Many men are under the assumption that low testosterone levels can cause erectile dysfunction, but is that really the case?  Before that question can be answered, it’s important to look at testosterone as a whole then focus on erectile dysfunction and low testosterone.



Testosterone: What Is It?

Testosterone is a hormone that is naturally produced in both men and women but is known more for being the main male sex hormone. The testicles produce the testosterone, which is then controlled by the pituitary gland and hypothalamus.  It’s the hormone that causes male sex organs to develop in the fetal stages and leads to bodily changes in men when they hit puberty. For adult men, it can control and maintain those male physical and psychological features. It can do the following:

  • Help with sperm production
  • Promote feelings of sexual desire and influence the sex drive
  • Affect mood and energy levels,
  • Influence bone strength and muscle mass


Does Low Testosterone Cause Erectile Dysfunction?

It’s a widely known misconception that erectile dysfunction (ED) is the result of low testosterone levels. Yes, androgen has a role in whether or not you get an erection but no clinical evidence ties the low hormone level to one’s ability to attain or maintain their erection. ED is more of a vascular issue rather than a hormonal one.

More recent studies show that men who use testosterone therapy saw no improvement at all with their ED problem. According to research, two facts dismiss the link between ED and low testosterone.

  • No requirement on normal testosterone levels for normal erections.
  • A rise in testosterone level will not increase an erection’s strength or frequency

So, why is it that people associated ED with low testosterone levels? It’s because a man with ED tends not to have the sexual desire or prowess as he once had and everyone automatically “assumes” a low testosterone level is to blame.

It’s normal for men who have ED or other sexual-related problems for any great length of time to lack the willingness for sex (perhaps to avoid the issue or depressed because of it). For these men, they think “Why bother?”.

It’s usually not low testosterone levels that cause ED.

Age is another reason people tie ED to low testosterone. When a man gets older, his level of testosterone drops up to two percent every year. Aging can also reduce a man’s desire for sex and keep an erection. The reality is that these two can happen at the same time, and not be because of low testosterone levels.

About two percent of testosterone roams freely in the body, with another 40 percent tied to the sex hormone-binding globulin. The rest of it, however, is tied to other proteins such as albumin. Both free and Albumin-linked testosterone is regarded as active testosterone.

A number of serious medical problems can cause a decrease in free testosterone even if the total amount of it is still the same. And, vice versa. When doctors are treating men suffering from low testosterone, they will look at both the whole and free testosterone levels before subscribing to any kind of treatment option.

Since there can be a great disparity in testosterone levels in the same person (based on when it’s measured), multiple measurements need to be taken before any treatment option is subscribed.


Low vs. Normal Testosterone Levels

Testosterone is measured, not by scale, but range. A simple blood test can determine its levels, but since the hormone fluctuates at any given time based on the time of day, an accurate reading can only be attained by testing at different times on different days.

Normal testosterone levels have a range of 300 to 1,200 nanograms per deciliter. Even if a man’s testosterone level is on the low end, it does not mean he has low testosterone.

The reality is that most men will not have real low testosterone (levels under 300 ng/dl).


What’s The Reason Behind Low Testosterone?


There are quite of few medical reasons a man may have low testosterone. Before a doctor chooses to place a man on a hormone replacement treatment, he/she will try ruling out other serious medical issues as the underlying cause. Low testosterone levels can be caused by:

  • Hypertension
  • Thyroid or pituitary problems
  • High cholesterol
  • Obesity
  • Kidney problems
  • Asthma (pulmonary disease)
  • Osteoporosis
  • Type 2 diabetes
  • Steroid exposure


Low Testosterone Symptoms

Only a medical professional can determine if the symptoms you have are the result of low testosterone. However, if a man does have low testosterone levels, he may experience any of the following:

  • Anxiety
  • Depression
  • Weight gain
  • Inability to concentrate
  • Low sex drive
  • Erectile dysfunction

These symptoms are not conclusively linked to low testosterone levels and may be caused by something else entirely. However, if your doctor reveals that you are androgen-deficient, he/she may start on you on a long-term TRT that could include taking pills, applying gels or creams or doing an injection or under-the-skin implant.Oral hormone treatments are not typically offered since they don’t absorb well and could cause bodily complications. The best way to replace testosterone is through skin delivery.

