Orchiectomy (removal of testes) significantly reduces testosterone.

: While estrogen promotes feminization, it does not inherently "block" blood flow. However, the resulting drop in libido can make achieving an erection more difficult or require more direct stimulation than before [3, 4]. Why Some Retain the Ability

: Some choose a hormone regimen that allows for a higher level of "functioning" testosterone or use erectile dysfunction medications (like Sildenafil) to assist with blood flow while still transitioning [3].

: Transition is not a monolith. Not every trans woman pursues "bottom surgery" (orchiectomy or SRS). For those who keep their original anatomy, the physiological mechanism for an erection remains present [1, 2]. Mental and Emotional Factors