In short
Overview
Testosterone and libido are genuinely linked. Testosterone and erections are linked much more weakly, and confusing the two is why a lot of men are disappointed by treatment.
Direct Answer
Testosterone is an important regulator of sexual desire, and replacement improves libido reliably in men who are actually deficient.
Its effect on erections is smaller. In TRAVERSE, testosterone improved sexual activity and desire but not erectile function. Where erections are the problem, it is normally added to a PDE5 inhibitor rather than used instead of one.
And in men whose testosterone is already normal, it does neither.
Who This Applies To
- Men whose desire has dropped, with or without erection problems
- Men on testosterone whose libido improved but whose erections did not
- Men considering testosterone specifically to fix erections
- Men who have been told their testosterone is low but have not had prolactin or thyroid checked
Option Comparison / Decision Criteria
The best known and the one usually measured alone
Raised levels reduce libido and are treatable
Both underactive and overactive cause it
Low levels are associated with low libido in men, which surprises most people
Why an In-Person Physician Review Matters
Why the order of symptoms matters Most men who present with erectile dysfunction do not report low desire.
When a man has both, which came first is what identifies the primary problem. Desire fell first, erections followed: look for a hormonal, mood, medication or relationship cause Erections failed first, desire followed: the loss of desire is often a consequence, and treating the erections resolves it What else lowers libido SSRIs are the most common medication cause. Antiandrogens, 5 alpha reductase inhibitors used for prostate symptoms, and opioids all contribute. Men on long term opioids usually have low testosterone as a consequence of the opioid rather than as a separate condition. Depression, alcohol, systemic illness and relationship conflict complete the list. Interpersonal conflict in particular is a common cause of male sexual dysfunction and is rarely raised. Why a single low result is not enough A subnormal testosterone should be confirmed on repeat morning samples, with LH and prolactin added to establish the cause. Starting treatment on one borderline number is easy to do and difficult to undo, because your own production takes a prolonged period to recover.
Frequently Asked Questions
Less reliably than it fixes desire. In TRAVERSE it improved sexual activity and desire but not erectile function. Where erections are the problem it is normally combined with a PDE5 inhibitor rather than used alone.
Unlikely. That pattern points toward vascular, neurological or psychological causes, and the assessment goes in a different direction, including a cardiovascular workup.
Testosterone, prolactin, thyroid stimulating hormone and oestradiol. All four have been associated with low libido in men, and measuring testosterone alone misses the other three.
SSRIs are the most common medication cause of low libido in men. There are specific strategies for managing this, and they are worth discussing rather than stopping the antidepressant on your own.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- The 'male menopause'
- Physical activity
- Viagra: European public assessment report
- Cialis: European public assessment report
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.