Does low testosterone cause erectile dysfunction (ED)? The short answer: not directly. But there may be a correlation.
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Does low testosterone cause erectile dysfunction (ED)? The short answer: not directly. But there may be a correlation.
It turns out that testosterone levels correlate with sexual desire. Low testosterone levels (sometimes called low T or male hypogonadism) can decrease sexual desire, making it tough to get in the mood for sex and get erect. In that sense, low testosterone may contribute to erectile issues, primarily by reducing libido, but the low level is not typically a direct physiological cause of ED.
Erectile dysfunction is defined as the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. The most common cause of ED is poor blood flow to the penis, often due to conditions like high blood pressure, high cholesterol, or atherosclerosis. Mental health issues like depression can also play a role.
While testosterone plays a role in sexual function, many men with low levels of testosterone can get erections just fine. On the other hand, guys with healthy testosterone levels might find it tough to get and maintain an erection during sex.
So… What’s the deal here?
Below, we’ll discuss testosterone’s role in male sexual health and performance, as well as the effects low T may have on your sex life. We’ll also list other common symptoms of low testosterone levels and steps you can take to increase testosterone levels naturally.
Though researchers still don’t fully understand the precise relationship between low testosterone and erectile dysfunction, they generally agree on two aspects:
First, you don’t need to have normal testosterone levels in order to get or keep an erection during sex.
Second, beyond a certain point, higher testosterone levels don’t appear to lead to stronger, more frequent, or more reliable erections.
Essentially, while testosterone plays a role in overall sexual function, classifying it as a direct cause of ED wouldn’t be entirely accurate. Hormones like testosterone are essential for healthy sexual desire. That said, erectile dysfunction is primarily a vascular issue, not a hormonal one.
An erection is the result of several factors, including sexual stimulation, sexual desire, and blood flow to the tissue of the penis. In other words, it’s a group effort from the brain, body systems, and external stimuli.
Low testosterone levels may cause low libido, an issue that might be linked to ED if you feel little or no desire for sex. However, the issues aren’t necessarily responsible for any changes in blood flow to the penis.
Though low testosterone doesn’t affect blood flow to the penis, there are a few biological ways in which having low T levels may impact erectile function.
Many of the body’s systems that help create and maintain an erection—like nitric oxide production and muscle control in the penis—rely on hormones, including testosterone. But just having low testosterone doesn’t automatically mean you’ll have severe erectile issues.
One 2022 study sought to understand how testosterone levels might affect blood flow in the penis; researchers looked at more than 2,500 men who were having sexual problems. They tested how much blood flowed into the penis after administering a medication that helps cause an erection, and compared that result with each man’s testosterone level.
The researchers found that testosterone was linked to better blood flow, but only slightly. They also found that age and health problems explained most of the differences in blood flow between men, not testosterone.
In summary, testosterone does play a role in erections, but it’s probably a small one, and it mostly matters in older men with very low levels of testosterone.
For most men, other factors like age and overall health have a much bigger impact on erections.
Low T and ED are related in other ways. Many of the common causes of low T are also risk factors or causes of erectile dysfunction.
For example, low testosterone is linked to medical conditions such as:
Obesity
High blood pressure (hypertension)
High cholesterol
These are also common risk factors for erectile dysfunction, given that they can compromise blood flow to the penis and affect sexual performance.
Both erectile function and T levels can also drop temporarily due to poor nutrition, severe illness, and certain medications.
Lastly, low testosterone may affect sex drive and mood, which could also be contributing factors to ED.
If you have any of these risk factors and also have ED, consider talking to your healthcare provider about checking your testosterone levels.
Other symptoms of low testosterone can have a major negative impact on your sexual health and quality of life.
Common signs of low testosterone include:
Reduced sex drive
Small testicles
Delayed or incomplete sexual development
Loss of body hair
Reduced beard growth
Infertility
Reduced bone mass
Increased body fat
Decreased energy and motivation
Depressed mood
Loss of concentration
If you have low testosterone, you might develop one or several of these symptoms.
The more signs you notice, the more critical it is to check your testosterone levels for a potential deficiency.
If you’re experiencing any of the aforementioned symptoms of low T or otherwise suspect your levels could be off, know that you can get them checked.
A medical professional may recommend getting your total testosterone and free testosterone levels checked if you have symptoms like infertility, ED, low sexual interest, and loss of muscle mass.
Hims makes testosterone testing easy with our at-home testosterone testing kits. With telehealth, you can review your results and talk to a licensed provider online, without needing an in-person visit.
The best way to evaluate testosterone levels is through a blood test, and in some cases, you might need to do this step twice to confirm the results.
A typical normal range for early-morning testosterone for men is between 300 and 1,000 ng/dL, so low testosterone may be diagnosed when the level drops below 300 ng/dL.
It might seem cliché, but getting exercise and eating healthy really can do wonders for your health.
A 2019 study of nearly 4,000 men with sexual dysfunction associated testosterone deficiency with diabetes, metabolic diseases, and other chronic illnesses. Since many metabolic diseases can be avoided through diet and exercise, staying active and eating healthy might be a healthy preventative measure that also stands to protect optimal sexual function.
Consider adding more exercise to your schedule, such as daily walks, a quick yoga video, or weekly gym visits. Adding a few more fruits, vegetables, and whole grains to your diet could also be helpful.
But before you make any drastic changes to your diet and exercise routine, chat with a medical provider and ask how testosterone and ED may be affected.
Making healthier food choices and moving your body can help you maintain a healthy weight. As mentioned above, chronic diseases like diabetes and obesity are associated with lower T levels and ED.
According to a 2019 review of research on younger males, low testosterone levels may be caused by underlying conditions that, if remedied, may improve T levels and sexual function. It also suggested that weight loss can increase testosterone levels in men.
