September 29, 2022/Men's Health

Does Low Testosterone Cause Erectile Dysfunction?

Despite assumptions, there really isn’t a one-to-one connection between the conditions

A drawing of a drop of red liquid coming out of a vial

Testosterone serves as a pretty high-octane fuel for sex drive. Know what else is kind of key while fooling around? Erectile function.

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So, if your testosterone tank is running a bit low, does that fuel shortage mean a certain body part won’t rev up for special activities? It’s a logical connection to make. After all, the two seem pretty related.

But the answer isn’t as simple as Low Testosterone = Erectile Dysfunction. The relationship is a bit more nuanced than that basic formula, explains urologist Brad Gill, MD, MS. Here’s why.

Low testosterone and ED

Let’s start with a basic statement: Low testosterone (low T) and erectile dysfunction (ED) are very different conditions, says Dr. Gill.

Low testosterone, or male hypogonadism, is an endocrine condition in which your testicles don’t produce enough testosterone, which can result in various symptoms. Testosterone serves many roles in your body, but the key one for this discussion focuses on how it powers libido.

If you have low T, your sex drive may be sputtering along in the slow lane or stalled in traffic. You just might not feel like … well, doing it.

Testosterone lowers naturally with aging, but a diagnosis of low testosterone is made in the presence of symptoms and can involve other factors. These can include medical conditions ­— having a BMI > 25 (overweight), for instance ­— or an injury to your testicles or pituitary gland.

Erectile dysfunction, meanwhile, refers to the inability of your penis to get and keep an erection firm enough for use. The issue typically involves some sort of breakdown in your penis-lifting teamwork between hormones, muscles, blood vessels and nerves.

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Many, many things can lead to ED. The most common causes, though, involve heart and vascular disease affecting blood flow, or diabetes causing a loss of nerve function.

“Low T and ED really are separate issues,” notes Dr. Gill. “But there are connections.”

Links between low T and ED

For starters, a symptom of low testosterone may be erectile dysfunction. An estimated 1 in 3 men with ED can also have low T, according to researchers.

But don’t get fooled by that statistic: “It’s not a one-to-one association,” emphasizes Dr. Gill. “Low T may co-exist with ED, but low T does not necessarily cause ED. There is no direct correlation.”

Plenty of people with low T have no trouble getting an erection, Dr. Gill points out. On the flip side, having higher levels of testosterone isn’t a complete safeguard against ED.

But low T can contribute to ED in the following ways.

  • Not thinking of sex as much. Erections occur when you get aroused, a process that can be as much mental as it can be physical. Low T can diminish those randy thoughts. “Sexual function is just as much above the shoulders as it is below the belt,” says Dr. Gill.
  • Stress. It’s not uncommon for low T to darken your mood and, as a result, potentially increase stress. That often interferes with your ability to get an erection.
  • Contributing factors that overlap. Low T may cause feelings of fatigue that can keep you from exercising or wanting to engage in sexual activity.
  • Weight gain. Reduced physical activity from fatigue related to low T can lead to increased body fat and weight gain, putting you more at risk for ED. Low T itself can also lead to body changes and weight gain due to hormonal shifts.
  • Other conditions that hurt erections. Excessive weight gain from Low T and reduced physical activity are risk factors for diabetes, high cholesterol, high blood pressure and heart disease — which are all tied to ED.

Don’t make assumptions about low T and ED

For those experiencing ED, it’s not unusual to presume a testosterone shortage is to blame. This is also supported by national guidelines that recommend checking testosterone levels in men or people assigned male at birth being seen for ED treatment.

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“It’s very, very common for guys to come in and ask for their testosterone to be checked because they’re having troubles with erections,” says Dr. Gill. “There’s an assumption that has to be the reason.”

But even if they have low T, addressing that issue typically doesn’t resolve ED. “You handle them separately,” he adds. “There’s really no great evidence that just treating low testosterone levels will help you get an erection.”

So, what should you do if you have ED? Start with talking to your doctor or a healthcare provider.

“Remember, erectile dysfunction can be an indicator of more serious medical issues,” warns Dr. Gill. “It’s important to understand why it is happening and find out what’s really going on. You can’t just write it off as a testosterone problem.”

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