Testosterone is a hormone responsible for male sexual development as well as sexual desire in all sexes. If your body doesn’t make an expected level of testosterone, you can experience a number of symptoms, including weight gain and decreased sex drive. Testosterone can play a role in erectile dysfunction, or the ability to achieve and maintain an erection.

Keep reading to find out about how testosterone could affect your erectile dysfunction and solutions for treating low testosterone and erectile dysfunction.

Low testosterone can cause you physical, mental, and sexual symptoms. Examples of sexual-related symptoms low testosterone can cause include:

  • lowered sexual desire
  • fewer sexual-related erections
  • fewer spontaneous erections (such as when you wake up with an erection)

Researchers have found sexual fantasies and even daydreaming can be affected by your testosterone levels. A lack of testosterone may then affect your ability to masturbate, as you may not be able to generate the sexual fantasies or desire to do so.

Testosterone also influences erections on two levels in your body. The first is in your central nervous system (CNS). Testosterone can stimulate your CNS to release neurotransmitters, or your brain’s chemical messengers, that are responsible for helping you achieve an erection, including dopamine, nitric oxide, and oxytocin.

The second level is to stimulate your spinal nerves to cause changes in the blood vessels that help you achieve and keep an erection.

Testosterone plays a role in sexual desire and achieving and keeping an erection. But it’s not the only factor that goes into sexual activity. Your testosterone levels and their effect on your ED also seem to have a dose-dependent relationship. This means unless your testosterone levels are very low, you probably won’t see a lot of sexual changes related to low testosterone.

But it’s important to know that people with low testosterone also commonly have other chronic medical conditions, including heart disease, high blood pressure, and diabetes mellitus. These disorders can contribute to ED because they affect blood flow and sensation. But chronic medical conditions don’t usually affect your sexual desire as significantly as having low testosterone does.

High testosterone levels aren’t usually known to cause ED. If you have naturally high testosterone levels and are experiencing erectile difficulties, you should speak with a doctor or healthcare professional, as it’s likely due to another issue.

But those that take testosterone illicitly (such as in an attempt to boost bodybuilding) may experience ED and a host of other symptoms as well. While it can seem like more is always better when it comes to testosterone, in reality, excess testosterone in your body is turned into estrogen (regardless of your sex). This rise in estrogen may further contribute to ED.

Will Viagra work if you have low testosterone?

Doctors prescribe the medication sildenafil (Viagra) to treat ED. This medication is a phosphodiesterase inhibitor that works to improve your blood flow to help you achieve an erection.

Several studies have suggested that if you have low testosterone, Viagra won’t work as well to treat ED. As a result, a doctor may recommend taking both testosterone replacement therapy as well as Viagra (depending on why you’re experiencing ED) together.

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If you have low testosterone and ED, you may benefit from testosterone therapy as well as taking phosphodiesterase inhibitors. Using this approach is more likely to effectively treat ED than taking phosphodiesterase inhibitors alone.

But taking testosterone replacement therapy alone isn’t likely to treat ED, according to the American Urological Association. This is likely because ED can have many underlying causes. Treating these causes as well as low testosterone can make improvements in your sexual health and overall health.

HRT and erectile dysfunction

Some transgender people who are assigned male at birth may wish to pursue hormone therapy as part of their medical transition. When this is the case, a doctor may prescribe hormone replacement therapy (HRT) in the forms of estrogen and gonadotropin-releasing hormone to increase estrogen and decrease testosterone. The results can be a more “feminine” appearance, including breast growth.

Another side effect of HRT can be fewer erections and lowered sex drive. If this happens to you and you wish to support your erectile function, talk with a doctor. They’ll typically prescribe medications used to treat erectile dysfunction, such as phosphodiesterase inhibitors like sildenafil (Viagra) or tadalafil (Cialis).

ED can have many contributing factors. As a result, a doctor may recommend several strategies to treat it. Examples include:

  • medications to improve your penile blood flow, such as sildenafil (Viagra), tadalafil (Adcirca and Cialis), vardenafil (Levtra and Staxyn), and avanafil (Stendra)
  • testosterone replacement
  • injections of the medication alprostadil (Caverject and Edex) to improve your erections
  • using penis pumps or vacuum erection devices
  • using penile implants
  • participating in counseling to aid in lowering stress, anxiety, or depression, which can contribute to ED

Talking with a doctor about your treatment options is important in regaining your sexual function and enjoying a healthy sex life at any age.

Low testosterone can be one of many factors that contributes to ED. If you’re having difficulty achieving or keeping erections or you have other symptoms of low testosterone, talk with a doctor.

A doctor can perform blood testing or other examinations to determine potential causes for your ED and recommend a course of treatment that’s right for you.