A man who has a 300 or less testosterone level could experience an array of symptoms such as:

  • Extreme fatigue even with exercise
  • Decrease in sex drive
  • Fertility problems due to low sperm count
  • Depression and irritability
  • Decrease in body hair
  • Decrease in muscle mass and bone strength
  • Excessive sweating/hot flashes
  • Increased body fat and weight gain

Special Note: Many of these symptoms are also a part of the normal aging process and are tied to other medical conditions as well. It’s best not to jump to conclusions until you talk with your doctor.


Should You Do Testosterone Replacement Therapy

There is no such thing as testosterone supplements, and studies have shown time and time again that any testosterone, androgen and hormone replacement therapies are not effective in treating ED.

Men who are diagnosed with low testosterone could start a testosterone replacement therapy, either with topical gels, injections, patches or pills. Topical gels like Axiron and AndroGel are usually the preferred choices and are applied to the upper areas of the body such as under armpits and shoulders.

When a TRT is given, it can lead to the body’s natural production to decrease or even stop. It can also cause sterility and testicle shrinkage. If a man is still in his reproductive years, this may not be a suitable option for him.

Some men who decide to go through with the TRT notice an increase in their sex drive and energy. However, it should only be prescribed to men who have severe cases of low testosterone and after thorough blood testing has been done to confirm the diagnosis.


Are There Any Dangerous Side Effects To Using Testosterone Replacement Therapy

At the present moment, testosterone is not supplemental. Low testosterone treatments work to replace the natural bodily production of testosterone and may actually cause the body to shut down its own process of it.

However, the pharmaceutical industry has heavily marketed the use of a testosterone replacement therapy, which has led to more doctors prescribing the treatment to men suffering from low testosterone.  The effects could be quite severe – more than what is currently known now.

It’s imperative that a man seeking a testosterone replacement therapy treatment consider talking to their doctor about the pros and cons – i.e., the benefits and the side effects including but not limited to:

  • Mood swings
  • Increased aggressiveness
  • Boost in appetite
  • Vomiting
  • Nausea


Special Note: The increase in energy and better mood men experience when using a testosterone replacement treatment is often mistaken are being effective. The reality is that the steroids in the testosterone are the reason for the changes. Once men stop their treatments, they’ll suffer from withdrawal and could experience a severe bout of depression and their body may be unable to generate testosterone naturally.


What are the some of the long-term side effects that occur with this kind of treatment? They include:

  • Urination difficulty
  • Permanent reliance on the treatment
  • Blood thickening and rise in red blood cell count
  • Growth of prostate cancer tumors
  • Blood clots, fluid retention, liver problems, stroke, etc.
  • Prostate tissue growth
  • Decrease in sperm count (could cause infertility)
  • Testicle shrinkage
  • Rising resistance to testosterone replacement
  • Permanent damage to natural testosterone production


Some serious side effects to be mindful of include:

  • Long-lasting erection that doesn’t go away (known as priapism)
  • Swelling
  • Liver damage
  • Addiction (men who use this often become unable to naturally produce testosterone)


Who Should Not Use A Testosterone Replacement TherapyTRT is not recommended for men who are healthy but have low testosterone levels. It should not be given to men who have prostate cancer, those with prostate issues, heart disease or high cholesterol levels. Testosterone treatment can aggravate prostate cancer in men who have undiagnosed cancer.

Men who consider this treatment should be tested first for prostate cancer.


How Effective Is Testosterone Replacement Therapy?

There has been no conclusive evidence that supports that TRT is effective, and it should never be given to any man without them knowing all the risks including prostate cancer and strokes.

Since TRT is a rather serious treatment option, men who have low testosterone levels could look at other possible alternatives. They should get regular health exams, including prostate screenings, from their doctor and make their doctor aware of medical problems right away.


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