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Male Hypogonadism & Erectile Dysfunction (ED): What to Know

Katelyn Hagerty

Reviewed by Katelyn Hagerty, FNP

Written by Nicholas Gibson

Published 02/17/2023

Levels of testosterone, the primary male sex hormone, vary from man to man. However, some men may have hypogonadism, a condition in which the male body doesn’t produce enough testosterone for optimal health and wellbeing.

Hypogonadism, or low testosterone, can have a noticeable effect on just about every aspect of your life, including your sexual function.

But is there a link between male hypogonadism and erectile dysfunction (ED)? While the exact link between low testosterone levels and ED isn’t completely understood, weak erections — or difficulty getting an erection at all — are a known symptom of hypogonadism.

The good news is that both low testosterone production and erectile dysfunction can be treated successfully, usually with a combination of medication and lifestyle changes. 

Below, we’ve discussed what hypogonadism is, as well as the key differences between primary and secondary hypogonadism. We’ve also explained the link between the levels of testosterone in your blood (serum testosterone levels) and your risk of sexual dysfunction, including erectile dysfunction.

Finally, we’ve shared treatment options that you can use to treat testosterone deficiency caused by hypogonadism, as well as the erectile dysfunction it can potentially cause.

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What is Hypogonadism in Men?

Hypogonadism is a condition in which your body doesn’t produce enough testosterone. It’s often referred to as low testosterone, testosterone deficiency or “low-T.”

The term “hypogonadism” refers to the activity of the gonads — in men, the testes, or balls. The prefix “hypo” means “below normal,” with the term hypogonadism referring to lower than normal testicular function.

Your body produces testosterone through a complex process that involves not only your testes, but also your pituitary gland.

In men, the normal range for testosterone is between 300 and 1,000 nanograms per deciliter of blood (ng/dL), or 10 to 35 nanomoles per liter (nmol/L).

If you have hypogonadism, your testes may still produce some testosterone, but not enough to put your serum testosterone concentration within this range.

There are two types of hypogonadism — primary and secondary. Primary hypogonadism can develop when there’s a specific problem with your testicles, such as a congenital problem or a physical injury that damages your testicles.

When this type of hypogonadism develops early in your life, it may cause issues related to your secondary sex characteristics, such as your bone structure, pubic hair, facial hair and voice. 

Secondary hypogonadism can develop when a problem occurs elsewhere in your body, such as in the areas of your brain responsible for controlling the function of your testes.

For example, a disease, pituitary disorder or certain medications could all affect the function of parts of your brain that are involved in testosterone production. 

Symptoms of Male Hypogonadism

Hypogonadism can cause a range of symptoms, including several that could affect your sexual performance and general sexual satisfaction.

Common clinical symptoms of male hypogonadism include:

  • Low sexual desire. Testosterone plays a key role in regulating your sex drive. If you’re affected by low testosterone levels, you may notice that you start to feel less interested in sexual activity than normal.

  • Reduced sperm count. Your testicles are responsible for sperm production. If you have hypogonadism, you may have a lower-than-normal sperm count, affecting your ability to impregnate your partner.

  • Reduced muscle mass and strength. Testosterone is an important anabolic hormone that plays a major role in producing muscle. If you have subnormal testosterone levels, you may feel weaker than normal and find it difficult to put on muscle.

  • Increased body fat levels. In addition to losing strength and muscle, you may find that you gain fat more easily. This could result in a general increase in body fat or extra fat in certain areas, such as around your waist.

  • Reduced bone strength. Testosterone is involved in ensuring your bones stay healthy and strong. If you have hypogonadism, you may notice that your bones are weaker and more at risk of fracturing.

  • Difficulty falling asleep or staying asleep. Suboptimal testosterone levels could affect your sleep, causing sleep disorders like insomnia (difficulty falling asleep, staying asleep or getting high quality sleep throughout the entire night).

  • Poor concentration. You may find it more difficult to focus on specific tasks, remember information or get things done. While the association isn’t perfectly clear, research has linked hypogonadism to lower cognitive function in some men.

  • Mood changes and/or depression. Testosterone helps to boost your energy levels and regulate your moods. If you have low endogenous testosterone, you may be more at risk of developing depression.

Not all hypogonadal males display all of these symptoms. You may have one or two symptoms that are more obvious than others, or a combination of symptoms that affect your wellbeing and general quality of life. 

Is There a Link Between Hypogonadism and Erectile Dysfunction?

In addition to potentially affecting your sex drive, strength and general health, there’s also a link between male hypogonadism and erectile dysfunction.

Testosterone is heavily involved in maintaining your sex drive and producing erections — ED is one of several known symptoms of low testosterone levels.

