Can Low Testosterone Cause Erectile Dysfunction(ED)?

The Connection Between Low Testosterone and Erectile Dysfunction

Erectile dysfunction is an inability to either maintain or produce an erection that is firm enough to have sexual intercourse. Although erectile dysfunction may be caused by so many underlying conditions such as atherosclerosis, diabetes, high blood pressure, smoking, and high cholesterol, there is no gainsaying that low testosterone is also one of the main causes of erectile dysfunction. The argument for this is even stronger when one considers the fact that several of the disorders that cause erectile dysfunction, such as obesity, metabolic syndrome, diabetes, and endothelial dysfunction, have some kind of relationship with low testosterone. In this blog post, we will explain what testosterone is, its relationship with erectile dysfunction and low libido, and decide whether testosterone replacement therapy is the best solution for anyone with this condition.


Testosterone is primarily a male sex hormone that is generated in men’s testicles. It also controls fertility, muscle mass, fat distribution, the synthesis of red blood cells, and sex drive. High or low testosterone levels can cause dysfunction in regions of the body that are normally regulated by the hormone. For example, when testosterone levels fall below healthy levels, it can cause hypogonadism or infertility. Also, when a man has lower testosterone, it can reduce his sex drive and his ability to have satisfying sex. Low testosterone can cause sexual issues like erectile dysfunction and a lack of sex drive. As people get older, their testosterone levels naturally decline. Low testosterone is diagnosed using a blood test that measures the level of testosterone in the blood. Because testosterone levels fluctuate throughout the day, it may take many measurements to determine if a patient has low testosterone.


The exact mechanism by which testosterone boosts libido is still a mystery to researchers. Although libido varies greatly among men, it is usual for men’s sex drive to gradually drop after reaching its peak in their teens and 20s. A low sex drive for one man could not be for another. Additionally, each man’s sex drive evolves through time and is influenced by stress, sleep, and sex possibilities. These factors make it extremely difficult to define a “normal” sex drive. A lack of sex drive is typically recognized as an issue by the males themselves. Sometimes, their partner might view it as a problem.

Feeling sexually inactive is not necessarily one of the signs of low testosterone. Even when their testosterone levels are low, some men still feel the urge to mate. Others may experience low libido while having appropriate testosterone levels. However, one of the potential causes of poor libido is low testosterone. Almost all men will experience some drop in sex drive if testosterone levels are sufficiently lowered.

About 11% of men overall in a sizable Massachusetts sample of men reported having little sex drive. The researchers next measured the testosterone levels of each man. Low libido was present in about 28% of males with low testosterone. With an average age of 47, these men were quite young; older men can experience more severe sexual complaints.

Insufficient libido can have many different causes, including low testosterone. A man’s desire for sex can also be diminished by stress, lack of sleep, sadness, and long-term medical conditions.


Erectile dysfunction (ED) is a highly prevalent multi-dimensional condition that negatively affects sexual and reproductive activities. As a result, it can significantly lower both the patient’s and his partner’s quality of life. ED is the most prevalent endocrine condition among men, according to a 2009 study of all population-based research carried out in the US. According to a European survey, the prevalence of ED in men increases with age.

Erectile dysfunction, or ED, is uncommonly brought on by low testosterone on its own. A small number of men with erectile dysfunction are caused by low testosterone alone, without any underlying health issues.

Atherosclerosis, or the hardening of the arteries, is the most common cause of erection issues. The tiniest blood capillaries that supply the penis must be unharmed in order to widen and provide the powerful blood flow required for a solid erection. The four main contributors to atherosclerosis and erectile dysfunction are diabetes, high blood pressure, smoking, and high cholesterol.

Atherosclerosis and low testosterone frequently work together to cause erectile dysfunction. One in three men who mention ED to their doctor has low testosterone, according to studies. Low testosterone may significantly contribute to erectile dysfunction in men who also have other underlying conditions, according to experts, aggravating an already challenging circumstance.

Several of the disorders that cause erectile dysfunction, such as obesity, metabolic syndrome, diabetes, and endothelial dysfunction, have some kind of relationship with low testosterone, which serves to strengthen the association.

The correlations between different medical disorders and low testosterone can be strong even when low testosterone isn’t known to cause them.

Many men find that testosterone therapy increases their libido desire and sexual satisfaction. The hazards and advantages of testosterone replacement therapy over the long term, however, are uncertain. Although results on testosterone replacement in males are still years away, research trials are still being conducted.

Five key observations made by Corona, G., and Maggi, M. in a study on the function of testosterone in erectile dysfunction are:

  • Male sexual behavior and attitudes are influenced by testosterone, in addition to the mechanical process of penile erection.
  • The three elements of erectile dysfunction—organic, intrapsychic, and relationship—can all be affected by changes in testosterone levels (ED).
  • Due to the complicated pathophysiology of ED, TRT alone may not be effective in all instances.
  • In hypogonadal patients with ED, testosterone replacement therapy (TRT) need to be the primary line of treatment.
  • Combination therapy using phosphodiesterase five inhibitors may help in certain situations.


