Does having one testicle affect erectile dysfunction? Many men who have undergone unilateral orchidectomy or have a single functioning testicle naturally worry about their sexual function. The reassuring answer is that one healthy testicle is typically sufficient to maintain normal erectile function and testosterone levels. Whilst psychological factors such as anxiety and body image concerns can contribute to erectile difficulties, the physical loss of one testicle alone does not usually cause erectile dysfunction. Understanding the distinction between physical and psychological causes, alongside appropriate medical assessment, ensures men receive the right support and treatment when needed.

Understanding Erectile Function with One Testicle

Erectile function is a complex physiological process that involves the nervous system, blood vessels, hormones, and psychological factors working in coordination. Many men who have undergone unilateral orchidectomy (surgical removal of one testicle) or who have a single functioning testicle due to other causes naturally have concerns about their sexual function and erectile capability.

The good news is that one healthy testicle is typically sufficient to maintain normal erectile function. The remaining testicle usually compensates by increasing its production of testosterone and sperm, often maintaining hormone levels within the normal physiological range. Erections depend primarily on adequate blood flow to the penis, intact nerve pathways, and sufficient testosterone levels—all of which can be preserved with a single functioning testicle. However, outcomes may vary depending on the reason for orchidectomy and whether additional treatments (such as chemotherapy or radiotherapy) have been given.

The psychological impact of having one testicle should not be underestimated. Body image concerns, anxiety about sexual performance, and worry about fertility can all contribute to erectile difficulties. These psychological factors may sometimes have a more significant impact on erectile function than the physical loss of one testicle itself. Understanding the distinction between physical and psychological causes is important for appropriate management. It is worth noting that erectile function and fertility are distinct issues; whilst one testicle usually maintains erectile function, men concerned about fertility should discuss this separately with their healthcare team.

The reason for testicle loss or absence matters clinically. Whether the orchidectomy was performed for testicular cancer, trauma, torsion, or infection can influence overall health outcomes and treatment approaches. Men who have had cancer treatment, for instance, may have additional considerations regarding their sexual health that extend beyond the loss of one testicle alone.

How Testosterone Levels Affect Erections After Orchidectomy

Testosterone plays a crucial role in male sexual function, including libido (sex drive), erectile function, and overall sexual satisfaction. This hormone is produced primarily in the Leydig cells of the testes, and concerns about testosterone deficiency are common after losing one testicle. However, the relationship between testosterone and erectile function is more nuanced than many people realise.

In most cases, a single healthy testicle produces adequate testosterone to maintain normal sexual function. Men with one testicle typically have testosterone levels within the normal reference range, though it is important to note that reference ranges vary between laboratories (commonly around 8–29 nmol/L in UK labs). The remaining testicle often undergoes compensatory hypertrophy, increasing in size and function to meet the body's hormonal needs. This physiological adaptation usually occurs within several months following orchidectomy. A minority of men, particularly those who have received cancer treatments, may develop low testosterone and require monitoring.

Testosterone is necessary but not always sufficient for normal erections. Whilst severe testosterone deficiency (hypogonadism) can contribute to erectile dysfunction, many men with low testosterone maintain adequate erectile function, and conversely, some men with normal testosterone levels experience erectile difficulties. Testosterone primarily influences sexual desire rather than the mechanical ability to achieve an erection, which depends more heavily on vascular and neurological factors.

If testosterone levels do fall below the normal range after orchidectomy, symptoms may include reduced libido, fatigue, mood changes, and potentially erectile difficulties. NICE Clinical Knowledge Summaries (CKS) recommend checking testosterone levels in men with sexual dysfunction symptoms, typically with two early morning blood tests (before 11 am, when levels are naturally highest) taken on separate occasions, avoiding testing during acute illness. Results should be interpreted against the local laboratory's reference range. If borderline, sex hormone-binding globulin (SHBG) and free testosterone may be measured. Luteinising hormone (LH) and follicle-stimulating hormone (FSH) help distinguish primary testicular failure from pituitary causes. If confirmed hypogonadism is present, testosterone replacement therapy may be considered, though this decision requires careful discussion with a specialist, particularly in men with a history of testicular cancer.

Does Having One Testicle Cause Erectile Dysfunction?

There is no direct causal link between having one testicle and erectile dysfunction in most men. The medical evidence indicates that unilateral orchidectomy alone does not typically cause erectile problems when the remaining testicle is healthy and functioning normally. Large-scale studies of testicular cancer survivors, many of whom have undergone orchidectomy, show that whilst some experience sexual difficulties, these are often related to other factors rather than the loss of one testicle per se.

Several factors may contribute to erectile dysfunction in men with one testicle, but these are generally independent of the testicle loss itself. Psychological factors, including anxiety, depression, body image concerns, and relationship stress, are common contributors. Men who have undergone orchidectomy for cancer may also have received additional treatments such as chemotherapy or radiotherapy, which can affect sexual function through various mechanisms including vascular damage, neuropathy, or hormonal disruption.

Underlying health conditions are often more relevant to erectile function than testicle number. Cardiovascular disease, diabetes, hypertension, high cholesterol, obesity, and smoking all significantly impair erectile function by affecting blood flow to the penis. These conditions should be identified and managed appropriately, as erectile dysfunction can sometimes be an early warning sign of cardiovascular disease. NICE CKS guidance on erectile dysfunction emphasises that assessment should include cardiovascular risk evaluation, including blood pressure, lipid profile, HbA1c or fasting glucose, and cardiovascular risk calculation (such as QRISK) in line with UK practice.