However, it’s important to understand that the link between hypogonadism and ED isn’t quite as simple as it might seem. Put simply, low testosterone may not always cause ED, nor is ED always caused by low testosterone.

Healthy erections depend on a variety of factors, including sexual desire, sexual stimulation and strong, consistent blood flow. 

When you’re sexually stimulated, blood flows into the erectile tissue inside your penis. This flow of blood causes your penis to become larger and firmer, creating an erection that’s hard enough for penetrative sex

Erectile dysfunction often occurs when one or several issues affect sexual arousal, blood flow or other aspects of sexual function.

For example, common physical causes of ED include heart disease, hypertension, diabetes and metabolic syndrome, which may affect blood flow and nerve function.

Psychological causes include sexual performance anxiety, depression, feelings of guilt related to sex and low self-esteem.

To learn more, you can read our article on the link between low testosterone and anxiety.

Low testosterone can also affect your level of sexual desire, which may make it harder for you to get hard in response to sexual stimulation. It’s also linked with depression, which can have a significant effect on your response to sexual contact.

There’s also a link between low testosterone levels and coronary artery disease (CAD), diabetes and metabolic syndrome in men. These conditions may affect blood flow to the penis and make getting and staying hard more difficult for you. 

In other words, while low testosterone doesn’t seem to cause erectile dysfunction directly, there is a significant overlap between hypogonadism and factors that can cause ED in men. 

Our guide to low testosterone and its role in erectile dysfunction covers this relationship in more detail, including how normal testosterone levels aren’t necessarily essential for having sex. 

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How to Treat Hypogonadism

Hypogonadism is a treatable condition. For adults, the most common form of treatment for low testosterone production is testosterone replacement therapy, or TRT.

This type of treatment involves using exogenous testosterone to supplement the small amounts of testosterone your body produces naturally. You can think of it as “topping up” the testosterone that’s produced in your testes to help you reach a healthy level of this hormone. 

Testosterone is available in several forms, including a gel, patch, implant, pill and injection. Your healthcare provider will work with you to select the best form of testosterone for your needs and work out a dosage that helps you maintain a normal testosterone level.

TRT is effective for most men. Many men with hypogonadism report beneficial effects after they start treatment with testosterone, including a stronger sex drive and improved physical function. 

However, TRT also has potential risks and adverse effects, including changes in your fertility, a higher risk of blood clots, prostate enlargement, sleep problems and increases in your levels of cholesterol.

We’ve talked about these in our guide to testosterone replacement therapy. If you’re prescribed testosterone, your healthcare provider will likely ask you to come in for checkups to assess your health and wellbeing.

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How to Treat Erectile Dysfunction

Much like hypogonadism, erectile dysfunction is also a treatable condition. If you’re affected by ED, you can improve your erections and sexual performance by using medication and making changes to your lifestyle to promote better general health.

Currently, the most effective way to treat erectile dysfunction is by using medications referred to as PDE5 inhibitors. These medications, which come in oral form, work by increasing blood flow to the erectile tissue inside your penis.

Popular PDE5 inhibitors include sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®).

We offer several of these medications online as part of our range of ED treatments, following a consultation with a healthcare provider who will determine if a prescription is appropriate.

In addition to using medication to improve your erections, making small changes to your habits can often have a real impact on your sexual function and physical performance, including your ability to get and maintain an erection. 

Try to eat a balanced diet, stay physically active, limit your alcohol consumption and maintain a healthy body weight to improve blood flow and reduce your risk of ED

If you smoke, quitting can have a positive impact on your erections and your general health, as smoking is associated with an elevated risk of experiencing erection problems. 

Our guide to maintaining an erection goes into more detail on these tips, as well as other tactics that you can use to improve your erections and sexual function. 

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The Bottom Line on Male Hypogonadism and Erectile Dysfunction

Male hypogonadism is a serious condition that can have a significant impact on your health and quality of life, including your erections and sexual performance.

If you have hypogonadism, your level of interest in sex may be reduced, and you may have a higher risk of issues such as erectile dysfunction.

If you’re worried that you might have hypogonadism, it’s best to talk to your healthcare provider as soon as you can. They’ll be able to se blood tests to check your testosterone levels and, if they’re low, give a diagnosis of hypogonadism. 

In some cases, they might suggest using testosterone replacement therapy to bring your levels of testosterone back up to normal. 

If you have normal testosterone levels but still find it difficult to get or maintain an erection, using medication can make getting hard and enjoying sex easier. You can get started by taking part in an ED consultation via our telehealth platform.

Want to learn more before taking action? Our guide to the signs of low testosterone in men goes into more detail about what to look out for if you’re worried about hypogonadism, while our guide to the most common ED treatments covers your options for improving your erections.

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