Can you get an erection without testes?

Losing one or both testicles can raise a lot of questions, especially about sex. Testicles play a key role in hormone production, but they aren't the only part of the erection process. So, can you get an erection without testes? The answer may be more reassuring than you think.

The testicles (aka testes) are small, egg-shaped reproductive organs inside the scrotum. They produce testosterone, the male sex hormone that influences things like muscle growth, hair patterns, voice changes, libido, and sperm production. 

But an erection involves more than just testosterone: It depends on a complex balance of blood flow, nerve signals, hormone levels, and emotional wellbeing. Understanding how these systems work together can make it easier to navigate what happens if one or both testicles are removed. Read on to learn more about getting an erection without testicles, the odds of experiencing erectile dysfunction (ED) sans-testes, and more. 

Yes, you can get an erection without testes. Unfortunately, however, many people experience ED after having their testicles removed. Still, everyone is different, and the impact on your sexual function, sex drive, and reproductive wellbeing depends on several factors, including the type of removal. 

• If you have one testicle removed (unilateral orchiectomy), your remaining testicle typically produces enough testosterone to maintain your sex drive, erections, and fertility.

• If both testicles are removed (bilateral orchiectomy), testosterone levels fall sharply. This often leads to a loss of libido and difficulty getting or keeping erections. But with treatments, such as testosterone replacement therapy, you can restore both libido and erectile function.

So, while the presence of testicles supports hormonal health and sexual function, their removal doesn't automatically mean you'll lose the ability to get erections or experience erectile dysfunction. It just means you might require some additional care.

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The removal of a testicle is called an orchiectomy. It’s a procedure often used to treat or prevent certain health conditions affecting the testicles. In some cases, only one testicle needs to be removed; in others, both may be taken out. Here are some of the most common reasons this surgery might be recommended.

Prostate cancer

Chronically elevated testosterone levels are a risk factor for prostate cancer. So in some cases, your healthcare provider may recommend lowering testosterone levels to treat the cancer. 

One way to do this is through a bilateral orchiectomy — i.e. removal of both testicles — which causes a sharp drop in testosterone. This approach is considered a permanent form of hormone therapy. Today, it’s used less often because medications can typically lower testosterone without needing to go under the knife.

Testicular cancer

Testicular cancer is one of the most common reasons a testicle may need to be removed. In most cases, the cancer is limited to one testicle, and removing it can not only treat the disease but also help confirm the diagnosis. 

This surgery — called a radical inguinal orchiectomy — is both diagnostic and therapeutic. Meaning, it allows healthcare providers to fully examine the testicle for cancer cells while also removing the tumor. 

Removing both testicles is rare, but it may be necessary if cancer affects both or comes back later.

Testicular torsion

Testicular torsion happens when the spermatic cord (a bundle of blood vessels, nerves, and the vas deferens that supports each testicle) twists, cutting off blood flow to the testicle. 

If reading this has you wincing at your screen (sorry!), that makes sense; though the condition is rare, it's very painful and requires immediate medical attention. That’s because when blood flow is blocked, the clock starts ticking on saving the testicle.

Surgery is usually required right away to untwist the cord and restore blood flow. The procedure also anchors the testicle in place to prevent future twisting. Without quick treatment, the lack of circulation can cause the tissue to die, which may mean losing the testicle entirely.

Trauma

A ball to the, err, balls or any blunt trauma to the area can be enough to leave you keeling over in pain. And while the occasional knock might just bruise your ego, a serious blow can sometimes cause lasting damage. If the injury results in a non-functional testicle, healthcare providers might need to remove the testicle to prevent further complications.

Not all orchiectomies are the same. The type of orchiectomy you get depends on the underlying condition, how advanced it is, and whether there’s a need to preserve any testicular function. Orchiectomies can be either unilateral or bilateral — removing one testicle or both — depending on what’s medically necessary. Here’s the breakdown.

Simple orchiectomy

This procedure removes the testicle through a small incision in the scrotum. It's usually done for hormone-related conditions or individuals undergoing gender-affirming surgery. The spermatic cord is left intact.

