Testosterone & Erectile Dysfunction
In this article, I am going to cover some of the main questions men have about testosterone levels and also answer whether testosterone levels impact sexual health and cause erectile dysfunction.
I will also go through whether testosterone can impact fertility status and libido levels, how and when to test your testosterone levels, and what the common symptoms of both low and high testosterone levels are.
We’ll also cover the treatment and lifestyle changes that can resolve and rectify low testosterone levels in your body, whilst also exploring what could be causing high testosterone and what to do if your levels are found to be elevated.
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What is Testosterone?
Testosterone is a type of androgen (also known as a steroid) hormone that in men, is produced mostly in the testicles. It is vital for sexual and reproductive development including creating a healthy sperm count and a healthy sex drive, and it also plays a role in bone and muscle mass, red cell production and even determining a mans mood.
During puberty, a man’s body will ramp up testosterone production until around age 30, where this production starts to slow and eventually decrease. This is what causes the deepening change in a man’s voice, and hair to suddenly develop on the face and body.
High testosterone levels rarely occur naturally, as differences between the normal, healthy ranges are hard to pinpoint. That said, those that have high testosterone levels are considered to have abnormally high levels generally due to supplementing large doses to increase overall muscle mass. This is commonly seen in athletes, and side effects of this type of testosterone can include:
- liver disease
- increased risk of blood clots
- prostate enlargement with difficulty urinating
Whereas, many men are considered the right candidates according to the Endocrine Society for much lower, more controlled doses of safer testosterone administered by their doctors when the following symptoms are seen:
- lowered cognitive ability
- lowered sex drive
- erectile dysfunction/impotence
Treatment was only administered for low testosterone in those whose total blood testosterone levels were 300 ng/dl or lower when tested before administering testosterone gels, and when symptoms of low testosterone levels were observed.
Women also benefit from small amounts of testosterone which the ovaries help to produce. It is interesting to note that if a woman has low levels during pregnancy, this is what can lead to micropenis syndrome.
Below you’ll find an illustration that shows the correlation between men’s testosterone and women’s Estrogen levels. You can see how men’s testosterone levels peak in the 20’s and then gradually start to decrease with the biggest decrease occurring when men are in their 70’s – a drop from 63% to 46% on average.
Treatment for erectile dysfunction, however, can include testosterone therapy, but it should be noted that this is usually only successful with men who have confirmed low testosterone levels done by a blood test (it doesn’t benefit those with normal levels) and the caveat to this treatment is if the men also have other symptoms beyond just erectile dysfunction.
As there are many reasons that low testosterone levels can occur including type 2 diabetes, chronic liver or kidney disease, COPD and other lung diseases, steroid use and even trauma, which can all contribute collectively to lowering testosterone and/or causing erectile dysfunction.
What Causes Low Testosterone Levels in Men?
Low testosterone isn’t quite as simple as having just one specific cause. There can be many and the causes unique to each male. The most common causes of low testosterone are listed here below:
- Type 2 Diabetes
- Chronic medical conditions (especially liver or kidney disease)
- Hormonal disorders
- Medications (narcotics, chemotherapy)
As a man hits age 30, testosterone production naturally declines. This drop in testosterone levels in older men is linked to a reduction of a protein that is made in the testes called StAR (steroidogenic acute regulatory protein).
This same protein is what is found in a woman’s ovaries and helps with the production of testosterone in women as well. StAR has also been found in any tissues that produce steroids, such as the brain and the adrenal cortex.
Total testosterone drops on average 1.6% every year thereafter, whilst free and bioavailable testosterone drops 2-3% every year thereafter. The changes in average serum testosterone levels however, change in ageing men that have been given a diagnosis of hypogonadism which also increases with ageing also.
Twenty percent of men aged over 60 have total testosterone levels below the normal range and the figure rises to 50% in those aged over 80. The figures concerning free testosterone are even higher as would be expected as the SHBG levels decrease at the same time.
Do I Need a Testosterone Test?
If you have any of the symptoms listed below that relate to either low or high testosterone levels, then it warrants a blood test to accurately determine if your body is making too much or too little testosterone.
