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In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies. The ability to get an erection, to produce sperm and to have a sex drive all depend on testosterone. The mention of any product, service, or therapy is not an endorsement by NCCIH. During sexual excitement, the corpora cavernosa and bulbs become engorged with blood, causing erection. Also for the record, the smallest average penises in the world are found in North Korea, measuring in at 38 inches long fully engorged.