Low testosterone and erectile dysfunction: What to know

If your body does not produce enough testosterone, you can experience several mental and physical symptoms, such as lowered sex drive and weight gain. Having lower levels of testosterone can make it difficult to maintain or achieve an erection, and it can play a role in erectile dysfunction (ED).

There are a number of symptoms of low testosterone and ED to look out for and several treatments for both.

Low testosterone and ED

ED is a common condition that can occur because of various factors, including low testosterone levels in your body. Some symptoms of ED you may experience if you have low testosterone include:

• difficulty maintaining or getting an erection
• decreased sexual drive
• fewer spontaneous erections, including in the morning when you wake up

Testosterone has many functions in your body, and there are two main ways it helps you get and maintain an erection.

It stimulates your brain to release neurotransmitters, such as dopamine, oxytocin, and nitric oxide, to help you achieve an erection. It also stimulates the nerve in your spine to make changes in the blood vessels and keep your penis erect.

About 1 in 3 people with a penis experience ED at some point in their lives. ED is not only linked to physical factors but also to psychological aspects. Testosterone also affects your sexual drive. This can cause difficulties with erections.

Low testosterone causes

Low testosterone can occur due to several health conditions or lifestyle habits, such as:

• obesity
• hypogonadism
• metabolic syndrome
• diabetes
• use of anabolic steroids
• use of illegal drugs

Certain people may be born with an underlying condition that causes testosterone deficiency, including:

• Noonan syndrome
• Klinefelter syndrome
• sex organs that have an atypical look (ambiguous genitalia)

Other potential causes that can lead to low testosterone at some point in life may include:

• being an older age
• using narcotic pain drugs or antidepressants
• chemotherapy or radiation therapy
• removal of testicles due to cancer
• sustaining testicle damage by accident
• infections, such as HIV
• autoimmune disease, including AIDS
• pituitary gland disease that can cause hormone deficiency

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Other symptoms

Other symptoms you may experience if you have low testosterone may include:

• decreased energy or motivation
• sleep difficulties
• infertility
• reduced or absent orgasm
• reduced muscle mass
• anemia
• difficulties concentrating or poor memory
• depressed mood
• loss of body hair
• reduced bone mass
• enlarged breasts (gynecomastia)
• delayed or incomplete sexual development
• small testes

Diagnosis

To diagnose low testosterone, doctors typically perform a blood test to check its levels in your body and measure if you have testosterone deficiency. This, combined with your medical history and the symptoms or signs of low testosterone you may experience, can help doctors determine if you have this condition.

Because low testosterone can have several causes, doctors may also perform a physical exam for hypogonadism and other relevant tests to rule out other underlying conditions that may be linked to low testosterone.

Treatments

The treatment of low testosterone and ED depends on their causes. Doctors can recommend the most appropriate treatment after diagnosis.

Low testosterone

If you have low testosterone, doctors may recommend undergoing testosterone therapy. They typically prescribe this alongside phosphodiesterase inhibitors, as the combination of these two drugs is usually very effective in treating low testosterone.

These medications come in different forms. The most common ones include:

• Patches: One example includes Androderm.
• Gels: A common example is testosterone gel 1% (Androgel). 
• Injections: Doctors usually prescribe testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Xyosted).

ED

The treatment for ED can vary depending on its causes. Testosterone therapy can sometimes help, but it does not usually treat ED on its own. This is because ED usually occurs due to a combination of physical and psychological factors.

If ED develops due to an underlying condition, such as problems with your blood pressure, depression, or other illnesses that can lower testosterone levels, treating them can help improve ED.

Some treatment options doctors may recommend for ED may include:

• phosphodiesterase inhibitors to improve the blood flow in the penis, such as
  • tadalafil (Cialis)
  • sildenafil (Viagra)
  • avanafil (Stendra)
  • vardenafil (Levtra, Staxyn)
• injections of alprostadil (Edex)
• the use of penis pumps
• penile implants

Quitting smoking, maintaining a healthy body weight, and getting regular physical exercise can help improve ED. Talk therapies and counseling can help treat and manage stress and anxiety that can also lead to ED.

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Summary

Low testosterone can cause ED. People can develop low levels of testosterone due to several conditions that they may be born with or that they acquire at some point in their lives.

But low testosterone may not be the only cause of ED. It can be a combination of different factors.

ED can happen because of a combination of psychological and physical factors. To treat it, doctors need to diagnose the underlying conditions that cause erectile difficulties.

Treatment can include testosterone replacement therapy as well as medications to help form an erection. If you are experiencing symptoms of low testosterone, talk with a healthcare professional to find the best treatment for you.

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