Partial orchiectomy

A partial orchiectomy involves removing only the tumor or abnormal area of the testicle, leaving as much healthy tissue intact as possible. It’s typically considered for small, slow-growing tumors or in situations where preserving fertility or hormone production is especially important, such as in people with one remaining testicle. 

While not used as often as full removal, it can be a safe and effective option in certain cases. The side effects for this procedure are also less severe than a radical orchiectomy; for instance, it doesn’t cause infertility, since part of the testes remain.

Radical orchiectomy

This is the most common surgery for treating testicular cancer. The surgeon makes an incision on the groin to remove the entire testicle and spermatic cord, which lowers the risk of cancer cells spreading during surgery.  This total removal results in more severe side effects, like hormone imbalances and infertility.

A radical orchiectomy not only removes the tumor but also allows healthcare providers to confirm the diagnosis by examining the tissue. This helps determine the exact type and stage of cancer, which can guide further treatment decisions.

Now you know it’s possible to get an erection without testicles. But your erections — and whether you may need hormone therapy or other treatment— often depend on whether one testicle remains. 

Erectile function after unilateral orchiectomy

The good news is that for most people, having one healthy testicle is enough to maintain normal testosterone levels, according to a 2021 study. But some individuals may notice changes, especially in the short term.

For instance, a 2020 meta-analysis found that about 16.9% of testicular cancer survivors who had undergone unilateral orchiectomy reported erectile difficulties, compared to 9.4% in the general population. 

Researchers believe this increased risk may be linked to a mix of physical and psychological factors. Treatments like chemotherapy or radiation can affect nerves and blood flow. At the same time, emotional reactions such as depression or changes in body image as a result of the disease and surgery can influence sexual confidence, desire, and function. (After all, ED is just as much about the mental as it is the physical.)

Fortunately, challenges with erections also tend to improve over time. The same meta-analysis found that the long-term risk of erectile dysfunction was lower than in the short term. This is partly because many men recover sexual function after treatment, and partly because ED becomes more common with age, even in men without cancer.

Importantly, most men who lose one testicle also typically go on to live healthy reproductive lives. One study of men who experienced unilateral testicular torsion found that nearly 84% of them were able to conceive children within 1.6 years after surgery.

Erectile function after bilateral orchiectomy

Things can feel uncertain when both testicles are removed. It’s important to know that help is available, and many people continue to have fulfilling sex lives after surgery. 

The testicles produce most of the body’s testosterone, so removing them causes hormone levels to drop significantly. This reduction in testosterone can lead to some common changes, including:

• Lower sex drive

• Difficulty getting or keeping an erection (i.e. ED)

• Depression

• Changes in muscle size or strength

• Difficulty sleeping

• Bone loss

• Increase in body fat

A 2021 review found that about 35% of all testicular cancer survivors reported some degree of erectile dysfunction after treatment, with higher rates among those who had more intensive treatments like a bilateral orchiectomy.

Luckily, there are options: Many people start testosterone replacement therapy (TRT) soon after surgery, which can bring hormone levels back into a healthy range. With TRT — available as gels, injections, patches, or pills — libido, energy, and erections can return or improve significantly. 

You may also notice some changes in ejaculation after surgery. Before you ask, yes, you can ejaculate without testicles. But here’s the deal: Since sperm is produced in the testicles, removing them stops sperm production and causes infertility. As a result, your ejaculate won’t contain sperm (just body fluids). Some also have dry orgasms, where no fluid is released.

However, orgasm is still possible, and many people continue to enjoy satisfying and intimate sexual experiences. If having biological children is important to you, talk to your healthcare provider about sperm banking before surgery.

Losing one or both testicles can bring up a lot of questions about your sex life. Fortunately, there are many ways to maintain or restore your sexual health. 

Testosterone replacement therapy (TRT)

If both testicles are removed, your body can no longer make its own testosterone. But that doesn’t mean you have to live with the symptoms of low T. TRT can replace the missing hormone and help: 

• Restore your sex drive

• Support erections

• Improve your mood

• Strengthen your bones and muscles

Keep in mind that while TRT can restore sexual function, it doesn’t bring back fertility after a bilateral orchiectomy. And even if you still have one testicle, infertility is one of the risks of TRT, along with:

• Trouble sleeping

• Enlarged prostate, which can make it difficult to urinate

• Blood clots

• Increased cholesterol

PDE-5 inhibitor medications

Medications like PDE5 inhibitors — e.g. Viagra (sildenafil), Cialis (tadalafil) — are often the go-to treatment for ED after an orchiectomy. They work by enhancing blood flow to the penis, making it easier to get and maintain an erection in response to sexual stimulation.

