Without testicles, your body can’t produce testosterone — and testosterone is essential to erectile function. But can you get an erection without testes? The answer is complicated.
Also known as testicles or balls, the testes have a number of critical functions. Not only do they help form sperm, but they’re also responsible for testosterone production.
For health reasons, some men have one or both testes removed. This may be due to testicular cancer, prostate cancer, testicular torsion or direct trauma to the scrotum. When this happens, it can negatively affect sexual function.
While you might be able to get an erection after losing one or both testes, many men experience erectile dysfunction (ED) after testes removal. Fortunately, various treatment options can help guys with one or no testes achieve erections.
A surgery to remove one or more testicles is called an orchiectomy (or orchidectomy). Orchiectomies may be performed to treat health conditions or prevent further health complications.
Here are some of the most common reasons for testicle removal.
Testosterone can worsen the growth of prostate cancer cells. Testicle removal stops the production of testosterone, which may prevent prostate cancer from spreading further.
Although testicle removal isn’t always a part of prostate cancer treatment, your treatment team may recommend it if you have a particularly aggressive case.
You might also need to have your prostate removed in a surgical procedure called a prostatectomy. Many people experience erectile dysfunction after prostate surgery — but certain medications can help you have satisfying sex after prostatectomy and testicle removal.
With the right treatment, the outlook for testicular cancer is quite good — especially if you’re diagnosed early. The five-year survival rate is over 95 percent.
Often, testicular cancer treatment includes orchiectomy. If only one testicle is affected, your treatment team might only remove that testicle.
Testicular torsion is a rare yet highly painful condition that mostly affects boys and men under age 25. It occurs when the testes rotate, causing a twist in the spermatic cord. Since the spermatic cord supplies blood to the testes, the torsion can cut off blood supply.
This condition requires urgent treatment, often surgery to untwist the spermatic cord called an orchiopexy. If blood flow is cut off for more than six hours, your testicular tissue might die — which means the affected testicle might need to be removed.
Blunt trauma to the genitals is painful enough — but sometimes, it can cause the testes to rupture. Beyond being extremely sore, you might also experience nausea and vomiting.
If you get emergency help ASAP, your testicles might survive. But if medical treatment can’t salvage your testicles, you may need an orchiectomy to remove one or both of them.
Not all testicle removal surgeries are the same. Different types of orchiectomies may be used to treat different conditions.
A simple orchiectomy is a procedure where the testes are surgically removed through the scrotum. This surgery is usually used to remove testicles that are no longer functioning because of trauma or torsion.
A partial orchiectomy is a procedure where only part of your testicle is removed. It may be done if you have a benign growth or tumor on your testicle. Your surgery team will remove the part with the mass or tumor while leaving the rest of your testicle intact.
Since this surgery leaves part of the testes behind, it has less severe side effects than a procedure that totally removes the testes.
If there’s an aggressive cancer in the testicles, a radical orchiectomy may be performed. During this surgery, your treatment team will remove the testicles and the spermatic cord.
While a radical orchiectomy might have a more severe impact on reproductive health, it may be a necessary part of cancer treatment.
Now for the answer to the question you’ve been asking: Can you have an erection without testicles? In short, yes.
It’s possible to get an erection without testicles, although many people experience ED after both of their testicles are removed. Whether you have one or both testicles removed will determine how it impacts your erectile function, sex drive and reproductive health.
A unilateral orchiectomy is a surgery where one testicle is removed. If the other testicle is healthy and functioning, you should still be able to have erections, engage in sexual activity and produce sperm.
One study surveyed men who experienced testicular torsion at a young age. Out of 72 respondents, 49 had undergone orchiectomy, while 23 had an orchiopexy to untwist the spermatic cord.
Of the 49 men who had undergone orchiectomy, 41 had experienced a successful first pregnancy — though some took longer to conceive.
Another study looked at 60 men who underwent unilateral orchiectomy to treat testicular cancer. At the start of the study, 36 patients were producing normal levels of sperm, seven produced no sperm, and 17 produced only small amounts of sperm.
