Does Testosterone Make Erections Harder?

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 T (hypogonadism) is pulling the strings.

Low T certainly could be the cause, 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, how big of a role does testosterone play in how hard you get? We asked experts to explain and share their recommendations for what you can do to have stronger erections.

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 Erections

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 less-hard hard-ons.

When your arousal is sputtering instead of roaring, your body releases less nitric oxide, a molecule that relaxes smooth muscle in the blood vessels of the penis, increasing blood flow and leading to an erection. Testosterone helps maintain nitric oxide synthase activity, which is essential for nitric oxide production. Low T 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. 

Testosterone levels and erectile dysfunction

Testosterone strengthens the libido to trigger your erections. But according to the National Institutes of Health, only one in three men with erectile dysfunction (ED) also have low T (2). That means for the majority of men, there’s something else behind their flagging erections.

Heart disease is a big one, as it can restrict blood flow to the penis and damage the inner lining of blood vessels (3, 4). 

Diabetes is another common culprit. 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 T. Men with type 2 diabetes are twice as likely to have low T than men who don’t have diabetes (5, 6, 7).

KNOW YOUR T

Can Low Testosterone Cause Anxiety and Depression?

How to Legally Buy Testosterone Online

Getting TRT for Better Erections

If a blood test shows you have low testosterone levels and your doctor has ruled out other underlying conditions that could be affecting your erections, testosterone replacement therapy may be able to help. 

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 medications include Viagra, Levitra, and Cialis and work by relaxing the smooth muscle of the penis and increasing blood flow. (10, 11)

Can TRT cause erectile dysfunction?

Yes, it can. High levels of testosterone can be caused by anabolic steroid abuse and sometimes testosterone replacement therapy, 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.

Could Low T Be Causing Your ED?

Hone’s at-home assessment, which you can take from the privacy of your home, can analyze your testosterone levels.

LET’S DO THIS

HELP YOUR ED

Can Quitting Booze Cure Your Erectile Dysfunction?

If You Have ED, Your Thyroid May Be Sending You Signals

Other Ways to Increase Testosterone

Making some smart lifestyle changes can raise T levels naturally. 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 T 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., previously wrote for The Edge. 

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 T levels decreased after both chronic and acute stress (15).

Improve your sleep

Clocking enough sleep—seven to eight hours per night—is important for improving T levels. But the quality of sleep matters, too, not just the quantity. 

Getting good sleep can dial down testosterone-lowering stress and anxiety. 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.