They’re effective for many people, including those using TRT or those who’ve had only one testicle removed. These ED medications don’t increase libido, but they can improve erection quality when testosterone levels are adequate.

Depending on the medication, they’re typically taken about an hour before sex or taken daily so you can always be ready for sex. Side effects are usually mild and may include headache, flushing, or dizziness.

There are also alternative formats beyond standard pills:

• Daily Rise Gummies. These chewables contain tadalafil (the same active ingredient found in Cialis). They’re intended for daily use, offering consistent levels of the medication to support more spontaneous sexual activity.

• Ro Sparks. This dissolvable tablet combines both sildenafil and tadalafil—the key ingredients in Viagra and Cialis—in a single dose that melts under the tongue for quicker absorption.

Although these specific products aren’t FDA-approved as treatments, their active ingredients have been FDA-approved individually for treating erectile dysfunction. A prescription from a licensed healthcare provider is still required.

Vacuum erection devices

A vacuum erection device, or penis pump, uses gentle suction to draw blood into the penis. Once an erection is achieved, a small ring is placed at the base of the penis to help maintain it during sex. These devices can be especially helpful for people who can’t take PDE5 inhibitors or want a medication-free solution. 

Counseling or sex therapy

Erectile function is about more than just hormones or blood flow. Mental health, self-image, and emotional connection all play a big role. If you’re feeling anxious, depressed, or uncertain about your body after an orchiectomy, talking to a mental health professional, such as a therapist, can be incredibly helpful.

Sex therapy or counseling can address:

• Performance anxiety or fear of rejection

• Loss of confidence or identity after surgery

• Conflict with partners

• Adjusting to physical changes in your body

Lifestyle changes

Your overall health has a major impact on your sexual wellbeing and function. Simple lifestyle adjustments may improve blood flow, boost energy, and support healthy testosterone levels in some cases (however, in other cases, TRT may be the only solution). 

Consider these science-backed habits:

• Exercise regularly: Staying active helps improve circulation and reduce ED risk.

• Maintain a healthy weight: Obesity is linked to lower testosterone and higher ED rates.

• Manage stress: Chronic stress can interfere with hormones and sexual performance.

• Quit smoking and limit alcohol: Both of these habits can damage blood vessels and impair erections.

Penile prosthesis

If you’ve had one or both testicles removed, you may choose to get a penile implant if non- or less-invasive options don’t help improve your erections. These implants are placed in the scrotum during or after surgery to create a natural appearance and feel, and they’re either malleable or inflatable to allow for erections.

A prosthesis doesn’t affect hormones or sexual function, but for many people, it can help restore confidence, comfort, and a sense of normalcy. This can have a positive impact on intimacy, body image, and mental wellbeing.

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If you’ve had — or are preparing for — an orchiectomy, it’s completely natural to have questions about your sex life and overall wellbeing. Fortunately, many people continue to have healthy, satisfying sexual experiences after losing one or both testicles. While there may be some changes, a wide range of treatments and support are available to help you feel confident and connected again. Here’s what to keep in mind:

• You can get an erection without testicles. Erections rely on more than just testosterone. With proper blood flow, nerve function, and support — especially hormone therapy if both testicles are removed — many people continue to have erections and enjoy sex.

• Losing one testicle usually doesn’t impact sexual function. Most people who have one testicle removed maintain normal hormone levels, libido, and erections. The remaining testicle typically compensates for the loss.

• Fertility can be affected, but intimacy isn’t lost. Losing both testicles ends sperm production, but orgasms are still possible. If you plan on having biological children, bank your sperm before surgery.

There are tools to help you feel like yourself again. Testicular implants, therapy, and healthy habits can all help rebuild confidence, restore body image, and support your sex life after surgery.