Symptoms of High Testosterone
- Changes in blood pressure (dizziness, headaches, fatigue, nausea, fainting)
- Trouble keeping an erection
- Trouble getting an erection
- Low libido
Symptoms of Low Testosterone
- Reduced sex drive
- Reduced erectile dysfunction
- Loss of lean muscle mass
- Feeling tired all the time
- Obesity (being overweight)
If you have one of the above symptoms it may not mean you necessarily have low testosterone/testosterone deficiency. That said, if you have two or more symptoms, then this would be more of a reason to test for low testosterone especially if advised or recommended by your doctor.
If you do have one symptom it shouldn’t stop you speaking to your doctor and still requesting a testosterone test to then conclusively put your mind at rest and rule it out.
How to Test for Low Testosterone At Home
If you and your doctor have discussed your symptoms and decide to go ahead with testing your testosterone levels, the next step is to go for a blood test which your doctor will write you a referral for or fill out a form for you to take to your local blood testing clinic.
For a conventional doctor to diagnose a man with low testosterone, the blood test reading would need to come back at less than 300 ng/dL. However, depending on which country you get your test done in, this could be lower than 264 nd/dl.
According to the Endocrine Society in the USA, new guidelines were agreed upon after a new study helped to refine the definition of the normal ranges for men. This was 264 – 916 ng/dL for men who were aged 19 years to 39 years old and were not obese at the time of testing.
In some countries, it is possible to do a testosterone test at home. These tests vary as some collect saliva which will give you the results of free testosterone in your system, others are home testosterone blood test kits which give the results of free and total testosterone (bound) to the proteins albumin and sex hormone-binding globulin.
If you want more insightful and accurate results, i’d recommend going the blood test route – the process is pretty simply once your kit arrives in the mail and usually includes a free return address envelope as well.
You simply need to collect a sample of your blood using a clever lancet device which essentially takes a pin-prick of your finger and collects a sample of your blood.
Having sent your blood sample back in the mail, speed of results do vary however in most cases you’ll be able to view and access your results within a matter of 2-3 days.
The below video is by Dan Rockwell and shows how to do a home testosterone test using a kit from Let’s Get Checked – this will at least give you an idea of whether you’re able to cope with a home blood test kit!
Doctors are not in agreement at which tests are better, however, at this point, The American Association of Clinical Endocrinology still recommends using a blood test over saliva for testosterone. For all tests, it is advised that no food is eating beyond 9 pm the previous day that you intend to test on.
Does Low Testosterone Levels Cause Erectile Dysfunction?
Yes – but only in a small number of men is low testosterone a cause on its own for erectile dysfunction. The majority of men with erectile dysfunction have other health concerns whereby erectile dysfunction is a secondary health issue. For many men, atherosclerosis is the most common underlying health concern behind erectile dysfunction.
Atherosclerosis is where the arteries have built up plaque in them that hardens the arteries, making it harder for blood to flow properly around the body. If you have atherosclerosis it means that one or more of your blood vessels are too narrow or are blocked.
This all gets set in motion when the heart pumps, which then helps the blood in our veins to get to the different parts of the body it is needed, which is a normal cycle. For this blood to be pumped to the penis area, the blood has to first go through arteries in the stomach area and then it branches off.
In short, in healthy people this isn’t an issue, but in those with atherosclerosis this causes erectile dysfunction by reducing blood flow to the penis and the entire genital area during arousal.
An erection requires more blood to flow into the penis to make it swell and “grow”. For someone with atherosclerosis this is not able to happen as the arteries cannot widen or dilate due to the hardened plaque on the narrowing artery walls or the blockages that have formed from the plaque.
In men over 60, research shows that atherosclerosis is the leading cause of erectile dysfunction and having erectile dysfunction is as much of a risk factor for heart disease as someone who has a history of smoking or a history of coronary artery disease.
Does Low Testosterone Cause Infertility?
If there is low testosterone in a man, this does not always cause infertility, as sperm production is mainly stimulated by other sex hormones. Low levels of testosterone may cause a lowered production of sperm, however.
