Relationship between testosterone levels and ED

The relationship between your testosterone levels and erectile function



Summary by Jasen Bruce

A recent study of a male population explores the relationship between your testosterone and erectile function. As suspected, higher levels of testosterone equals a better erection and improved sex drive. This study also helps to explain the different types of blood tests used to check testosterone, and why it is important for men and women to have more than just the total testosterone checked (also known as serum testosterone).

The study observed over 700 men from a specific population(population-based study) and established a correlation between a man’s testosterone level and his erectile function. The men in the study were followed for a period of 4 years and were selected to participate after receiving a comprehensive survey and baseline examination designed to narrow down the participants. Erectile function was determined by having each participant complete the widely used IIEF erectile function questionnaire in addition to blood testing. The men had to have been “in a stable sexual relationship for at least 6 months” at the time of the study. Their IIEF results helped to quantify their level of erectile dysfunction (ED) into three categories; none, mild, and moderate to severe (ED).

You can take the IIEF erectile function questionnaire used in this study by clicking the link below.

What is your IIEF erectile function score? http://defymedical.com/services/sexual-health

Results will generate a score that can be used to recommend the next clinical step towards treatment.

The blood tests performed in the study include measurements of total testosterone, free testosterone, bio-available testosterone, and a protein called sex hormone binding globulin (SHBG). Many men (and women) along with their primary care doctors focus on just total testosterone, which measures the total sum of both bound and unbound testosterone. There is a difference between bound and unbound testosterone. Your body cannot use all of the testosterone measured in a total testosterone test. SHBG is a protein which can attach to testosterone very tightly which prevents testosterone from entering your cells. Any testosterone attached to SHBG would be considered bound, which the body cannot use. The level of SHBG was tested along with testosterone in this study. There are other proteins which can also bind to the testosterone molecule, such as albumin. Albumin does not bind as tightly as SHBG and therefore can quickly become unbound so that testosterone can be used by your cells. Free testosterone describes the testosterone which is not bound by any proteins and is available to be immediately used. Bio-available testosterone is a measurement of both free testosterone and also testosterone bound to albumin which, as mentioned, is easily separated so that the testosterone becomes available for use (free) when needed. Your body can use bio-available testosterone but it cannot use testosterone bound by SHBG.

This study explored the relationship between testosterone, our primary sex hormone, and erectile function. The conclusion showed a clear cause-effect relationship between the two. This is important to know since erectile dysfunction (ED) “is a worldwide disorder that affects millions of men” and has a negative influence on quality of life. If this relationship is not understood then ED treatments can fail for many men without understanding why. For example, PDE-5 inhibitors (Viagra, Cialis, Levitra) are commonly prescribed medications to treat ED. They work by inhibiting the enzyme (PDE-5) that prevents nitric oxide from relaxing the spongy erectile tissue in the penis (corpus cavernosum). Nitric oxide is released in the penis when a man is sexually aroused. Studies show that PDE-5 inhibitors like Viagra work more efficiently when there is a sufficient amount of testosterone present. These medications are more likely to fail if a man has low testosterone. Interestingly there is a positive relationship between testosterone and nitric oxide. Aging men who are experiencing ED should request to have a testosterone blood test to see if low testosterone, or more specifically low free-testosterone is the cause. The study came to the conclusion that “men with low free testosterone and high SHBG were at the highest risk of ED”. Remember, free testosterone is not bound by proteins and can be immediately used to support an erection and improve overall sexual performance. This study emphasizes why it is important to always blood test both total and free testosterone. It can be additionally beneficial for some men experiencing poor erectile function to also blood test sex hormone binding globulin (SHBG), and Dihydrotestosterone (DHT)-an androgenic byproduct of testosterone. Androgens are shown to help maintain healthy erectile function in aging men (Testosterone is also an androgen). Testosterone in a younger man plays a role in the development of sex organs and male characteristics, such as the voice deepening and increase in body hair. After these tasks have been completed testosterone continues to play a role in the maintenance of erectile function and sex drive in aging men.
There can be many factors leading to erectile dysfunction but amongst all the causes it was common to find a deficiency or insufficiency of testosterone. It is important to first check testosterone levels when experiencing ED. Testosterone replacement therapy can be prescribed by a trained doctor to help restore low levels but first you must determine if your low testosterone may be caused by lifestyle habits, such as alcohol or drug use, or by disease. Restoring testosterone to a good level can help improve your erectile performance and libido.

To download the full study as a PDF for free please visit our clinical study library by clicking on the link below. The study is listed under the title “Sex Hormones Predict the Incidence of Erectile Dysfunction: From a Population-Based Prospective Cohort Study (FAMHES)”. You can also email jasen@defymedical to request a PDF copy.

Clinical study library: http://defymedical.com/resources/clinical-studies/24-testosterone-replacement-therapy
Other references used:
The role of testosterone in erectile function and dysfunction. L. Gooren, MD, PhD, Available online 7 September 2006
Combining Testosterone and PDE5 Inhibitors in Erectile Dysfunction: Basic Rationale and Clinical Evidences. Emanuela A. Greco, Giovanni Spera, Antonio Aversa. Department

Great read. I've got to say, testosterone did wonders for my libido. Some how I think I lost just a little sensitivity in my penis while on test and I lose my erections a little quicker. Not enough to bother me, just enough to notice. But for libido, good lord, testosterone works!!!!

I wish it worked for all guys on TRT, but sadly it does not. I have been on TRT for 4 years and my libido is no better than it was with low T. And yes, I am dialed in with TT,Free T, E2, etc...

ERO

Any HCG or low dose cialis? Are you on anastrozole? Are you on antidepressants or blood pressure meds?

