Experts explain whether low T can make it harder to stay up.
When it comes to sex, most men would probably rather be compared to the Energizer Bunny than Speedy Gonzales. Lots of guys may think they don’t last long enough in the sack, but are they actually fast finishers or just…normal?
“Everybody thinks—thanks to way too much porn consumption—that they should be able to have sex for 45 minutes to an hour,” says Andrew Sun, M.D., a urologist at Urology Partners of North Texas. “That’s not actually reality for the vast majority of people.”
So what is “normal”? You might be surprised. The average time from penetration to ejaculation (not including any foreplay or other warm-up) is between five to seven minutes, Sun explains.
“Sometimes patients will say, ‘Man, I can only go for 10 minutes,’” Sun says. “And I’m like, ‘That’s above average, my friend.’”
But premature ejaculation is most definitely a concern. Studies suggest around 20 to 30 percent (or more) of men deal with premature ejaculation, the most common form of sexual dysfunction when orgasm occurs sooner than desired (1, 2). According to Sun, that’s around the two-minute mark.
Johns Hopkins Medicine defines premature ejaculation as ejaculation within about one minute of penetration, an inability to delay ejaculation during most sexual encounters, and resulting negative feelings about sex (3). There are two main types: lifelong, which is ongoing and acquired, which develops later and can be situational.
Whether you experience premature ejaculation or just want to last longer, how much of a role does testosterone play?
We asked experts to explain testosterone’s role in sexual stamina and—most importantly—how to fix premature ejaculation once and for all.
About the Experts
Andrew Sun, M.D., is a urologist specializing in testosterone replacement therapy and sexual dysfunction, and the director of men’s health for Urology Partners of North Texas.
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.
The relationship between testosterone and premature ejaculation isn’t definitive. Some research suggests having too much testosterone can cause premature ejaculation, while other research suggests having too little can also cause it. Still, other research has found no solid connection between premature ejaculation and testosterone (2).
“There’s no data showing that testosterone can either cause premature ejaculation or delayed ejaculation,” says Paul Gittens, M.D., urologist and medical director at Rockwell Centers for Sexual Medicine & Wellness. “There’s also no direct link between testosterone levels and sexual stamina—high testosterone doesn’t guarantee lasting and low testosterone doesn’t guarantee premature ejaculation.”
Other hormones, including those from the pituitary, adrenal, and thyroid glands, also influence ejaculation. And endocrine disorders can contribute to premature ejaculation (4, 5).
While testosterone regulates nitric oxide, essential for erectile function and penile health, it has little impact on how quickly men orgasm, says Gittens (6).
So, even if testosterone levels are too high or too low, the consensus is that T is not the only cause of premature ejaculation (2).
Some research suggests testosterone levels that are too high, from testosterone replacement therapy (TRT) or anabolic steroid use, can cause premature ejaculation.
For starters, testosterone directly affects libido, the desire to have sex, and arousal. So, getting too aroused may lead to reaching orgasm more quickly than you’d like.
It’s a myth that everyone with low testosterone has erectile dysfunction. So is the inverse: that erectile dysfunction is always caused by low T.
Low T can certainly cause a drop in libido, which can have a downstream effect on arousal. But research has found testosterone needs to really bottom out before it affects erectile function (2, 7).
Even if you’re not technically in the premature ejaculation or erectile dysfunction category, pay attention if you’ve had any significant drop in your sexual stamina or changes to your erections, notes Sun. “If there’s a huge difference from where you were at your baseline—let’s say 20 minutes previously and five minutes now—I would still say that there are some issues with ejaculation.”
Probably not directly. If you have low T, testosterone replacement therapy may be able to boost your sex drive and improve insulin resistance, both of which impact your erection quality. But if you also have another health problem alongside low testosterone, TRT isn’t going to fix the problem entirely. Each root cause needs to be diagnosed and treated.
Sun isn’t convinced TRT will directly affect the ability to last longer in bed. “There are some treatments for premature ejaculation, but none of them really have to do with testosterone,” he says.
TRT may offer some indirect benefits related to the ejaculation part of sex, Gittens says. TRT can help build more muscle, improve sleep, increase libido, and boost mood—all of which can have a positive impact in the bedroom.
