Reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
As a man, your testosterone levels play a key role in many aspects of your sexual desire and function, including your general level of interest in sex.
As such, it might seem logical that low levels of testosterone can result in erectile dysfunction (ED). However, the relationship between your testosterone levels and your erections is a little more complicated.
While testosterone definitely plays a role in your sexual function, many men with low levels of testosterone (also referred to as low-T or hypogonadism) can get erections just fine.
On the other hand, many guys with healthy testosterone levels find it hard to get and maintain an erection during sex.
Below, we’ve discussed testosterone’s role in male sexual health and performance, as well as the effects that low testosterone may have on your sex life.
We’ve also listed other common symptoms you may experience if you have low testosterone levels, as well as the steps that you can take to remedy this.
Testosterone is the main male sex hormone in your body. It’s produced in your testes and plays a key role in everything from the development of your musculoskeletal system to secondary sex characteristics such as your voice and body hair.
Beyond its obvious effects on the physical side of being a man, testosterone is also responsible for many aspects of your cognitive function.
As a man, it’s normal to have a total testosterone level between 300 and 1,000 nanograms per deciliter (ng/dL) or 10 and 35 nanomoles per liter (nmol/L).
Testosterone levels usually decline with age. Most men reach their peak testosterone levels in their 30s, after which the amount of testosterone produced by their testicles gradually declines to a lower level.
If your testosterone levels are below this range or unusually low relatively to your age, you may be diagnosed with low testosterone, or low-T.
Low testosterone can affect men in all age groups. However, it’s most common in middle-aged and older men.
According to data published in the journal, Frontiers in Endocrinology, approximately 40 percent of men over 45 and 50 percent of men in their 80s are hypogonadal, meaning their bodies don’t produce enough testosterone to place them in the normal reference range.
In younger men, low testosterone isn’t so common. According to the Urology Care Foundation, only around one percent of young men are affected by low testosterone, although reliable data isn’t very easy to come by.
Low testosterone can develop for a variety of reasons, ranging from medical issues to lifestyle factors.
In addition to aging and obesity, common causes of low testosterone include testicular damage, autoimmune diseases, infections and metabolic syndrome -- a cluster of medical conditions that includes high blood pressure (hypertension), high blood sugar and fat around the waist.
In some cases, testosterone levels may be low because of genetic conditions, such as Noonan syndrome or Klinefelter syndrome, or due to certain types of medication.
Although testosterone certainly plays a role in your sexual function as a whole, the idea that it’s a common cause of erectile dysfunction doesn’t appear to be true.
Hormones like testosterone are vital for healthy sexual desire. However, erectile dysfunction is primarily a vascular issue, not a hormonal one.
Erections develop due to a combination of factors, including sexual stimulation and the effects of blood flow into the tissue of your penis.
When you’re sexually aroused, the nerves inside your brain and around your penis cause the muscles that control blood flow into your penis to relax, allowing blood to flow into the pairs of erectile tissue called the corpora cavernosa.
As blood flows into this tissue, a fibrous membrane called the tunica albuginea contracts and seals the blood inside your penis, resulting in an erection.
This process takes place in reverse after you reach orgasm and ejaculate, with blood flowing out from your penis and the erection disappearing.
While low testosterone levels may affect your level of sexual arousal -- an issue that might be linked to ED if you feel little or no desire for sex -- they don’t appear to be responsible for any changes in blood flow to your penis.
Though researchers still don’t fully understand the precise relationship between testosterone and erectile dysfunction, they generally agree on two things.
The first is that you don’t need to have normal testosterone levels to get or keep an erection during sex. So no need to go searching for the best testosterone booster for ED just yet.
The second is that, beyond a certain point, higher testosterone levels don’t appear to lead to stronger, more frequent or more reliable erections. But can you get an erection without testes?
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While low testosterone doesn’t necessarily cause erectile dysfunction, many of the potential contributing factors for both conditions overlap.
For example, low testosterone is associated with obesity, high blood pressure, heart disease and type 2 diabetes.
These are also common risk factors for erectile dysfunction that can compromise blood flow to your penis and affect your sexual performance.
If you’ve been diagnosed with any of these risk factors and have ED, you may want to consider talking to your healthcare provider about checking your testosterone levels.
Although low testosterone likely isn’t to blame for ED in most men, it can cause a wide range of different symptoms.
Some of these symptoms may have a major negative impact on your sexual health and general quality of life.
Common symptoms of low testosterone include:
Reduced sex drive
Loss of body hair
Reduced beard growth
Feelings of tiredness (fatigue)
Increase in body fat
Lower muscle mass and physical strength
Changes in mood, such as symptoms of depression
Difficulty focusing, remembering things and doing well at work
If you have low testosterone, you may develop one or several of these symptoms.
