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It’s common among men to occasionally have trouble achieving an erection when stressed, drinking excessively, smoking etc. But, if this problem persists and you experience trouble gaining an erection more than 50% of the time, you may have erectile dysfunction and need proper treatment.

Erectile dysfunction, abbreviated as ED, is a sex condition in men that affects nearly one in five men in the UK. It can happen due to multiple reasons, including low testosterone levels. A proper diagnosis of the cause is necessary to design a suitable treatment plan.

This article explains how low testosterone and erectile dysfunction are connected to each other and how it can be treated.

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What is erectile dysfunction?

Erectile dysfunction is a condition in men whereby they face trouble attaining and keeping an erection. Although it is normal among men to have trouble with erections occasionally, erectile dysfunction that happens routinely indicates abnormality and requires timely treatment.

Here are the most common symptoms of erectile dysfunction.

  • Inability to get an erection
  • Inability to maintain an erection for a longer time duration
  • Low libido

Erectile dysfunction can occur due to multiple reasons. That’s why your doctor will first identify the cause and then design a treatment plan accordingly. Here are the most common causes of erectile dysfunction in men.

  • Certain health problems such as high blood pressure, heart and blood vessel disease, type 2 diabetes, and testosterone deficiency
  • Certain medications such as tranquillisers, high blood pressure medicines, and antidepressants
  • Psychological or emotional problems such as low self-confidence, anxiety, depression, and stress
  • Poor lifestyle habits such as smoking, drinking, lack of physical activity, and obesity


Diagnosing erectile dysfunction

If you have trouble getting an erection, it is better to visit a healthcare provider and find a suitable treatment for the issue. Your healthcare provider will start with questions and a physical examination. They will ask you questions about your lifestyle habits, current health condition, and medical history.

Here are a few questions that a healthcare provider may ask you when diagnosing erectile dysfunction.

  • Do you have an active lifestyle?
  • Do you exercise?
  • Do you smoke/drink? If yes, then how often?
  • Do you take any medication?
  • For how long have you been experiencing these symptoms?

After asking you questions and evaluating your condition through your answer, the doctor will conduct a physical examination. During this examination, they will mainly focus on your genitals.

Next, they may ask you to have a few lab tests, such as serum testosterone test, urine test, ultrasonography, pelvic x-ray, etc., to identify the underlying cause of the problem.


The connection between low testosterone and erectile dysfunction

If your body is not producing enough testosterone and your serum testosterone levels are below 300 nanograms per deciliter (ng/dL), you may have low testosterone (low T).

Men suffering from this condition often experience low libido (sexual desire) and trouble gaining an erection. Researchers have found that low testosterone can even have a negative effect on your sex life.

Testosterone is connected to erection in two ways

  • Testosterone stimulates the production of certain chemical messengers in the brain. A few examples of these messengers are dopamine, oxytocin, and nitric oxide. These chemicals are involved in achieving and gaining an erection.
  • Testosterone also stimulates spinal nerves that bring changes to your blood vessels. These nerves send signals to the penis and make certain muscles relaxed. As a result, blood flow and pressure in your genitals increase, helping it expand and gain an erection.

Low testosterone can negatively influence your sex life, but it rarely causes erectile dysfunction. There are numerous causes of this condition, which often makes it challenging for the doctor to identify the real cause. Also, men with erectile dysfunction sometimes have normal testosterone levels, but they still have a problem achieving an erection.

That is why identifying the real cause before starting treatment is very important. If the cause is low testosterone levels, your doctor may suggest you have testosterone replacement therapy (TRT).


What other changes occur in the body due to low T?

Erectile dysfunction is not the only sign of low testosterone. There are many other symptoms of this issue, which may help you diagnose it. Here are the common signs and symptoms that men with low T report.

If your erectile dysfunction is due to low T, you may experience some of the symptoms mentioned above.


What can cause low T?

