Testosterone’s Role in Erectile Function

Testosterone is often thought of as the puppetmaster of everything sex-related. If your erections have gotten a little limper than you’d like, it makes sense you might be wondering if low testosterone (hypogonadism) is pulling the strings.

Low testosterone certainly could be the cause of your erectile dysfunction, but it’s not the only possibility, says Scott Miller, M.D., M.B.A., medical director of urology and director of robotic surgical services at Wellstar Health System in Atlanta. “Any change in erection quality is an indicator to go see a physician. Low testosterone is a common cause of that, but there are a lot of other causes.”

So, does testosterone make your erections harder, and will TRT help? We asked experts to explain and share their recommendations for managing your erectile dysfunction and whether it’s caused by low testosterone levels.

About the Experts

Scott Miller, M.D., M.B.A., medical director of urology and director of robotic surgical services at Wellstar Health System in Atlanta.

Paul Gittens, M.D., is a urologist specializing in sexual medicine and male infertility. He’s the medical director at Rockwell Centers for Sexual Medicine & Wellness. 

Jim Staheli, D.O., medical director for Broad Health, Hone Health’s affiliated medical practice, and a family medicine doctor in Atlanta.

Testosterone’s Role in Erectile Function

Because testosterone is a male sex hormone, it play a significant role in erectile function:

• Blood flow: Testosterone helps maintain nitric oxide production, a molecule that relaxes smooth muscle in the blood vessels of the penis, increasing blood flow and leading to an erection. Low testosterone can also lead to an increase in asymmetric dimethylarginine, a substance that blocks nitric oxide production.¹ “In order to get an erection, the blood vessels get larger and push more blood flow into the penis, and then the penis muscles relax and allow for more blood flow to come in. Testosterone plays a big role in that,” explains Paul Gittens, M.D., urologist and medical director at Rockwell Centers for Sexual Medicine & Wellness. 
• Libido: Testosterone is directly linked to libido and arousal. When your sex drive is low, it’s harder to get aroused. And if you’re not getting as turned on as you once did, that can lead to challenges with erectile function.

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Other causes of erectile dysfunction

Testosterone makes you harder by strengthening your libido overall. But according to the National Institutes of Health, only one in three men with erectile dysfunction (ED) also have low testosterone.² That means for the majority of men, something besides testosterone is behind their flagging erections.

Heart disease is a big cause of erectile dysfunction, as it can restrict blood flow to the penis and damage the inner lining of blood vessels.^{3 4} 

Diabetes is another common culprit for erectile dysfunction. More than half (52.5 percent) of men with diabetes have erectile dysfunction. Diabetes affects blood flow and damages nerves responsible for sexual stimulation. There’s also an association between diabetes and low testosterone. Men with type 2 diabetes are twice as likely to have low testosterone than men who don’t have diabetes.^{5 6 7}

TRT for Erectile Function

Testosterone replacement therapy can help men get harder, more consistent erections if they are diagnosed with hypogonadism (low testosterone). 

More testosterone can add more bang to your sex drive and arousal, which can make erections stronger.^{8 9} If your doctor has also prescribed a PDE5 inhibitor, TRT can help it work more effectively. These erectile dysfunction medications include Viagra, Levitra, and Cialis and work by relaxing the smooth muscle of the penis and increasing blood flow.^{10 11}

To get a TRT prescription, patients need a blood test that shows they have low testosterone levels and their doctor should have ruled out other underlying health conditions as the cause of their erection issues.

Can TRT cause erectile dysfunction?

Yes, too much TRT can cause erectile dysfunction. High levels of testosterone can be caused by anabolic steroid abuse and sometimes testosterone replacement therapy at the wrong dose, if it’s not monitored properly.

Your body converts testosterone into dihydrotestosterone (DHT)—the most potent form of testosterone—via an enzyme called 5 alpha-reductase. In the process, your body also produces the hormone estradiol through the aromatization of testosterone. 

Estradiol is one of the three types of the hormone estrogen, which helps regulate your libido and erections. Too much estrogen can squash your sex drive and cause ED. So, if you have too much testosterone, you’ll produce excess DHT and extra estradiol. 

Finding the right balance is key. If a blood test indicates that your estradiol levels are too high, your doctor may prescribe an estrogen-blocking medication called anastrozole to regulate how much estrogen you produce.

Other Ways to Increase Testosterone

Making some smart lifestyle changes can raise testosterone levels naturally and get stronger erections as a result. Experts recommend adopting these habits:

Exercise

Obesity is a precursor to conditions such as heart disease and diabetes, which can lower testosterone levels and cause ED and other sexual dysfunction. Regular exercise can not only help you trim excess weight and build muscle, but it can also boost testosterone levels and improve cardiovascular health. (Good blood flow means good erections.¹²)

Aim for 160 minutes of moderate to intense aerobic exercise a week. A review published in Sexual Medicine found that hitting this target for six months decreased ED caused by obesity, hypertension, metabolic syndrome, and cardiovascular disease.¹³

Be sure to include strength or resistance training in your workouts, too. “Resistance exercises tend to raise testosterone levels and also cause vascular changes that help maintain erectile tissue,” Miller says.

Clean up your diet

Plant-based diets rich in green leafy vegetables promote nitric oxide production, Jim Staheli, D.O.

Limit fats, sugar, and sodium. They contribute to inflammation, which can lead to cardiovascular and metabolic diseases that can affect erection quality. 

Other foods that are natural testosterone boosters include fatty fish, extra virgin olive oil, ginger, and bananas. 

Manage stress

Chill out and calm your mind via breathing exercises, yoga, or meditation. “Stress hormones can reduce testosterone,” Gittens says.

A study published in The Journal of Cellular and Molecular Medicine found male rats exposed to continuous stress for 21 days had decreased testosterone levels.¹⁴ Other research has found testosterone levels decreased after both chronic and acute stress.¹⁵

Improve your sleep

Low testosterone is associated with poor sleep quality and sleeping fewer hours per night, so it’s important to plan your Z’s accordingly.

Getting good sleep can lessen stress and anxiety, supporting healthy testosterone levels. Plus, poor sleep is associated with difficulty getting and maintaining erections.¹⁶ 

“There have been studies that have shown that sleep-deprived people or people with sleep disorders definitely have a higher rate of erectile dysfunction, so make sleep a priority,” Miller says.

Mentioned in This Article:

Testosterone

Testosterone provides the foundation for Hone’s testosterone replacement therapy plans, used to treat low testosterone levels and boost energy, strength, and libido. Available via injections, cream and dissolvable troches.

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Sildenafil

Sildenafil, the generic for Viagra®, effectively treats erectile dysfunction, ensuring you’re ready when the moment feels right.

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Tadalafil

Tadalafil, an FDA-approved generic for Cialis®, helps you achieve and maintain an erection, empowering you to regain your confidence and intimacy.

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About the author

Austin Letorney is a writer who covers health, entertainment, lifestyle, and fitness.

About the reviewer

Joshua Calvert, M.D., is a urologist who specializes in vasectomy and vasectomy reversal, Peyronie’s disease, testosterone management, and male infertility.