Sexual Dysfunction
Men with low testosterone commonly experience a constellation of sexual symptoms including decreased libido (reduced interest in sex), erectile dysfunction (difficulty achieving or maintaining erections), reduced frequency of spontaneous and nocturnal erections, diminished penile sensation, difficulty reaching orgasm, and decreased ejaculate volume. These sexual symptoms often occur alongside reduced energy and stamina, depressed mood, irritability, and difficulty concentrating. The severity of sexual dysfunction typically correlates with the degree of testosterone deficiency, with some men maintaining normal erectile function despite below-normal testosterone levels, while others experience significant sexual impairment.
Bidirectional Linkage: Sexual Dysfunction ↔ Low Testosterone
Low testosterone → sexual dysfunction. Testosterone deficiency leads to decreased libido (sexual desire) and erectile dysfunction Disrupted NO signaling pathway: less NO production in erectile tissue → poorer erection quality Demonstrated relationship between testosterone deficiency and morning erections, sexual motivation, and satisfaction Lowered energy, mood and physical functioning amplify sexual problems
Sexual dysfunction → low testosterone. Chronic sexual passivity can cause further testosterone decline through less stimulation of the HPG axis Psychological suffering and comorbidities (depression, obesity, chronic diseases) exacerbate hormonal dysregulation
Vicious circle: Less testosterone → less libido and erection → less sexual activity → suppresses HPG axis → even lower testosterone → etc.