The more of these symptoms you notice, the more important it is to get your testosterone levels checked for a potential deficiency.
A variety of factors play a role in how much testosterone your body produces, from your general fitness level to your age, lifestyle and habits.
Making small, simple changes to your habits and lifestyle can often increase your testosterone production and improve your quality of life. Try to:
Research published in the European Journal of Applied Physiology shows that regular physical activity is associated with a higher level of testosterone, as well as luteinizing hormone (LH) and follicle-stimulating hormone (FSH) -- supporting hormones that assist in testosterone production.
Try to exercise regularly, whether it’s a walk or bike ride every day, weight training or a combination of different forms of exercise.
Stress triggers the release of cortisol, a hormone that may reduce testosterone levels. Try to minimize your exposure to sources of stress at work, around the house or in other environments.
Research published in the Asian Journal of Andrology has found that obesity may reduce testosterone levels by suppressing the hypothalamic–pituitary–thyroid axis (HPT axis) -- a part of the neuroendocrine system that’s responsible for regulating hormone production.
If you’re overweight or obese, try to lose weight. It’s best to aim for a BMI in the normal range, which is between 18.5 and 24.9.
Your testosterone levels increase when you sleep and fall when you’re awake, meaning it’s important to get enough sleep for optimal testosterone production.
Try to sleep for at least seven hours per night -- the CDC’s recommendation for healthy adults.
Foods such as, legumes, fatty fish, oysters, beef liver and leafy green vegetables are rich in nutrients that may help to boost your testosterone production.
Similarly, certain supplements, such as vitamin D, ashwagandha, zinc and magnesium may help to stimulate testosterone production.
Our guide to increasing your testosterone levels goes into more detail about the strategies listed above and other techniques that you can use to stimulate testosterone production.
If you have low testosterone that doesn’t improve with natural lifestyle changes, your healthcare provider may bring up testosterone replacement therapy, or TRT.
TRT involves using artificial testosterone to replace the testosterone that’s produced naturally in your testes. This can help you to maintain healthy testosterone levels even if your natural levels are low.
Testosterone comes in several forms, including topical gels, patches, capsules and an injectable solution.
Although testosterone replacement therapy can increase your testosterone levels, it comes with a risk of causing side effects.
Immediate side effects of TRT can include acne, swelling in the ankles, tenderness in the breast tissue and disturbed breathing during sleep.
These affect a relatively small percentage of men who use therapeutic testosterone.
TRT can also cause an increase in red blood cell count, which may increase your risk for blood clotting.
Over the long term, men who use TRT appear to have a higher risk for cardiovascular problems, such as heart disease, heart attack and stroke.
However, research is mixed on the relationship between testosterone and high cholesterol.
TRT may also cause prostate enlargement, which is a common issue for middle-aged and older men.
It’s worth noting that the potential side effects of testosterone replacement therapy are still being actively studied.
It’s also important to note that testosterone is a mild contraceptive that can reduce sperm count and fertility.
If you’re prescribed testosterone, you may want to undergo semen analysis if you plan to have children in the near future.
Testosterone hormone replacement may also cause your body’s natural testosterone production to reduce or stop completely – a side effect that may be irreversible.
For these reasons, if you have low-T, it’s best to try natural approaches to stimulate testosterone production before you turn to testosterone replacement therapy.
Although the relationship between testosterone and erections is debatable, there’s a very clear link between testosterone and your sex drive.
Research published in the Journal of Clinical Endocrinology & Metabolism shows that men with low sex drive are more likely to have low testosterone than their peers.
Other studies, such as this one published in the journal, Current Opinion in Urology, have found that men with low testosterone who are treated with TRT are likely to experience an increase in sexual desire.
Interestingly, this research also found that men with low testosterone often report getting better erections following testosterone treatment.
This may be caused by testosterone’s effects on your level of interest in sex and the stimulation required to get an erection.
Healthy, reliable erections require a combination of psychological arousal and steady blood flow to the erectile tissue of your penis.
While low testosterone may affect your level of arousal, it doesn’t appear to have any significant impact on blood flow throughout your body.
If you’ve noticed the signs of low testosterone and erection issues, you may want to talk to your healthcare provider about getting a blood test to check your testosterone levels.
If you have low testosterone, your healthcare provider may suggest making certain changes to your lifestyle or undergoing testosterone replacement therapy (TRT).
However, if you have erectile dysfunction with normal levels of testosterone, you’ll likely notice more of an improvement by using ED medication.
We offer several FDA-approved ED medications online following a consultation with a licensed healthcare provider, including sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®) and Stendra®.
Our guide to erectile dysfunction goes into more detail about the causes of ED and the options you have available to improve your erections and sexual performance.