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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Low testosterone and erectile dysfunction (ED) are two subjects of men’s health you may not want to think about, but nonetheless, you may be living with. Testosterone is the male sex hormone responsible for many processes in a man’s body—growing facial hair, building muscles, making sperm, libido, and yes, maybe even helping you get an erection.
If you’re living with low testosterone and you have ED, you may wonder, does low testosterone cause ED? Yes and no. It’s not as simple as you might think.
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Can low testosterone cause ED?
Low testosterone, or low T, can play a role in ED, but it’s not necessarily as direct of a link as you may think. It’s often not as simple as low T = ED. Many processes are involved in getting and maintaining an erection, and testosterone levels are only one piece of that puzzle. That means that some men can have healthy erections despite testosterone levels well below the normal range, and other men have ED despite normal T levels.
Here’s why: Many things have to be working correctly for a man to get and maintain an erection. Understanding how erectile function is supposed to work can be a good place to start. Once sexual stimulation occurs, a cascade of processes begins. The nerves in the penis send signals to the spinal cord and brain, which cause the muscles and blood vessels in the penis to relax and allow more blood in. The corpora cavernosa, tubes that run along the length of the penis, then fill with blood. This is what allows the penis to become hard (Jung, 2014).
The role of testosterone in erectile function during sex is mainly related to libido (sex drive). If a man’s testosterone levels aren’t where they should be, he may lack the sexual desire to get the erection process started. Some sexual stimulation is needed, whether it’s the thought of something sexual or seeing something sexually stimulating. Low T, though, might prevent this desire from even getting started. Without that spark, an erection isn’t happening (Zhu, 2020). In other words: treating low T can improve a man’s sex life by increasing libido and renewing his interest in sex.
Erectile dysfunction tends to be caused by things other than low T. Basically, any medical condition that affects how well nerves or blood vessels work can also contribute to ED. These conditions include high blood pressure (hypertension), cardiovascular disease, and diabetes (Sooriyamoorthy, 2022).
How do you know if you have low testosterone?
Testosterone is made in the testicles. Over time, it’s natural to produce less testosterone in adulthood than when you were a teenager, with T levels starting to decline in a man’s 30s. The medical term for this is called hypogonadism, and symptoms of low testosterone can include (Millar, 2016):
- Low sex drive
- Erectile dysfunction
- Loss of facial and pubic hair
- Decreased muscle mass
- Depressed mood
- Weight gain (usually due to increased body fat)
- Difficulty concentrating
- Difficulty sleeping
- Decreased sperm production
- Anemia (low red blood cells)
10 signs and symptoms of low testosterone
Many of the symptoms above can also be caused by other health conditions. If you suspect you may have low T, contact your healthcare provider for medical advice. In addition to reviewing your symptoms and performing a physical exam, your healthcare provider can order blood tests to help determine your testosterone levels.
Blood testosterone tests to diagnose low T are usually done twice, on two separate days in the morning. Other hormone levels, such as luteinizing hormone, prolactin, and thyroid stimulating hormone, may be checked as well to see if they are at normal levels (Rivas, 2014).
How to treat low testosterone
If your healthcare provider has diagnosed you with low T, you may be wondering what can be done to treat it. If T levels are low, your provider may suggest testosterone replacement therapy, or TRT.
You can get TRT through a patch placed on the skin or with a gel used daily. It can also be given through intramuscular injection or through pellets which are injected and release testosterone slowly into the body (Qaseem, 2020).
Studies of older men with age-related testosterone loss have shown TRT helps with sexual function, bone density, anemia, muscle strength, and loss of body fat. However, TRT must be provided by a licensed healthcare professional, with testosterone levels monitored regularly (Park, 2019).
You might have also read about a prescription drug called Clomid (generic name: clomiphene or clomiphene citrate)—an alternative to TRT. Healthcare providers can prescribe Clomid off-label for hypogonadism in men, a condition that involves low levels of sperm, testosterone, or both. Because clomiphene doesn’t dull testosterone production like TRT, it can maintain male fertility while gradually increasing testosterone levels. That’s why men with low testosterone who want to start a family may opt for an alternative like clomiphene.
