Can I get an erection if both testicles were removed?

Dear Reader,  

Testicular torsion is a painful condition, and kudos to you for empathizing with your friend’s pain. Having both testicles removed can affect erections, and it can also lead to other side effects like lowered testosterone and infertility. However, various treatments exist to alleviate some of these concerns. Read on to learn more! 

What are testicles? 

Testicles or testes are a part of the reproductive system in people assigned male at birth. The scrotum, likely more commonly recognized as the external sack that houses the testicles, contains blood vessels, nerves, and vas deferens (which transmits sperm). Testicles produce sperm, testosterone, and other hormones related to the development of reproductive organs. Testosterone is specifically responsible for muscle development, voice deepening, body hair growth, and producing sex drive.  

What is testicular torsion and how common is it? 

Your friend’s condition of testicular torsion is rare. Around 1 in 4,000 people under 25 years of age experience testicular torsion and only two percent of them experience testicular torsion in both testicles.  

Testicular torsion involves the twisting of the spermatic cord, which connects from the abdomen to the testicles inside the scrotum. The twisting cuts blood supply to the testicles.  

Testicular torsion often starts without clear causes, although it’s sometimes caused by physical injury. In many cases, it’s a result of an unusual structure in the testicles called “bell clapper deformity.” People with this condition have the testicles that can move freely in the scrotum like clappers in a bell, rather than being firmly attached. This makes it possible for twisting to occur.  

A common symptom of testicular torsion is a sudden and severe pain in one testicle. Other symptoms may include: 

• Swelling on one side your scrotum 
• Lumps on your testicles 
• Uneven testicles in your scrotum 
• Discolored (red, purple, brown, black) scrotum 
• Nausea and vomiting 
• Stomach pain 
• Increased urination 
• Fever 

List adapted from Cleveland Clinic 

The testicles are most likely to be saved if torsion is detected and treated within six hours. When the twisting takes place for too long, especially if it lasts for more than 24 hours, the testicle(s) are likely to have experienced permanent damage. This requires surgical removal or the testicle(s) (orchiectomy). Overall, 20 to 40 percent of testicular torsion cases lead to the need for removal surgery. 

Are there side effects to having your testicle(s) removed? 

The short answer is yes; but having one or both testicles removed might have different effects for different people. Regarding your question, getting an erection is more difficult when both testicles are removed. However, the direct connection between erection and testosterone level still isn’t fully understood. What is known is that testosterone levels drop more after having both testicles removed, which can lead to a decrease in sex drive.  

Another side effect of having both testicles removed is that the body can no longer produce sperm, which means that your friend can no longer have biological children. However, if only one testicle is removed, a person would still be able to produce sperm. 

Additionally, muscle loss, weight gain, tiredness, and mood swings can be among the side effects of testicle removal regardless of whether it’s one or both. 

Are the unwanted effects of testicle removal treatable? 

Luckily, testosterone replacement therapy can help counteract the surgery’s side effects of decreased sex drive. It typically involves the use of testosterone in the form of a gel, patch, or shot. This therapy raises testosterone level, which might in turn increase sex drive, improve mood, and restore erection. 

Some people also have concerns about their appearance, especially when they’re with a partner(s) or in public spaces like locker rooms. Artificial testicle implant surgery can be an option to help those with this concern. This surgery involves the implantation of artificial testicles filled with saline and designed to look like real testicles into the scrotom. 

The impact of testicular removal surgery can be uneasy for some, and your friend may want to talk with someone about his feelings after the surgery. In addition to continuing to be supportive, you might encourage him to reach out to a mental health professional to discuss the recent changes in his body. 

Your friend is lucky to have your support!