It is important to recognise that some men do experience sexual difficulties after orchidectomy, but attributing these solely to having one testicle oversimplifies a complex situation. A comprehensive assessment by a healthcare professional can help identify the actual contributing factors—whether hormonal, vascular, neurological, psychological, or a combination—and guide appropriate treatment. Men should feel reassured that having one testicle does not inevitably lead to erectile problems, and effective treatments are available if difficulties do arise.

Medical Treatments for Erectile Dysfunction with One Testicle

Treatment for erectile dysfunction in men with one testicle follows the same evidence-based approaches used for erectile dysfunction generally, as recommended by NICE guidelines. The first-line treatment typically involves phosphodiesterase type 5 (PDE5) inhibitors, which include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). These medications work by enhancing the natural erectile response to sexual stimulation by increasing blood flow to the penis. They do not directly affect testosterone levels but improve the mechanical process of achieving and maintaining an erection.

PDE5 inhibitors are effective in many men with erectile dysfunction, regardless of whether they have one or two testicles, though response rates are lower in men with diabetes, severe cardiovascular disease, or following prostatectomy. These medications should be taken as prescribed, typically 30–60 minutes before sexual activity (though tadalafil can be taken daily at a lower dose). Sildenafil is less effective when taken with heavy or fatty meals. Common side effects include headache, facial flushing, indigestion, and nasal congestion.

Important safety information for PDE5 inhibitors: These medicines are absolutely contraindicated in men taking nitrate medications (used for angina) or riociguat (used for pulmonary hypertension) due to the risk of severe hypotension. They should be avoided in patients for whom sexual activity is inadvisable due to cardiovascular status. Product-specific restrictions apply regarding recent myocardial infarction or stroke, and dose adjustments or avoidance may be necessary in severe hepatic or renal impairment—consult the Summary of Product Characteristics (SmPC) for each medicine. Caution is required in men taking alpha-blockers (used for prostate symptoms or hypertension) due to the risk of hypotension; dose separation and starting with the lowest dose is advised. Men with hereditary retinal disorders, a history of non-arteritic anterior ischaemic optic neuropathy (NAION), or hypotension should use these medicines with caution. Seek urgent medical help if you experience an erection lasting more than four hours (priapism) or sudden loss of vision or hearing. Men should always consult their GP before starting these medications. If you experience side effects, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

If testosterone deficiency is confirmed through blood tests, testosterone replacement therapy (TRT) may be appropriate. TRT is available in various formulations including gels (such as Testogel), injections (such as Nebido), and patches. However, TRT is contraindicated in men with prostate cancer or breast cancer. In men with a history of testicular cancer, the decision to use TRT should be made in consultation with an oncologist. Important: TRT suppresses sperm production and is not a treatment for infertility. Men receiving TRT require baseline and ongoing monitoring, including prostate assessment (digital rectal examination and prostate-specific antigen [PSA] testing where clinically appropriate), full blood count (to monitor haematocrit and haemoglobin), and liver function tests, in line with UK guidance. It is important to note that TRT alone may not resolve erectile dysfunction if other factors (vascular, neurological, or psychological) are the primary cause.

Additional treatment options include vacuum erection devices, intracavernosal injections (alprostadil), intraurethral medication, and in some cases, penile implants. Psychological interventions, including cognitive behavioural therapy (CBT) and psychosexual counselling, can be highly effective, particularly when anxiety or relationship issues contribute to erectile difficulties. The NHS provides access to sexual health services and psychosexual therapy through GP referral. A holistic approach addressing both physical and psychological factors typically yields the best outcomes.

When to Seek Medical Advice About Sexual Function

Men should consult their GP if they experience persistent erectile difficulties lasting more than a few weeks, as early intervention often leads to better outcomes. Erectile dysfunction can be an indicator of underlying health conditions, particularly cardiovascular disease, diabetes, or hormonal imbalances, which require appropriate investigation and management. There is no need to feel embarrassed—GPs routinely discuss sexual health concerns and can provide confidential, professional support.

Specific situations warrant prompt medical attention. Seek urgent medical help if you experience an erection lasting more than four hours (priapism) or sudden loss of vision or hearing, as these require immediate treatment. If erectile dysfunction develops suddenly, particularly in younger men, this may indicate an underlying medical condition requiring investigation. Men who experience erectile problems alongside other symptoms such as extreme fatigue, mood changes, loss of body hair, reduced muscle mass, or breast enlargement should seek assessment, as these may indicate testosterone deficiency. Additionally, if erectile dysfunction is accompanied by chest pain, breathlessness, or other cardiovascular symptoms, urgent medical evaluation is necessary.

Your GP will typically carry out an assessment that includes measuring blood pressure, checking fasting lipid profile and HbA1c or fasting glucose, calculating cardiovascular risk (such as QRISK), and arranging targeted hormonal tests if clinically indicated, in line with NICE CKS guidance on erectile dysfunction.

Men with one testicle should attend regular follow-up appointments as recommended by their healthcare team, particularly if the orchidectomy was performed for cancer. These appointments typically include physical examination and may involve blood tests to monitor testosterone levels and, where appropriate to the cancer type and initial marker status, tumour markers. Sexual function should be discussed as part of holistic care, and any concerns should be raised proactively. The NHS provides comprehensive support for testicular cancer survivors, including access to specialist nurses and support services.

Referral triggers to specialist services include failure to respond to first-line treatments, complex cases involving multiple contributing factors, confirmed hormonal abnormalities requiring specialist management, or significant psychological distress affecting quality of life. Urology, endocrinology, and sexual health specialists can provide advanced assessment and treatment options. Men should also be aware that many areas have dedicated sexual health clinics offering confidential services. Remember that effective treatments are available, and seeking help is an important step towards maintaining sexual health and overall wellbeing.

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