There’s strong evidence other health conditions can have a negative impact on both erections and ejaculation. Heart disease, high blood pressure, diabetes, and obesity can impact erections, typically by affecting blood flow to the penis. They’ve also been found to increase the prevalence of premature ejaculation (4).
Other conditions, including erectile dysfunction, prostate inflammation, and nervous system disorders have been linked to premature ejaculation (3, 4). Other factors affecting sexual function include sleep apnea, thyroid disorders, pituitary gland disorders, and vitamin D deficiency.
Testosterone won’t help with premature ejaculation or psychological erectile dysfunction. Performance anxiety has been linked to acquired premature ejaculation. Premature ejaculation can also cause feelings of guilt and inadequacy and can lead to a lack of confidence and relationship problems (8).
Depression and anxiety can impact sex life, and sexual dysfunction is a common side effect of SSRI antidepressants. However, SSRIs usually affect libido and delay orgasm rather than causing premature ejaculation.
Making smart lifestyle tweaks can help to increase testosterone production and improve not only your sex life but your health in general. Sun puts it simply: “Healthy body, healthy penis.”
Exercise can improve sex in many ways. Cardio is good for the heart and improves overall stamina during any type of exertion, Gittens says.
A review published in Sexual Medicine found that 160 minutes of moderate to intense aerobic exercise a week for six months might help reduce erectile dysfunction caused by obesity, hypertension, metabolic syndrome, and cardiovascular disease (9).
Running and yoga have also shown promising results for treating premature ejaculation (10).
Gittens recommends strength training three times a week, along with cardio. When lifting weights, focus on big muscle groups like your legs and back for a bigger impact.
“The best way to increase testosterone is by losing weight,” Gittens says. And you can’t lose weight with a crappy diet.
Plant-based diets rich in green leafy vegetables promote nitric oxide production (11). On the flip side, diets rich in fat, sugar, and salt promote inflammation, which is linked to chronic disease.
Complex carbs (like whole grains and legumes), lean protein (fish and lean meat), and healthy fats rich in omega-3 fatty acids (fatty fish or flax, chia, or hemp seeds) are all foods that may help you last longer.
Stress, whether from daily life or performance anxiety, can significantly affect your sex life.
Therapy may be able to help you cope with stress and any psychological issues related to sex. Gittens recommends talking to a therapist who’s trained in sexual dysfunction. “A sex therapist can really help with premature ejaculation,” he says.
Yoga offers a dual benefit by combining exercise with stress management.
Ejaculation control exercises include strengthening the pelvic floor muscles—the muscles that contribute to ejaculation. According to the Mayo Clinic, stronger pelvic floor muscles might help you delay ejaculation. Practice doing Kegels—squeezing the muscles you use to stop peeing (12). Work up to three sets of 10 to 15 reps per day.
Although they require practice and may not work for everyone, techniques like the start-stop and squeeze methods can help slow down the big O. The start-stop method involves stimulating the penis until just before orgasm, then stopping and repeating to recognize and control the pre-ejaculation stage. The squeeze method involves squeezing the head of the penis before orgasm to reduce arousal and last longer (13).
Wearing condoms and using a numbing spray or cream can reduce penis sensitivity during sex, which can pump the brakes a bit on ejaculation.
People who take certain SSRIs for anxiety or depression may have a more difficult time reaching orgasm, Sun says. So, conversely, doctors may prescribe a super-low dose of an SSRI (like Zoloft or Paxil) to slow down the time it takes to orgasm. “What you’re trying to do is give that medication, not because they’re depressed, but for the side effect of delayed ejaculation,” Sun says.
It’s possible to have low T and no sexual symptoms. It’s also possible to have normal T levels and some issues in bed. Testosterone replacement therapy may be able to help improve other areas of the sexual experience, from libido to confidence, which may increase your ability to go at it longer.
Gittens calls testosterone the main support system for the sexual response. “It might not be doing everything, but it’s helping support some of the other neurotransmitters and hormones and allows them to do their job more efficiently.”
Testosterone regulates several aspects of sexual function, including libido and arousal. Some studies show high or low testosterone might be linked to premature ejaculation, but it typically isn’t the only cause. Overall and psychological health are big factors in to how long you last. TRT may help boost performance, along with lifestyle changes like diet, exercise, stress reduction, and ejaculation control techniques like kegels.
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