Testosterone Replacement Therapy (TRT), also referred to as androgen replacement therapy is a medical procedure that is generally used to treat low testosterone levels in males. Increasing your testosterone through testosterone replacement treatment (TRT) generally won’t assist your ED if it is within the normal range. You must instead identify and deal with other reasons. TRT has a better track record than treating ED in reviving a man’s sex desire in men who actually have low testosterone levels. Even though many men on TRT report improvements in their erections, they frequently require additional assistance from ED medications known as PDE-5 inhibitors, such as:

  • sildenafil (Viagra)
  • avanafil (Stendra)
  • vardenafil (Levitra)
  • tadalafil (Cialis)

By boosting blood flow to the penis, these medications promote erections. On the other hand, some low T men don’t respond to these medications without additionally undergoing TRT. According to certain studies, TRT-induced erection improvements could not persist over time. By reviving a man’s libido and lifting his spirits, treating low testosterone can enhance his sexual life and rekindle his desire for sex. TRT may help guard against some of the risk factors for ED in men with low testosterone by lowering belly fat, improving insulin sensitivity, and reducing the chance of developing diabetes.

According to some studies, TRT may improve heart health in men with low T levels, yet it can exacerbate heart disease when used in large doses. TRT does have dangers and side effects, and further research is needed to determine its long-term effectiveness and safety. Acne, testicular shrinking, and bigger breasts are some of the negative effects of TRT.

Your doctor may recommend a trial of TRT if you have low testosterone and ED to determine whether increasing your testosterone levels will help improve other low T symptoms and the quality of your erections. Regular exercise and a balanced diet, especially if you’re overweight or obese, can also help to raise your testosterone levels in addition to low T treatment. Both can raise libido and ED as well.

In spite of the fact that endocrine diseases themselves are among the rarest of all causes of ED, Rajfer J.’s research on the connection between testosterone and erectile dysfunction found that hypogonadism is the most frequent cause of endocrinopathy leading to ED. Age-related decreases in blood testosterone levels are a common occurrence in males, but these levels are typically too high to cause erectile dysfunction (ED). If there are no restrictions on taking exogenous androgens in this situation, treatment with them is advised when hypogonadism is suspected of being the cause of ED. After a limited period of exogenous testosterone therapy, if the ED has not improved, additional explanations (vascular and/or neurologic) must be considered. Because of additional constitutional symptoms, even men with normal serum testosterone levels may need or seek exogenous testosterone therapy. Every six to twelve months, patients receiving long-term androgen therapy need to have their PSA, hematocrit, and liver enzymes checked.


The body may retain too much fluid as a result of testosterone therapy. Acne, an enlarged prostate, and swollen breasts can also be brought on by it. Reduced fertility, an increase in red blood cells, and an increase in sleep apnea symptoms are some additional negative effects. Women and kids should refrain from touching parts of the skin where a guy has applied testosterone gel that are unwashed or unclothed. Skin contact has the potential to spread the gel.

The Food and Drug Administration (FDA) has determined that there is a chance that testosterone usage increases cardiovascular risk (issues with the heart and blood arteries), notwithstanding the conflicting evidence currently available. Only drugs that have been approved by the FDA should be used, according to the AUA, and physical exams and follow-up care are crucial.

A skin patch, gel, or injection can be used as a testosterone treatment. These are all pricey. Depending on the treatment, they could run you hundreds of dollars each month. To get and maintain the maximum benefit, men who utilize a testosterone treatment must continue to do so.

Consult your doctor if you haven’t had an erection in three months. He or she will enquire about each symptom you have and perform a physical examination. Less sex desire, body hair loss, breast growth, the need to shave less frequently, a decline in muscle size and strength, and more easily broken bones are all signs of low testosterone. Your doctor can order a blood test to check your testosterone levels if you have some of these symptoms. More than one blood test should be performed. When testosterone levels are at their peak, the morning is the best time to do it. If no other cause is found for your low testosterone, testosterone therapy would be appropriate.

Due to the above-stated risks of getting testosterone replacement therapy for erectile dysfunction, it is important to get it done by experts with years of experience, and that’s why we proudly recommend you our HRT Doctors Group clinic where a team of board-certified doctors is committed to addressing many hormonal issues in both men and women. If you have any additional questions about this topic, feel free to contact us! Our doctor consultations are available by phone or video call, so no more sitting in the waiting room!

Research Citations

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  • Corona, G. et al. Age related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J. Sex. Med. doi:10.1111/ j.1743-6109.2009.01601.x
  • Corona, G., Maggi, M. The role of testosterone in erectile dysfunction. Nat Rev Urol 7, 46–56 (2010).
  • Golden, S. H., robinson, K. A., Saldanha, I., Anton, B. & Ladenson, P. w. Clinical review: prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J. Clin. Endocrinol. Metab. 94, 1853–1878 (2009).
  • Mikhail N. Does testosterone have a role in erectile function? Am J Med. 2006 May;119(5):373-82. doi: 10.1016/j.amjmed.2005.07.042. PMID: 16651047.
  • Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol. 2000;2(2):122-128.
  • Traish AM, Goldstein I, Kim NN. Testosterone and erectile function: from basic research to a new clinical paradigm for managing men with androgen insufficiency and erectile dysfunction. Eur Urol. 2007;52(1):54-70. doi:10.1016/j.eururo.2007.02.034