A 2014 review found that low testosterone is quite common in obese men because insulin resistance can reduce certain sex hormones. If low T levels result from obesity, it could be possible to restore the levels, but doing so may require substantial weight loss.
High stress levels can lead to issues related to sleep, pain processing, sexual performance anxiety, and more. Stress can be amplified (or even caused) by anxiety and depression, two psychological ED factors.
Mental health issues aside, severe stress could lead to unhealthy coping mechanisms like substance abuse. Abuse of drugs or alcohol is dangerous for myriad reasons, and it’s associated with both low testosterone and erectile dysfunction.
Stress-relieving techniques like meditation, exercise, or talking to a mental health professional could be helpful.
Sleep and stress are also closely connected. Lack of shut-eye could lead to various physical and mental health issues that could, in turn, affect T levels and possibly contribute to ED.
According to the Centers for Disease Control and Prevention (CDC), adults should get seven or more hours of sleep per night.
One small 2011 study of 10 healthy older men examined how one week of sleep restriction to five hours per night affected their testosterone levels. It concluded that daytime testosterone levels decreased by 10 to 15 percent. While more research is needed to confirm conclusive findings, it’s generally accepted that getting enough sleep stands to do you and your health good on many levels.
Eating healthy: important. Eating foods that boost testosterone: even better.
There’s no harm in adopting a diet that’s also a testosterone booster (that is, of course, if you’re not allergic or sensitive to any of these foods). T-level-boosting supplements could help, too.
Some foods may boost testosterone by curbing the body’s natural process of converting the male hormone into estrogen. However, most evidence remains preliminary and requires further validation in large human studies.
If you’re curious, a 2021 review examined which foods, extracts, and supplements pulled this off best. Some of the listed foods that were found to support testosterone production include. But while some foods and plant extracts may influence testosterone pathways in lab settings, their real-world impact on hormone levels in humans is still under investigation:
Ginseng
Red wine (Cabernet Sauvignon seems to be best)
Grape seed extract
White button mushrooms
Red clover flower
Mangosteen extract
Extract from saw palmetto
Collard green extract
Green tea
Chamomile tea
Coffee
Cocoa
Kale
Potato
Parsley
Celery
The review also noted that boron, an element found in various foods, may increase testosterone concentrations. Foods containing large amounts of boron include:
Fruit
Milk
Beans
Potatoes
Sweet potatoes
Legumes
Coffee
Cider
Wine
Beer
If you deal with erectile dysfunction, you might want to seek reinforcements through pharmaceutical treatments, particularly the PDE5 inhibitors, which help increase blood flow to the penis.
PDE5-inhibiting ED treatments include:
Sildenafil. Sildenafil is both the active ingredient in and the generic form of Viagra®. It provides relief from ED for around four hours per dose.
Tadalafil. Tadalafil is the active ingredient and generic version of Cialis®. It’s a longer-lasting ED medication that can work for up to 36 hours per dose.
Stendra®. Also sold in generic form as avanafil, Stendra® is a second-generation ED medication that’s fast to work and less likely to cause certain side effects associated with other ED drugs.
Don’t love taking oral medications? Consider chewable ED hard mints.
One treatment option for low T is testosterone replacement therapy (TRT), which involves taking prescription testosterone in the form of an injection, patch, gel, pill, or pellet.
The effect of testosterone on ED is mostly positive. For instance, one 2017 review found that TRT can improve erectile function in men with mild ED, but may not be as effective in men with moderate or severe ED.
In men with low testosterone who don’t respond to PDE5 inhibitors like Viagra or Cialis, regulating testosterone levels with TRT may help improve the response to these medications.
TRT may improve erectile function primarily in men with confirmed hypogonadism and suboptimal response to PDE5 inhibitors.
It’s important to note that TRT isn’t for everyone. TRT may reduce sperm count and cause infertility in men, which makes it a less-than-ideal option for men who are trying to conceive.
In that case, you can ask your healthcare provider about fertility-safe testosterone treatments like enclomiphene citrate, a compounded medication that supports your body’s natural testosterone production. Though there’s not enough evidence linking enclomiphene to improved erectile function, it can be a good alternative to men with low testosterone who are concerned about their fertility.
If you want to improve your erectile function and low testosterone levels at the same time, you may want to consider a 2-in-1 combination treatment like Hims Testosterone Rx with Enclomiphene & Tadalafil. The medication supports your body’s natural testosterone production and improves blood flow to the penis without negatively affecting your sperm count.
Lab testing can be completed at home, and follow-up care can be done via telehealth. A provider reviews your results and discusses safe, personalized treatment options.
Low testosterone doesn’t exactly cause ED, but there’s significant overlap between medical and mental health conditions that can contribute to both ED and low T levels.
By changing up your lifestyle habits, treating underlying health conditions, and considering medication, you can boost testosterone levels and get your sex life back on track.
Here’s what to remember:
Aging can affect your hormonal and sexual health. As you age, your testosterone levels naturally decrease, and erectile dysfunction may be more likely to occur.
ED and low T may or may not be signs of an underlying condition. Obesity, lack of sleep, high stress levels, and conditions like diabetes are risk factors for both low T and ED.
Lifestyle changes and medical treatments can help. Erectile dysfunction medications like Viagra, Cialis, and Stendra may help you get and maintain better erections. Testosterone replacement therapy is another option if you have low T. If you’re interested in exploring any of these options, it’s important you discuss them with a healthcare professional.
You’ll also want to loop in your provider on any changes or abnormalities in your sexual activity. They can help you figure out the root cause(s) of what you’re navigating to land on the best treatment option available to you.
Want to learn more about erectile dysfunction and how to solve some of the most common men’s health problems? Get advice from a healthcare provider today.
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