Your low T can either be due to the inability of the testes to produce testosterone or the inability of the brain to send signals to the testes to form testosterone. If your testes are not producing enough testosterone even after getting a signal from the brain, you have primary hypogonadism. Common causes of this issue are:

  • Injury or infection of testes
  • A chromosomal disorder such as Klinefelter syndrome
  • Chemotherapy for testicular cancer
  • Undescended testes

Sometimes, your pituitary gland and hypothalamus (parts of the brain that send signals to testes to form testosterone) do not produce the signal that testes need to start testosterone formation. This condition is called secondary hypogonadism. Common causes of this problem are:

  • Pituitary disorders
  • Type 2 diabetes
  • Ageing
  • Certain medications such as antidepressants etc.


How to diagnose low T?

Like erectile dysfunction, low T also has multiple causes. You need to identify its actual cause to start its treatment and get rid of the issue.

When you visit your doctor to discuss your low T, they will ask you certain questions and conduct a physical examination. Later, you will be asked to have a blood test in which your serum testosterone levels will be measured. This test will measure your free testosterone and total testosterone (the sum of free and bound testosterone) levels.

A blood sample for the serum testosterone test is taken in the morning when testosterone levels are usually high. If your first test indicates low T, your doctor will suggest another test to ensure you really have this issue.

Once low T has been identified, the doctor will look for its cause. Primary and secondary hypogonadism are treated in different ways in men. However, the most popular treatment for low T is testosterone replacement therapy.

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How to treat erectile dysfunction caused by low T?

If you have been diagnosed with erectile dysfunction caused by low T, then the most suitable treatment option for you might be testosterone replacement therapy.

It is a hormone replacement therapy in which you receive synthetic testosterone to boost your serum testosterone levels. You can have testosterone in different forms, such as pills, patches, pellets, injections, and gels.

Your doctor will determine your testosterone dose based on how low your testosterone levels are. Your dose will be adjusted throughout the treatment on the basis of how your body responds to the starting dose.

Many men worldwide have this treatment and report experiencing the following benefits.


Who should not consider testosterone replacement therapy?

Though testosterone replacement therapy is a beneficial treatment, it comes with a few side effects that make it unsuitable for some people.

If you have congestive heart failure, sleep apnea, prostate cancer, benign prostate hypertrophy, and breast cancer, it is advised to not have testosterone replacement therapy as it can worsen your health condition.



What are the other ways of treating erectile dysfunction?

Depending on the cause of erectile dysfunction, your doctor can suggest different treatment options. Some of these treatment options are:

  • Oral drugs such as PDH5 inhibitors
  • Urethra therapy in which a medicated pellet is placed in the urethra
  • Vacuum erection device
  • Surgical treatment in which an implant is inserted into the body. This option is considered when all the options mentioned above fail to work.

Can high testosterone levels also cause erectile dysfunction?

No, high testosterone levels are not linked to erectile dysfunction. However, bodybuilders who illicitly take testosterone may experience this issue as a side effect of taking testosterone when it is already present in their body in the normal range.

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Erectile dysfunction can make a man feel less ‘manly’ and lead to low self-esteem. That is why, if you have this condition, you should not hesitate to talk about it with your doctor and find a solution.

Testosterone replacement therapy is very effective in reducing symptoms of erectile dysfunction in men with low T. Men with testosterone levels below 300 ng/dL need to discuss the benefits and risks of the treatment with their doctor before selecting it as an ED treatment.


References/Further Reading/Bibliography/Scientific Studies

Kessler, A., Sollie, S., Challacombe, B., Briggs, K. and Van Hemelrijck, M., 2019. The global prevalence of erectile dysfunction: a review. BJU international124(4), pp.587-599.

Efesoy, O., Çayan, S. and Akbay, E., 2018. The effect of testosterone replacement therapy on penile hemodynamics in hypogonadal men with erectile dysfunction, having veno-occlusive dysfunction. American Journal of Men’s Health12(3), pp.634-638.

Rajfer, J., 2000. Relationship between testosterone and erectile dysfunction. Reviews in urology2(2), p.122.

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Evidence Based Research

This article has been researched and written based on scientific evidence and fact sheets that have then been crossed checked by our team of doctors and subject matter experts.

References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.

Our team of healthcare experts and GMC registered doctors are licensed to UK GMC standards. We strive to provide you with the latest evidence based, researched articles that are unbiased, honest and provide you with accurate insights, statistics and helpful information on the discussed topic to ensure you gain a better understanding of the subject.

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About the Author: Mike Kocsis

Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.

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Last update: July 28th, 2022

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