What is TRT? ￼
Having high levels of testosterone is also not good. Taking too much testosterone, especially if it’s not given to you by an experienced provider, can lead to other health problems and side effects. These problems can include (Harvard Health Publishing, 2019):
- High red blood cell counts
- Blood clots
- Mood swings
How to treat ED
First things first: If your testosterone levels are in the normal range, raising it to higher levels is not medically recommended, and it probably won’t help your ED—your libido might increase, but you still might have issues getting an erection. Also, if you have low T, normalizing testosterone levels only works for ED if low T is the main cause of your ED—and that’s pretty rare, as we’ve learned above.
The most common treatment for ED can include medications and lifestyle changes.
The class of medications to treat ED are called PDE-5 inhibitors (phosphodiesterase 5 inhibitors). These medications include sildenafil (Viagra; see Important Safety Information) and tadalafil (Cialis; see Important Safety Information), which work by helping the muscles and blood vessels inside the penis relax so that blood can fill the penis and an erection can happen. It’s important to note that some sexual stimulation is still required to start the process (Sooriyamoorthy, 2022).
If ED meds don’t work, or someone isn’t a good candidate for them, some other options are available, such as penile injections.
Non-medication ways to treat ED include using external vacuum devices (penis pumps) that are placed over the penis, creating an air-tight seal. A vacuum pump then applies suction, which pulls blood into the penis, enlarging it and helping it get an erection. A ring is placed at the bottom of the penis to help keep the blood in.
It’s also important to manage risk factors and treat underlying health conditions that may be contributing to ED. Examples of these types of treatment include weight loss to manage obesity, treating sleep apnea, managing diabetes, improving cholesterol levels, eating a healthy diet, and getting regular exercise.
Erectile dysfunction (ED): everything you want to know
Talk to your healthcare provider if you suspect you have ED, low testosterone levels, or both. Your sexual health is an essential part of your overall health. Your provider can help get to the bottom of what’s going on and develop a safe and effective treatment plan for you.
- Halpern, J. A. & Brannigan, R. E. (2019). Testosterone deficiency. JAMA, 322(11), 1116-1116. doi:10.1001/jama.2019.9290. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/2749876
- Harvard Health Publishing. (2019). Testosterone- what it does and doesn’t do. Retrieved from https://www.health.harvard.edu/medications/testosterone–what-it-does-and-doesnt-do
- Jung, J., Jo, H. W., Kwon, H., & Jeong, N. Y. (2014). Clinical neuroanatomy and neurotransmitter-mediated regulation of penile erection. International Neurourology Journal, 18(2), 58-62. doi:58.10.5213/inj.2014.18.2.58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076481/
- Millar, A. C., Lau, A. N., Tomlinson, G., et al. (2016). Predicting low testosterone in aging men: a systematic review. Canadian Medical Association Journal, 188(13), E321-E330. doi:10.1503/cmaj.150262. Retrieved from https://www.cmaj.ca/content/188/13/E321.full
- Park, H. J., Ahn, S. T., & Moon, D. G. (2019). Evolution of guidelines for testosterone replacement therapy. Journal of Clinical Medicine, 8(3), 410. doi:10.3390/jcm8030410. Retrieved from https://www.mdpi.com/2077-0383/8/3/410/htm
- Qaseem, A., Horwitch, C. A., Vijan, S., et al. (2020). Testosterone treatment in adult men with age-related low testosterone: a clinical guideline from the American College of Physicians. Annals of Internal Medicine, 172(2), 126-133. doi:10.7326/M19-0882. Retrieved from https://www.acpjournals.org/doi/full/10.7326/M19-0882
- Rivas, A. M., Mulkey, Z., Lado-Abeal, J., & Yarbrough, S. (2014). Diagnosing and managing low serum testosterone. Baylor University Medical Center Proceedings, 27(4), 321-324. doi:10.1080/08998280.2014.11929145. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/08998280.2014.11929145
- Sooriyamoorthy, T. & Leslie, S. (2022). Erectile dysfunction. StatPearls. Retrieved on Oct. 9, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK562253/
- Zhu, J., Zhang, W., Ou, N., et al. (2020). Do testosterone supplements enhance response to phosphodiesterase 5 inhibitors in men with erectile dysfunction and hypogonadism: a systematic review and meta-analysis. Translational Andrology and Urology, 9(2), 591. doi:10.21037/tau.2020.01.13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215032/