When it comes to causes of infertility, according to The Mayo Clinic these can include:
- Abnormal sperm production or function due to undescended testicles
- Genetic defects
- Health problems including diabetes
- Infections such as chlamydia, gonorrhoea, mumps or HIV
- Enlarged veins in the testes
Low sperm production can, however, be considered a major cause of male infertility according to Health Line. They also go on to say that sperm count is considered low if it dips below 15 million sperm per millilitre (mL) of semen, although the average is around 75 million sperm per mL.
Health Line also states that having obesity or being overweight, having experienced trauma or surgery in or around the testicles and taking certain medications can all increase your chances of having a lowered sperm production.
Can Low Testosterone Cause Lack of Libido?
Lowered testosterone can definitely cause a lack of libido in some men. However, some men can still maintain feeling sexual despite having quite low testosterone levels.
It is hard to determine what is truly considered healthy testosterone levels in a man, some men can experience lowered sexual desire even when they themselves test and have their results come back within the ‘normal’ range.
This is why seeking out a doctor who can help you find your true optimal range is always desired. There is no one size fits all range for normal testosterone levels. Almost all men will notice a decline in sex drive if their testosterone is lowered far enough.
Can Low Testosterone Cause Premature Ejaculation?
As we discussed earlier, low testosterone can cause erectile dysfunction in a small number of cases. It is this presence of erectile dysfunction that is a common contributor to premature ejaculation. So in some cases, it is definitely possible.
For the majority of cases, premature ejaculation is connected to erectile dysfunction that has other causes outside of low testosterone.
Low Testosterone in Young Men
Even though testosterone levels in men typically decline from aged 30-40, Parsley Health functional medicine practice in America reports that low levels of testosterone are becoming more and more common in young and middle-aged men.
Low testosterone can also be accompanied with other hormonal imbalances or substantial decreases. These combined hormonal changes then can go on to cause “a variety of unnecessary symptoms and complications for men”.
Making it worthwhile to do a comprehensive hormonal test of several hormones when suspecting low testosterone, to be sure that you get a complete picture of what is going on.
Low Testosterone in Older Men
It is unknown when a man’s testosterone will start to naturally decline exactly, as each person is unique. Factors that contribute to this include diet, lifestyle and genetics.
Typically, in healthy individuals, older men will experience lower testosterone levels as soon as the StAR protein stops being made in the same amounts as when a man was younger.
This StAR protein is made specifically in the testes and it is possible that when the decline in this protein happens, that this is in part why men can appear to have a ‘mid-life crisis’ as it can go on to affect the brain and mood as the body adjusts to lowered levels.
Men that are living with the following lifestyle issues, according to Dr Axe, are at risk of speeding up the natural decline of testosterone:
- Chronic stress
- Insufficient nutrition
- Imbalanced Microflora
- Low levels of Vitamin D
- Weight gain
- Not enough exercise
- Taking prescription medications (statins especially)
Dr Axe goes on to state that these factors all reduce the body’s ability to have a normal immune response, which goes on to then cause diabetes and obesity, taxing the body further and lowering metabolism.
Treatment for Low Testosterone Levels
Once you have been diagnosed with low testosterone levels, there are a variety of treatment options you can look at to rectify and resolve your lower levels – some treatment options are more invasive than others.
The variety of treatment options for low testosterone levels include:
- Modifying lifestyle and diet, including eating specific foods known to boost natural testosterone production.
- Using more natural methods such as taking supplements to go on to help the body produce its own testosterone naturally, and even taking bioidentical testosterone replacement in the form of creams, tablets, pills (and injections).
- Using synthetic testosterone replacement therapy that is also available in a variety of forms such as patches, tablet and injection forms.
Testosterone Boosting Supplements & Erectile Dysfunction
An important but under-discussed supplement that is super important for the manufacture of testosterone is vitamin D.
Many people have no idea what their vitamin D status is, so it is always advisable to have a test done and if your levels are low, supplementation of Vitamin D3 (that is the most bioavailable form that the body will receive and use) of up to 5000 iu per day.
Dr Axe says without correcting this deficiency, testosterone levels will always remain low, no matter what other treatments you try.