Lowering SHBG worked for my ED. I first started with hcg monotherapy and upped my T to 24 Nmol/l but no change with my SHBG that still was at 57 Nmol/l. My libido was realy high on hcg but still ED, didnt work so well with 100mg Viagra either. Changed to testogel and now my T was at 17 Nmol/l and SHBG lowered to 32 Nmol/l and my FT its on the right side of 2% and my ED is much better but low libido instead, so i think my T its to low right now.

Ero, great questions from Nelson
I have learned over the years that testosterone is only a part of libido and erectile function. Neurohormones (dopamine, oxytocin, etc) and your psychology plays a significant, if not equal role. Some things can affect neurohormones which can negatively affect libido and erectile function. Maybe there is another area to focus on now that your testosterone is dialed in

Jonsson, would your doctor be willing to write a prescription for a higher concentrated compounded testosterone cream? A 10% compounded gel/cream would give you 100mg/ml of testosterone. You may absorb the higher concentration better than with testogel. The Rx is typically written this way: testosterone gel/cream 10% X 30ml

I have used HCG @ 500 iu twice a week for most of the 4 years that I have been on TRT. I know it back fills important pathways, but for me, it does nothing for my libido. Low-dose Cialis does nothing for my libido, either, although since it is an ED drug, I would not really expect it to do that.

No anti-depressants or blood pressure meds. Overall I am quite healthy and I exercise 5-6 days a week with my body fat at a measured 20% (Bod-Pod test) I am working to get that down to 15%, but my point here is that I am not grossly overweight.

I do have low SHBG that averages 7-13 on a scale where 20-70 is normal, and I suspect that is the reason. Guys with low SHBG often do not have wonderful results on TRT, although there are of course exceptions.

Well heres my situation, I use a compounded transdermal with T/Chrysin/DHEA (175mg/50mg/30mg) 4 clicks daily to shoulders. I dont have my numbers handy but I run in the high 800's on T. I also have elevated e2 at 40 on ultra sensitive test but am not an AI at this point and elevated DHT at 160. Thing is, alittle water weight occasionally, I have no other noticable side effects of the higher e2 level. I take Genes nitric stack daily minus the cialis and cardio walk 6 days a week and weight train 3 days a week. Im currrntly on blood pressure meds (30 yrs in L.E.) and have NO libido or ED issues.
I ran into some probs few months ago as I was dialing in my regimine and lowered my dose to 3 clicks to control e2 and hemacrit but with blood donations I keep hema around 48. On my lower dose of cream, I lowered my T to around 500 and started having inconsistant wood, even though e2 was under 30, libido disappeared and it was hard to maintain wood even during sexytime. I do notice my balls have shrunk and I no longer have an old mans ball sack...lol...but ive had a vasectomy yrs ago and not interested in being fertile so besides alittle cosmetic looks when im looking in the mirror im not concerned
I dont know if im an exception to the rule or just respond really well with a transdermal but my nitetime wood and morning wood is daily. Its like a I have a 25 yr old stuck in a 51 yr old body! Lol...
Not to mention overall well being, mood, energy and quality of life.

ERO, do you have any test result numbers for your DHT level? I have low testosterone but high DHT and have very little issue with libido. Just curious if there is a co-relation between the two?

nydheart, great personal detail. DHT is a byproduct of testosterone and is a potent androgen in its own regard. As most of us know, testosterone is also an androgen. Androgenic hormones play a role in both maintaining libido and erectile function. Although your testosterone is lower, a higher DHT level can pick up the slack in the sex department.

On my last test my DHT was in the high normal range, but I suspect that it needs to be higher for me to have a decent libido again. Trans dermals never worked to raise my T, but maybe I need a combination of shots and transdermal to get a higher DHT level. I could care less about hair loss as I am half bald now

Like I said earlier, my DHT has always been on the high side and since I have been on TRT almost exactly 1 year, I absolutely feel optimal where I am right now even with e2 alittle higher than what it should be. Couple weeks ago my Dr momentarily lost her mind and wanted to put me on finesteride to lower DHT even though I have no PSA or baldness issues. Just alittle acne that I can deal with. That was a very short conversation....no! Lol. Hopefully If you can raise DHT that may help cuz even on bp meds and such I have no ed or libido problems

I am glad to hear that you are having such great results on trans-dermals. I know a few guys that have tried it and they soon switched to injections because it never raised their T above 500 and then got worse over time. I don't see many guys on the forums that like it either, but it seems to be working awesome in your case!

I may ask my new Doc if I can do a small amount of trans-dermal along with injections to see if I can raise my DHT to the point where my libido comes back. I had a high libido from about age 12 to my mid-40s so I know what it used to feel like...I just hope I can get it back. I don't expect it to be like it was when I was 20 or anything, but right now its mostly a memory, so any improvement is more than welcome.

The only thing i can add and thats what I have learned from this site is if you rub some TD on your nut sack it will increase DHT. All this stuff is new to me still and I learn as I go..

I'd love to k ow what causes loss of sensation in the penis. Whenever I switch protocols it gets more and more numb. I feel like trt should increase that.

I hear you ERO, I was the same from an early age. Very high drive but as soon as I hit 40 this year it's like my libido just went down a couple of notches. I bet if you ask my wife she would probably tell you its not a bad thing

HCG and low dose ED drugs like Cialis can increase the sensation on your penis (at least it does for me)

Here is a cool article I found on potential causes of penile numbness:

http://www.stronghealthtips.com/numb-penis

Maybe I'll check with a uro. Possible pudental nerve issues? Idk seems more related to hormones. Idk how my pudental nerve would be messed with