Testosterone-Science
for health and longevity
ANDROMAN
Last Updated
2025-09-26 14:18:01

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.

Effect of TRT

  • No major safety concerns noted specifically for sexual function improvements
  • Better sexual function. Significantly improves sexual activity, desire, and erectile function in older men with low testosterone and reduced libido
  • Enhances frequency of intercourse and quality of erections compared to placebo treatment
  • More effect the lower the T. Provides more pronounced benefits in men with severe hypogonadism rather than borderline cases
  • Improves mild to moderate erectile dysfunction, with stronger effects on libido than severe ED
  • Works synergistically when combined with PDE5 inhibitors (like Viagra) for enhanced outcomes
  • Normalizing testosterone levels provides threshold benefits - further increases beyond normal don't add value
  • Longer treatment durations may yield progressively better sexual function results
  • Improvements are linked to increases in both testosterone and estradiol levels
  • Restores sexual satisfaction and overall quality of sexual life
  • Benefits persist as long as testosterone levels remain normalized
Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels (27355400) (2016) (Placebo-controlled trial)
  • Testosterone treatment improved sexual activity, desire, and erectile function in older men with low testosterone and low libido.
  • Improvements were linked to increases in testosterone and estradiol levels, with no clear minimum level needed for benefits.
  • Most measures of sexual function, like frequency of intercourse and erections, saw significant gains compared to placebo.
  • No specific baseline traits predicted who would benefit most from the treatment.
Relationship Between Testosterone and Erectile Dysfunction (16985751) (2000) (Review)
  • Low testosterone is a rare but significant cause of erectile dysfunction, often improving other hypogonadism symptoms but not always ED itself.
  • Normal erections don't require high testosterone levels; a threshold exists beyond which more testosterone doesn't help.
  • Testosterone therapy is recommended for suspected low testosterone cases, but if ED persists, other causes like vascular issues should be explored.
  • Men with normal testosterone might still request therapy for other symptoms, requiring monitoring for side effects.
  • Hypogonadism and ED are common in aging but not always directly linked.
Testosterone and sexual function (23997801) (2013) (Review)
  • Low testosterone strongly associates with reduced libido and erectile dysfunction.
  • Testosterone replacement can improve sexual desire and function, especially in hypogonadal men.
  • Benefits may vary, with stronger effects on libido than on severe ED.
  • Combination with other therapies enhances outcomes for sexual dysfunction.