancer, especially as we get close to and just over 40 years old. This is why its important for us to feel our testes monthly at least for any kind of changes in hardness, size, or especially the development of nodules or bumps on their surface. Your doctor can check your blood to see if your testes are functioning well (producing normal amounts of testosterone) or not. If they are not working well, and especially if there are changes in a testis itself, your doctor may determine that removing them is safest to avoid your having to deal with possibly deadly testicular cancer.

At that point you have some choices to face. A second opinion is always a good choice, and repeating tests to be sure about a diagnosis is just plain responsible. But if it turns out that the organs need to come out, there isn’t too much to think about, since avoiding cancer is a no-brainer. Once you have determined that you will have your testes removed, you face the choice of getting testicular implants or not. Testicular implants are plastic prostheses that take up the space in your scrotum that your testes once did. They are optional. You can go through life with plenty of good feeling in your genitals without having to live the rest of your life with a couple of plastic pieces in your body. If you decide to get implants, you can sit with your surgeon and choose ones that will fit in your skin (no, you can’t get implants that are twice the size of your old natural testes). After the implants have healed in, the sensation on the skin of the scrotum won’t be harmed, and you will still have good feeling, but getting used to these pieces being in your body does take a period of adjustment since they aren’t standard human issue.

So surgery isn’t always a bad idea; it just has to be considered carefully. I will be writing about several other of these kinds of choices in newsletters to come.