This is a natural amino acid that can boost testosterone levels. According to research, it works by increasing follicle-stimulating hormone and luteinizing hormone, which is important as it is the luteinizing hormones makes the Leydig cells in the testicles increase the production of testosterone. It may also help to aid sperm quality and production.
DHEA (dehydroepiandrosterone) is a steroid hormone that is produced naturally by the adrenal glands. It is then converted by the body into several sex hormones including testosterone.
This is why it is often supplemented to help boost testosterone, which is why testing for this hormone as well as testosterone is important.
Low DHEA could be the cause of your low testosterone, and then that would need to be explored as to why. DHEA is banned in professional sports, so do not take this if you are an athlete.
Testosterone Injections & Testosterone Hormone Therapy
There are two types of hormonal therapy options. The first being the synthetic types which are not identical to the natural type the body produces. The second type being identical to the type the body naturally produces. When seeing your doctor he or she may prescribe either of them.
It is good however to do some research before going down this route into both so you are aware of any negative side-effects that may be associated with either.
Generally speaking, the bioidentical types are better received by the body and therefore easier to absorb and less challenging when it comes to excretion by the liver and other organs that help excrete hormones when they have completed their job.
There are also many studies demonstrating that bioidentical hormones have fewer side-effects than synthetic hormones issued.
Natural identical hormone therapy is generally called ‘BHRT’ which is an abbreviation for Bioidentical Hormone Replacement Therapy. There is also a type of BHRT called BioTE that is a method of BHRT using pellet therapy. Synthetic hormones are generally called HRT (hormone replacement therapy).
Both types of testosterone hormone replacement therapies are available in different forms which include:
- Creams and gels
- Patches (including scrotal)
Testosterone Boosting Foods & Dietary Interventions
What you eat can have a profound effect on your health and also enable healthy hormone expression and function. Listed below are a combination of proven dietary interventions or additions that have demonstrated the ability to boost testosterone levels.
Fats for many decades were demonized and were thought to be the cause of weight gain. We know now when this misinformation was spread, people reduced their fat intake of all types and increased their consumption of carbohydrates.
People then noticed health did not improve as predicted. Thankfully many new studies have helped to demonstrate the truth – that not all fat is unhealthy and in fact, several types are needed daily for good health.
Be sure to add plenty of healthy fats in your diet if you want to ensure your whole endocrine system (where your hormones are made) is functioning correctly and making all its hormones, including testosterone.
A study has also demonstrated that when men reduce their healthy fat intake (potentially because they still believe that fats are unhealthy) their levels of free testosterone, testosterone and androstenedione decreased. Types of healthy fats include:
- Coconut oil
- Raw, fermented dairy products like goat milk kefir, yoghurt
- Raw goat or sheep milk cheese
- Flax seeds
- Chia seeds
- Wild salmon
The most dangerous type of fat out there is trans fats. These are to be avoided at all costs. Dr Axe does advise avoiding conventional dairy because it will actually damper your testosterone.
Sometimes it can feel all we are told these days is to avoid sugar. But here is how overconsumption can relate to testosterone levels.
Eating processed grains and sugars as the main part of your typical diet, causes your blood sugar to become dangerously high. To stop your high blood sugar causing damage, the pancreas works even harder to produce more insulin that is a hormone needed to take the sugar from the bloodstream and into the cells to then be broken down into energy.
If this cycle continues, eventually a person will develop insulin resistance. If this isn’t resolved, then a person will eventually move into type 2 diabetes.
At this point, the body is also not able to produce the right levels of testosterone. So whether you are a diabetic or not – if your diet is full of refined foods and sugars, having a testosterone test is a good idea as well as working on kicking the sugar habit.
Intermittent fasting has been shown to increase testosterone between 200 and 400 percent in a recent study. A further study at the University of Virginia Medical School observed that when men ate no calories for 24 hours, growth hormone levels increased 2,000 percent over the baseline.
Growth hormone levels are directly correlated with testosterone, meaning what influences growth hormone also directly impacts testosterone.
A typical intermittent fasting schedule involves skipping breakfast, and usually eating your first meal of the day at noon, another at 3 pm, and your last meal of the day at 6 pm. Fasting then allows your organs to rest, many of which are involved in digestion and hormone production including testosterone.
