ED and Testosterone: What’s the Connection?
It’s easy to find places online that claim erectile dysfunction is caused by a lack of testosterone. But the reality is more complicated than that. We reveal the truth below.
Updated: Thursday 15 April 2021
It’s difficult to find reliable advice on erectile dysfunction (ED) online. Although the condition is very common, the stigma attached to it leads countless men to delay or refuse to seek medical treatment. In these cases, men who would benefit hugely from consulting a GP or pharmacist can instead come across advice and treatments for ED that are dubious, false, or even dangerous. Untrustworthy sites often make spurious claims about ED to sell unregulated and unsafe products. Among these claims, one of the most stubborn is the myth that ED is caused by low testosterone.
It’s easy to see why such an assertion would gain traction. In social circles and the media, the ability for a man to get an erection and have sex is closely associated with his masculinity. As the primary sex hormone in males, testosterone is similarly seen as a prerequisite or indicator of manliness. This explains why numerous men are led to believe that ED is the result of a lack of masculinity, which in turn could be caused by low testosterone.
In online spaces, entire communities have emerged obsessing over testosterone levels. In fact, they’ve become so prevalent that perceived shortfalls in masculinity have been given their own nickname: Low-T. In these communities, it isn’t uncommon for people to recommend anabolic steroids for people worried about arbitrary indicators of masculinity - and to be clear, these are illegal unless prescribed by a doctor. But it’s also common for users to direct people to supplements that claim to boost testosterone naturally.
In reality, most supplements which claim to boost testosterone naturally are little more than multivitamins that contain extremely high levels of each nutrient - sometimes to the point where they can cause more harm than good. This is why any man who is concerned about his testosterone levels should see a GP to check whether they are actually low. If they are, the doctor can decide whether treatment is necessary, and what that treatment should be.
Nevertheless, the link between testosterone and ED is a topic shrouded in misinformation. For that reason, it’s important to ask a number of questions: what causes low testosterone? How do you know if you have it? Does low testosterone really cause ED? And what should you do if your testosterone levels are low?
What causes low testosterone?
The most common risk factor for reduced testosterone in men is age. As men get older, the pituitary gland sends fewer signals to the testes to produce testosterone, which gradually lowers the level of testosterone in the body. In addition, the body produces more of a protein called sex hormone-binding globulin (SHBG), which reduces active testosterone levels with age. Together, these processes cause testosterone levels to decline at an average of 1-2% a year as men get older.
There are, however, other risk factors that can cause testosterone levels to drop as well. These include:
- Uncontrolled type 2 diabetes
- Alcohol abuse
- Obstructive sleep apnoea
- Use of anabolic steroids
Wait - don’t anabolic steroids increase testosterone levels?
In some cases, men turn to anabolic steroids as a way to increase muscle mass and strength beyond their natural limit. Anabolic steroids are a synthetic form of testosterone that have rapid-acting anti-inflammatory properties. These allow athletes to train harder and for longer, increasing protein synthesis, reducing body fat and enhancing strength and recovery.
Although men may have no trouble whilst self-medicating with anabolic steroids, problems often emerge when they stop. After artificially boosting your testosterone levels for a period of time, cessation may cause your natural testosterone levels to drastically drop, resulting in the emergence of distressing symptoms.
So how do I know if my testosterone levels are low?
The only way to know for sure is to ask your GP to test your testosterone levels. If the results show you don’t have low testosterone, your GP will be able to explore other possible causes for your symptoms. If, on the other hand, you do have low testosterone, your GP will be able to explore treatment options.
What symptoms should I be looking for?
Men with testosterone levels substantially lower than average can experience a number of symptoms, including:
- Small testicles
- Reduced body and facial hair
- Reduced muscle mass
- Hot flashes
- Mood changes, such as irritability and depression
- Difficulty concentrating
- Decreased bone density
- Reduced sperm count
- Reduced sex drive
But can’t a reduced sex drive cause ED?
Yes, it can. But not every man who experiences a low sex drive will have low testosterone, and not every man with low testosterone will experience a low sex drive. In fact, the evidence shows that testosterone treatment does not help men with low testosterone levels if ED is their only symptom. And for men with normal testosterone levels, studies show that testosterone treatment will not solve their ED either.
The reality is that ED is almost always caused by physiological conditions restricting blood flow to the penis. Around 80% of ED cases have an underlying physical cause, while 10% of cases can be attributed to psychological factors. Hormone or endocrine disorders, meanwhile, are rarest of the major causes of ED. If you’re struggling with ED, the likelihood is that it is a physical condition - and those are overwhelmingly treatable with the right medication.
It’s important to remember as well that even if you have low testosterone levels, they on their own rarely cause ED. Yes, you may have a reduced sex drive - but those do not necessarily go hand-in-hand.
When should I consider testosterone therapy for ED?
Testosterone therapy should only be considered for ED if tests show your testosterone levels are low and your doctor recommends it. In many cases, however, low testosterone levels don’t need treatment at all. If ED is your only symptom, it is highly unlikely that your doctor will prescribe hormone treatment.
The bottom line
If you’re struggling with ED, it’s useful to speak to your GP or a pharmacist. They’ll be able to work with you to figure out what could be causing your ED and what treatments would work best. If it’s determined your testosterone levels are low, your doctor will be able to consider hormone therapy. If not, don’t worry: there are a number of effective ED treatments available today and it is likely that at least one will be effective for you.