After a year, 45 patients were producing sperm normally, two patients who initially produced low amounts normalized, and 28 had conceived.
With that said, living with only one testicle can still affect your hormone levels and overall well-being. Research shows that testosterone levels decrease significantly after a unilateral orchiectomy. The procedure also results in a decrease in other hormone levels, including hcG and estradiol.
If your hormone levels are too low, you might benefit from hormone replacement therapy.
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Whenever possible, medical professionals try to avoid removing both testicles. But in some situations, it’s necessary to perform a bilateral orchiectomy in which both testicles are surgically removed.
What happens if you lose both testicles? How does it affect erectile function, and can you ejaculate without testicles? All good questions.
After a bilateral orchiectomy, you might experience:
Low levels of testosterone
Low semen volume
Sexual disorders, like erectile dysfunction
A 2021 review looked at sexual function in testicular cancer survivors. It found that those who had both testicles removed were more likely to experience erectile dysfunction. This is likely because testosterone plays an essential role in erectile function, and your sex drive might decrease as a result of lower testosterone levels.
One study evaluated sexual function in 98 people who had both testicles removed. Only a minority experienced difficulties getting or maintaining an erection. However, some participants were receiving testosterone replacement therapy.
Out of the 98 men, 25 percent experienced low libido, and 24 percent had lower semen volume after surgery. Although you can ejaculate without testicles, an orchiectomy can affect this bodily function. The study noted that 14 percent of participants experienced premature ejaculation, while 2 percent had late ejaculation or no ejaculate.
Research has also shown that orchiectomy may cause psychological stress. While having testicular cancer or another condition is stressful on its own, many men also deal with body image issues and a feeling of not being “normal” after surgery. This may, in turn, affect your self-esteem, which can negatively affect your sex life.
Though it’s possible to get an erection without testicles, many men struggle with erectile dysfunction after an orchiectomy. This could be because of hormonal factors (namely, low testosterone levels) or psychological implications.
The good news is that there are ways to treat erectile dysfunction after orchiectomy. Depending on your health, the cause of your ED and your current erectile function, some treatments may be more suitable than others.
Common treatment options include:
Testosterone replacement therapy. Testosterone is an androgen (male sex hormone) that affects sex drive and erectile function. If you have low levels of testosterone, hormone therapy may improve erectile dysfunction.
Erectile dysfunction medications. Most of these are PDE5 inhibitors, which help you get an erection by increasing blood flow to your penis. Popular erectile dysfunction meds include sildenafil (the generic version of Viagra®), tadalafil (the generic version of Cialis®), Stendra® (and its generic avanafil) and our hard mints chewable ED meds.
Talk therapy. Testicular health issues can be traumatic, and an orchiectomy might affect your body image and self-esteem. If you’re experiencing psychological ED, mental health counseling can make a major difference.
Beyond the above treatments, you can try implementing some lifestyle changes for erectile function. A healthy diet, regular exercise and a decent sleep schedule can help. It’s also a good idea to quit smoking, reduce your alcohol and drug intake, and manage any chronic conditions like high blood pressure.
Yes, you can get an erection without testes. Many men experience erectile dysfunction after having one or both testicles removed, but hormone therapy and ED treatments can help.
Testicle removal can affect erectile function. You may or may not experience erectile dysfunction after having one or both testicles removed. There’s no way to predict how an orchiectomy will affect sexual function, but it can decrease it.
Different types of orchiectomies have different effects. While having one healthy testicle is usually enough to maintain erections and even become pregnant, losing both testes is more likely to cause sexual dysfunction.
Treatments are available. The good news? Various erectile dysfunction medications and devices can improve erectile function. You might also want to try talk therapy and healthy lifestyle changes.
Treating ED after orchiectomy often starts with reaching out for help. While your sexual health may be a difficult thing to discuss, healthcare providers are trained to assist people experiencing these kinds of issues.
When you’re ready to take that step, we can connect you with a qualified professional through our telehealth platform. Fill out our quick sexual health questionnaire to get started.
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Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.