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:
- Impaired the release of Nitric Oxide
- Altered the function of PDE5
- Impaired cavernosal nerve function
- Contribution to veno-occlusive disease in the penis1
However, Low T is not a significant cause of ED. A study published in Reviews in Urology2 found that “endocrinopathy is a rare cause of erectile dysfunction.” (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 T3. However, raising testosterone can improve your libido, or “sex drive.”
What to Do If You Suspect Low T?
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If you experience symptoms associated with low testosterone, you may want to get a blood test. A simple and inexpensive test can measure your testosterone level; you don’t even need a prescription or referral.
Test results will typically show total testosterone, and free testosterone. Most of the testosterone in your body is chemically bound to other molecules, and cannot be metabolized. Free testosterone is not bound to other molecules, and is easily processed. Your free testosterone should be at least 2% of your total testosterone.
You can determine these and other relevant hormone values with a simple blood test.
If your blood test shows low total testosterone or low free testosterone, talk to your doctor, who can determine the cause of your Low T, and recommend appropriate treatment.
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 damage4.
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 men5. Side effects can include:
- Increased risk of blood clots and stroke.
- Sleep apnea.
- Acne or other skin reactions.
- Breast enlargement.
- 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.
- Rajfer, Jocob. “Relationship Between Testosterone and Erectile Dysfunction.” Reviews in Urology. Spring 2000; v(2).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.
- Spitz, Aaron. The Penis Book. Rodale Wellness, 2018, pp 153-155.
- 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. <https://doi.org/10.1210/jc.2009-2575>