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The Low-Down on Testosterone and Its Role in Erectile Dysfunction

Kristin Hall, FNP
Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 5/12/2020

As a man, your testosterone levels are closely linked to your sexual function but is low-T the reason for your erectile dysfunction? It may seem logical that low levels of testosterone might contribute to impotence but, in reality, this is rarely the case. In fact, many men who experience erectile dysfunction have normal levels of this essential male hormone.

So, what role does testosterone really play in male reproductive health and does it really have an effect on your sexual performance? Here’s what you need to know about testosterone and its relationship to erectile dysfunction.

Everything You Need to Know About Testosterone

According to the American Urological Association, about 1 in 5 men over the age of 60 have low testosterone levels but this is a problem that affects younger men as well. In fact, by the time you hit 30, your testosterone levels are probably already on their way down. Whereas a woman’s estrogen level eventually reaches zero during menopause, a man’s testosterone level never bottoms out but declining levels of this hormone may contribute to physical symptoms including daytime fatigue, loss of muscle mass, and low sex drive.

Testosterone is a male sex hormone that belongs to a class of hormones known as androgens. This hormone is primarily produced in the testes, though the adrenal glands produce a little bit as well. Testosterone production is regulated by the hypothalamus in the brain which sends a message to the pituitary gland – the pituitary gland then passes the message along to the testes to stimulate testosterone production.

Prior to birth, testosterone plays a role in the development of male sex organs and, at puberty, it is involved in developing secondary sex characteristics such as the growth of body hair and facial hair, the deepening of the voice, and increased penis and testes size.

In addition to its role in the development of male characteristics, testosterone is also involved in sperm production and sex drive. Low testosterone levels have been associated with erectile dysfunction, reduced sperm count, loss of muscle mass or hair, reduced sex drive, and increased breast size. Just because erectile dysfunction may be a symptom of low testosterone levels, however, doesn’t mean that low-T causes ED. Keep reading to learn why.

Debunking the Myth About Low-T and Erectile Dysfunction

Low testosterone levels may affect your sex drive and your ability to reach orgasm, but they do not have a physiological impact on your ability to achieve or maintain an erection. It is important to understand that erectile dysfunction is primarily a vascular issue, not a hormonal one. In order to achieve an erection, you must have adequate blood flow to the penis and that requires a healthy heart and strong circulation – your testosterone levels don’t have anything to do with this.

Though researchers still don’t fully understand the relationship between testosterone and erectile dysfunction, they know two things for certain:

  1. Normal testosterone levels are not required to achieve a normal erection.
  2. Increasing testosterone levels (such as with testosterone therapy) does not increase the strength or frequency of erections.

Though low-T does not necessarily cause erectile dysfunction, many of the contributing factors for both conditions overlap. For example, low testosterone can be caused by high blood pressure, obesity, high cholesterol, and type 2 diabetes. These and other conditions have been identified as risk factors for erectile dysfunction, particularly in regard to their effect on nerve and vascular function.

The Dangers of Testosterone Replacement Therapy

By now it should be clear to you that your testosterone levels are not to blame for your erectile dysfunction but low-T can contribute to symptoms unpleasant enough that you may want to seek treatment. In addition to affecting your sex drive, low testosterone may cause the following:

  • Hair loss
  • Extreme fatigue
  • Loss of muscle mass
  • Increased body fat
  • Decreased bone mass
  • Changes in mood
  • Difficulty concentrating

In cases where these symptoms because severe enough to warrant treatment, testosterone replacement therapy is an option. Unfortunately, there is no way to supplement your body’s natural testosterone production but testosterone replacement therapy (TRT), or hormone replacement therapy (HRT), does exist. Treatment options include medications, topical gels, patches, and injections.

Though testosterone replacement therapy may boost testosterone levels, it is generally only recommended as a short-term treatment because it comes with a high risk for side effects. It is also worth noting that the long-term safety of TRT is still being studied. Interestingly, testosterone replacement therapy might actually reduce your sperm count and these effects could be permanent.

Short-term side effects of TRT may include increased appetite, changes in mood, nausea, and vomiting. In addition to reduced sperm count or permanent sterility, some of the long-term effects of TRT may include the following:

  • Difficulty urinating
  • Increase in red blood cell count
  • Liver problems
  • Prostate tissue growth and/or tumors
  • Fluid retention
  • Shrinking of the testicles
  • Permanent dependence on TRT

Testosterone hormone replacement may also cause your body’s natural testosterone production to stop – this too may be irreversible. For all of these reasons, you need to think very carefully and consult your doctor before even considering TRT as an option.

This treatment is typically reserved for older men with low-T and those experiencing extreme fatigue. If you want to become a father someday, TRT could make that impossible, so be careful.

Although testosterone replacement therapy is generally not a smart choice for younger men, you do have other options. If obesity is a factor, losing weight may boost your natural testosterone production. Short periods of high-intensity exercise have also been shown to elevate testosterone levels.

Increasing your intake of certain nutrients such as zinc, Vitamin D, healthy fats, and branch chain amino acids (BCAAs) are beneficial for healthy testosterone production and limiting your intake of refined sugar will help you out as well.

Though low-T may not be the cause for your erectile dysfunction, testosterone definitely plays an important role in your sexual health and libido. If you’re concerned about your testosterone levels, talk to your doctor about getting a blood test to see whether your levels are within the normal range.

If not, consider natural options for boosting your body’s testosterone production before you even think about testosterone replacement therapy. You may be surprised to learn that some of the simplest changes to your lifestyle and diet might have the biggest benefit.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.