Testosterone for Erection Problems

When you need it—and when you don’t

Most men have problems with erections from time to time. But some men have erectile dysfunction, or ED. This is when it is difficult to get or keep an erection that’s firm enough for sexual intercourse.

If you have ED, you may think that testosterone treatment will help. Testosterone is a male sex hormone. After age 50, men’s levels of testosterone slowly go down and ED becomes more common. But unless you have other symptoms of low testosterone, you should think twice about the treatment. Here’s why:

Testosterone treatment usually isn’t helpful for ED.

Testosterone treatment has not been shown to improve erections in men with normal testosterone levels. Studies also show that testosterone treatment does not significantly improve erections in men who have low testosterone.

ED usually has other causes.

ED is almost always caused by low blood flow to the penis. This is a result of other conditions, such as hardening of the arteries, high blood pressure, and high cholesterol. These conditions narrow the blood vessels and reduce blood flow to the penis. Low testosterone may affect the desire for sex, but it rarely causes ED.

Testosterone replacement therapy has many risks.

Testosterone treatment can cause the body to retain too much fluid. It can also cause acne and enlarged breasts. Other side effects include lower fertility; an increase in red blood cells; and an increase in sleep apnea symptoms.

Women and children should avoid touching unwashed or unclothed areas of skin where a man has applied testosterone gel. The gel can be transferred through skin contact.

Although available data is conflicting, the Food and Drug Administration (FDA) has concluded that increased cardiovascular risk (problems with the heart and blood vessels) associated with testosterone use is a possibility. The AUA recommends that only FDA-approved medications should be used and a physical evaluation and follow up are important.

Testosterone replacement therapy can be costly.

Testosterone treatment can be an injection, a gel, or a patch that is put on the skin. All of these are costly. They may cost hundreds of dollars a month, depending on the treatment.

Men who use a testosterone treatment must use it indefinitely to get and keep the full effect.

When should you consider testosterone treatment for ED?

If you’ve had trouble having erections for three months, talk to your doctor. He or she will ask about all your symptoms and give you a physical exam. Symptoms of low testosterone can include less of a sex drive, loss of body hair, breast growth, needing to shave less often, a drop in muscle size and strength, and bones that break more easily.

If you have some of these symptoms, your doctor may have you get a blood test to measure your testosterone levels. The blood test should be done more than once. It is best to do it in the morning when testosterone levels are highest.

If the tests show that you have low testosterone levels, your doctor should look for possible causes. For example, the low levels might be caused by a problem in the pituitary glands.

If no other cause is found, you can try testosterone treatment.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2018 ABIM Foundation. Developed in cooperation with the American Urological Association.