Exercise & Lifestyle Changes For Boosting Testosterone
How much we exercise and sleep can also have a major impact on a healthy hormonal system, including how much testosterone is produced. That is why the next three items listed below are some of the most important in the area of exercise type and lifestyle change type.
Stress can be a good thing, and can actually motivate us through the day to achieve our goals. However, chronic stress (long term stress) can cause major health issues and overtime can impact hormones including testosterone production. As long term stress causes the body to constantly increasing levels of cortisol and other stress hormones.
A study published in 2010 demonstrated that when cortisol is high, testosterone levels also respond by increasing. However, not too long after they drop to really low levels, even lower levels than when cortisol production was increased. So finding ways to deal with chronic stress, or get to the root cause of chronic stress is a must for anyone looking to keep their testosterone levels healthy or to increase them naturally and bring them back to the optimal, healthy range.
Get Quality Sleep
Quality deep sleep at the right time is another way to ensure your testosterone levels are raised if they are low. A study that confirmed this theory found that sleeping between 10 pm and 6 am every night helps to release cortisol and then balance hormones, helping to prevent low testosterone.
Heavy Weight Training & Interval Training
Going to the gym at least three days a week and combining weight training with HIIT workouts (high-intensity interval training) has been shown to boost testosterone levels naturally, alongside HGH (as the two influence each other). Lifting at least 30 minutes up to 1 hour can be very beneficial in boosting low testosterone levels.
Can High Testosterone Levels Cause Erectile Dysfunction?
The most common cause of high testosterone levels is due to testosterone replacement therapy given to those looking to boost testosterone levels and anabolic steroids that athletes use to enhance their performance. With high testosterone levels affecting sexual health in some cases, such as causing erectile dysfunction.
Symptoms of High Testosterone
Dr. Lucille, who is a registered nurse and naturopathic doctor, stated that many men are being over-treated for ‘low testosterone’ with replacement therapy. Testosterone replacement can then induce high testosterone levels that can then go on to cause the following symptoms:
- Acne or oily skin
- Prostate swelling
- Breast enlargement
- Worsening of sleep apnea
- Fluid retention
- Decreased testicle size
- A decrease in sperm count
- Increase in red blood cells
Changes to your sexual health including ED (erectile dysfunction)
Dr Lucille then stated the only behaviour symptom she has seen with too much testosterone replacement therapy such as injections, are mood swings. She then said the best way to avoid these symptoms is to avoid testosterone replacement therapy unless you really need to take it.
Advising that if low testosterone is a concern for you, to try changes to your lifestyle and diet first as mentioned above.
Causes of High Testosterone
Outside of being on testosterone replacement therapy, having high testosterone levels naturally is not common at all. If testosterone levels are found to be high and you are not taking testosterone supplement this could mean that you have an underlying health condition such as having a tumour growth near hormonal glands such as your adrenal gland or testicles.
If you experience the symptoms of high testosterone and are taking anabolic steroids or you are taking testosterone supplements or replacement therapy for diagnosed low levels of testosterone, it is really important you speak to your doctor right away.
Impotence, Testosterone & Men’s Health
Erectile dysfunction can be caused by a variety of physical and physiological factors, which are not just related to low or high testosterone levels. From all the current research available, if you have normal testosterone levels it doesn’t make a difference to the erectile dysfunction you may be experiencing if you increase testosterone production.
So many sources state that low testosterone by itself rarely causes erectile dysfunction, and this particular article written by the Urology Care Foundation highlights clearly that erectile dysfunction is rarely caused by low testosterone.
They also state that it is totally normal for some men to experience trouble with their erections from time to time. However, erectile dysfunction that progresses or happens frequently during sex should be treated immediately.
If frequent problems with erections are what you encounter, ensure you visit a doctor right away to make sure they get to the bottom of it. Your doctor will also then be able to rule out or begin treating some serious health conditions (that often cause erectile dysfunction) which can get worse with time if not addressed as soon as any unusual symptoms are noticed.
So what about you? Do you think you’ve got high or low testosterone? Have you tried a home testosterone kit? How did you get on? Let us know in the comments, along with any additional questions you may have.