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Upright Troubles: The Link Between Low Testosterone and Erectile Dysfunction

Dr. Fartash Sarwar

2 min read

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Known in the common tongue as the ‘male hormone’ despite being present in both males and females, testosterone is responsible for sex organ development during pregnancy and physical changes during puberty in males, along with affecting sex drive, sperm, red blood cell and sex hormone production, bone density, fat distribution, and strength.

Like estrogen (the female hormone), testosterone levels begins to decline with age (30 being the bottom threshold for testosterone decline) at 1% per year, and with this decline come numerous, sometimes highly concerning bodily changes that might urge a visit to the top urologist in Lahore.

Low T Side-Effects:

  • Insomnia
  • Depression
  • Sleep apnea
  • Extreme fatigue
  • High cholesterol
  • Increased body fat
  • Body-wide hair loss
  • Reduced sexual function
  • Swollen or tender breasts
  • Decreased muscle and bone mass
  • Hot Flashes (sudden feelings of feverish heat)
  • Memory, concentration, motivation, and self-confidence issues

Erectile Dysfunction (ED):

Of all the side-effects of age-related testosterone decline, sexual dysfunction is perhaps the most disconcerting for most of the male population. As a result, another related phenomenon known as Erectile Dysfunction, i.e. difficulty getting or keeping a firm erection during intercourse, is often blamed on testosterone decline.

ED commonly results in reduced number of erections, decreased libido (sexual desire), and a slightly lowered sperm count. Another reason why low T and ED are often related is because ED is more common after 50, when testosterone levels are at an all-time low.

Does Low T Cause ED?

Some men continue to have healthy erections despite reduced testosterone, while others with normal-range testosterone often find erections difficult. So, while testosterone does play an important role in proper and timely erections in that low libido can make getting or maintaining an erection difficult, low testosterone is rarely ever the prime ED-causing factor. On the contrary, other, seemingly unrelated bodily conditions account for most cases of ED.

Other Causes:

A large majority of ED cases are caused by atherosclerosis (hardening and narrowing of arteries due to cholesterol buildup), which in turn, may be attributed to diabetes, hypertension, smoking, and high cholesterol; all correlated conditions. Since an erection requires excess blood to the genitals, hardened or damaged blood vessels are unable to dilate, resulting in a weak erection or none at all.

Other common causes of ED include depression, anxiety, stress, chronic back pain, spinal cord injuries, multiple sclerosis, certain medications and medical procedures, or injured sexual organs.

Is Testosterone Replacement Therapy (TRT) Useful for ED?

TRT, the primary low T treatment, works to increase testosterone count via muscular injections, topical patches over the skin or inside the mouth, or pellets inserted under buttock skin. Previously administered as an ED treatment, it has now been known to be highly ineffective in most individuals and poses numerous health risks.

1-Primarily Ineffective:

If low libido is the root cause of ED, testosterone replacement may be effective. However, no significant changes were observed in ED-affected men with both normal testosterone and low testosterone levels.

2-Major Risks:

While immediate physical reactions include increased appetite, nausea, vomiting and mood alterations, TRT also presents multiple long-term health risks like:

  • Permanent inability to naturally produce testosterone
  • Fluid retention
  • Reduced fertility that may eventually cause sterility (therefore not recommended in younger men contemplating fatherhood)
  • Sleep apnea and increased risk of cardiovascular disease
  • Testicle shrinkage
  • Priapism (an erection that does not go away without medical aid)
  • Increased risk of prostate cancer and activation of tumors in the prostate (therefore not recommended for men at high risk of prostate cancer and cardiovascular disease)


TRT gels, patches, and pallets are expensive in themselves, and since indefinite treatment is required for continued effects, the expenses can pile up significantly.

Treatment Alternatives:

1-ED-Specific Medication:

Specifically for men with normal-range testosterone levels, PDE-5 inhibitors that enhance blood flow to the spongy tissues responsible for creating erections in the penis are commonly prescribed. These include Viagra, Levitra, Cialis, and Stendra. However, despite being faster and more effective than TRT, 30% of men with ED do not respond to these drugs.

Additionally, strength-training exercise, weight loss (in case of obesity), reducing sugar intake, and a diet containing zinc, vitamin D, Branch Chain Amino Acids (BCAAs), and healthy fats may also help with improving erections.

TRT should only be reserved for severe cases of ED and only when low testosterone has been identified as the causative factor. Therefore, if you experience erectile issues, consult with your doctor to help determine the root cause. You can also book an appointment with a top Urologist in Lahore, Karachi and Islamabad through oladoc or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your genital concerns.

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Dr. Fartash Sarwar
Dr. Fartash Sarwar - Author Dr. Fartash Sarwar is among the Best Urologists in Rawalpindi. Dr. Fartash Sarwar is a Urologist practicing in Rawalpindi. Dr. Fartash Sarwar has the following degrees: MBBS, FCPS (Urology) and has 20 years of experience.

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