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Does Low Testosterone Cause Erectile Dysfunction?


As men age, production of testosterone, the male sex hormone, naturally falls (one in five men over the age of 60 suffer from low testosterone). There are also a number of medical conditions that can lower testosterone production, even among younger men.

If testosterone levels are too low, it can cause a number of problems, including:

  • Low libido, or sex drive.
  • Lowered ability to achieve orgasm.
  • Loss of muscle mass.
  • Loss of bone density (osteoporosis).
  • Increased body fat.
  • Extreme fatigue.
  • Hair loss.
  • Changes in mood, including irritability and depression.

Low testosterone is also linked to a significantly increased risk of heart disease, and a shorter life span.

Testosterone and ED

Low testosterone (Low T) is linked to a number of chronic conditions, such as diabetes, obesity, and heart disease, which are also linked to ED. Low T is known to play a role in erections (see our article, “How Do Erections Work“), through several mechanisms:

  1. Impaired the release of Nitric Oxide
  2. Altered the function of PDE5
  3. Impaired cavernosal nerve function
  4. Contribution to veno-occlusive disease in the penis1

However, Low T is not a significant cause of ED. (See our article, “Causes of Erectile Dysfunction.”)

In fact, most men with ED have normal testosterone levels, and many men with Low T are able to achieve erections.

Studies have shown that raising testosterone levels usually does not improve erectile dysfunction, even in men with Low T2.

What to Do If You Suspect Low T?

If you experience symptoms associated with low testosterone, you should discuss your symptoms with your doctor. A simple blood test can measure your testosterone level. More importantly, your doctor will determine the cause of your Low T, and prescribe appropriate treatment.

Testosterone Replacement Therapy (TRT)

Testosterone Replacement Therapy (TRT) may include injections, topical gels, and patches. Testosterone pills are not available in the United States, because they have been linked to liver damage3.

Changes in diet and exercise can also increase testosterone levels.

TRT can have a number of side-effects; it may not be advisable for all men4. Side effects can include:

  • Increased risk of blood clots and stroke.
  • Sleep apnea.
  • Acne or other skin reactions.
  • Breast enlargement.


  1. Khera, M. “Androgens and erectile function: a case for early androgen use in postprostatectomy hypogonadal men.” Journal of Sexual Medicine. Mar 2009;6:234–8.
  2. Yucel, C; Keskin, M Z; Peskircioglu, C L. “The Effect of Transdermal Testosterone Administration on Lower Urinary Tract Symptoms and Erectile Dysfunction: A Prospective, Randomized, Placebo-Controlled Trial.” Current Urology. Nov 2017;11:4-8.
  3. Spitz, Aaron. The Penis Book. Rodale Wellness, 2018, pp 153-155.
  4. Fernández-Balsells, M M; Murad, M H; Lane, Melanie; Lampropulos, Juliana F; Albuquerque, Felipe; Mullan, Rebecca J; Agrwal, Neera; Elamin, Mohamed B; Gallegos-Orozco, Juan F; Wang, Amy T; Erwin, Patricia J; Bhasin, Shalender; Montori, Victor M. “Adverse Effects of Testosterone Therapy in Adult Men: A Systematic Review and Meta-Analysis.” The Journal of Clinical Endocrinology & Metabolism. Jun 2010, Volume 95, Issue 6, pp 2560–2575. <>

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