Low Testosterone (Hypogonadism) as a Cause of Erectile Dysfunction (ED)

by Alex Shteynshlyuger MD

If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5211.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office

We offer affordable appointment prices with or without insurance.  Low-cost Viagra (sildenafil) and Cialis (tadalafil) are available to our patients.

What is Low Testosterone?

Hypogonadism or low testosterone levels occur when the body does not produce enough sex hormones to carry out normal physiological or sexual processes in the body.  In men, hypogonadism is caused by low testosterone level which is the male sex hormone. It can lead to infertility or developmental problems in men and a number of other symptoms. Hypogonadism may also occur due to the imbalance between testosterone and estrogen levels.

The most common cause of low testosterone in men is age-related testosterone deficiency.  Testosterone levels tend to decrease slowly as men age.

Low testosterone levels are a common cause of erectile dysfunction in men.  Often, medications such as Viagra or Cialis do not work well in men who have low testosterone levels.  Shockwave therapy for ED works best in men who have normal testosterone levels.  Treatment of low testosterone levels is an important component of treatment in men with erectile dysfunction.

Signs and Symptoms of Low Testosterone Levels in Men

Low T Treatment in NYC

Low testosterone and ED Treatment

Hypogonadism can produce a variety of symptoms, which vary among individuals. Hypogonadism during fetal life can lead to the development of female-like genitalia or poorly developed male sexual organs.

During childhood, low or absent testosterone will prevent the attainment of secondary sexual characteristics, which will be manifest as less muscle mass, long stature, bone weakness, lack of penile growth and lack of pubic hair growth, and high pitched voice.

In adult life, low testosterone levels can cause infertility, development of breasts (gynecomastia or man-boobs), loss of libido and erectile dysfunction. Loss of muscle mass and decreased bone density may also occur.  Malaise and lack of energy can be caused by low testosterone levels, as well as many other causes.

Hypogonadism and Erectile Dysfunction

Hypogonadism can cause erectile dysfunction. It is a very important cause of impotence in males. A low level of testosterone can also cause low libido or decreased sexual desire.

Treatment for Erectile Dysfunction due to Hypogonadism

In order to treat erectile dysfunction caused by low testosterone levels, it is necessary to treat hypogonadism.  In addition to that, treatment for erectile dysfunction with medications such as Viagra and Cialis can be started. Often treatment of low testosterone levels with testosterone replacement therapy (TRT) improves or reverses erectile dysfunction.  Other times, men require treatment of both erectile dysfunction and low testosterone levels.

It is not possible to treat congenital hypogonadism during fetal life (this is a very rare condition).

Hypogonadism that occurs during childhood or adult life can be treated very effectively by addressing the cause, or by hormone replacement therapy.

It is important to know that testosterone replacement therapy with testosterone (cream, gel, injections, pellets, nasal spray) can cause male infertility.  For men who plan to have children, alternative treatment options should be considered.

The diagnosis of low testosterone levels is established by a blood test.    An early morning blood test is advised as it gives the most accurate results. If low testosterone levels are discovered, the test needs to be repeated to confirm the findings.  Testosterone levels fluctuate during the day, with levels highest in the morning and lowest in the evening. They also vary day-to-day.  As a result, low levels need to be repeated to verify that they are truly low.

For secondary hypogonadism, treatment is targeted at the correction of disease in the pituitary and replacement of pituitary hormones that may induce the production of testosterone by testes.

For primary hypogonadism, e.g. in testicular failure, treatment is targeted at the replacement of testosterone in the body. Testosterone replacement therapy is useful in correcting erectile dysfunction and a number of other symptoms associated with low testosterone in adults. In young boys, testosterone replacement therapy is effective in bringing about normal puberty and preventing infertility in later life. Testosterone replacement therapy can be in the form of injection, patch, gel, gum or oral tablets.

In men who are planning to have children, special approach must be undertaken during testosterone replacement therapy (TRT) to avoid suppressing testicular function.

Testosterone Injections are usually safe and effective and given via the intramuscular route. Normally a single shot every two weeks is all that is required for normal blood levels.

Testosterone replacement therapy in the form of a patch or gel can be applied once a day, either on the back, thigh, abdomen or arm.

In men of reproductive age, testosterone replacement can cause infertility. In these men, treatment with medications that stimulate testosterone production instead of giving testosterone is a better option.

Biological Explanation for ED in Men with Hypogonadism

Testosterone is the male sex hormone that is secreted by Leydig cells in the testicles. Testosterone synthesis is controlled by the luteinizing hormone, LH, produced in the pituitary gland. LH is released from the anterior pituitary gland along with follicle-stimulating hormone or FSH. FSH is not responsible for testosterone release but controls the maturation of sperm. Testosterone is responsible for the development of male sexual organs during fetal life. After birth, it plays a major role in the development of secondary sexual characteristics, including hair pattern, deepening of the voice and development of male genitalia. Later on in life, testosterone is responsible for the maintenance of libido, i.e. desire for sex, and thus plays a major role in sexuality.

Hypogonadism may be primary or secondary.  Primary hypogonadism is usually caused by defective synthesis of testosterone or testosterone receptor insensitivity due to a mutation. It may be due to autoimmune disease, infection, tumors, surgery, radiation or congenital diseases such as Klinefelter syndrome.

In secondary hypogonadism, the testosterone biosynthetic machinery is intact, but there may be a defect in the stimulus for the production of testosterone, and this defect is usually linked to a decreased production of FSH and LH.  The problem may originate in the hypothalamus or more commonly in the pituitary gland. The causes of secondary hypogonadism include trauma, tumors, infection, genetic causes or nutritional deficiencies.

Hypogonadism may be present at birth, in which case it is known as congenital hypogonadism.  Congenital hypogonadism may be due to developmental disorders, or it may be due to genetic alterations of the biosynthetic machinery. Acquired hypogonadism is a type that develops later in life, usually during adulthood and can be due to pathology in the hypothalamus and pituitary gland or testicular failure.  Varicocele is another treatable cause of primary hypogonadism.

Where to Get Treatment for ED in NYC?

At New York Urology Specialists, we offer specialized treatment for ED for men. Same-day appointments are available.

Call/text today: 1-646-663-5211 or make an appointment online.  

We treat sexual and erection problems and offer comprehensive STD testing for infections.  We treat penile problems in men, including phimosis, balanitis, penile irritation, and penile redness. We perform a no-scalpel vasectomy, vasectomy reversal, cosmetic circumcision, circumcision revision, penile frenuloplasty. We offer confidential appointments.

Our prices are ED treatment prices are affordable with or without insuranceLow-cost Viagra (sildenafil) and Cialis (tadalafil) are available to our patients.  We offer free insurance verification.

Read Real Stories of Men who Underwent Treatment for ED at New York Urology Specialists.

We offer ED treatment to patients within driving distance to our offices as well as from other states and countries.  Our patients come from New York, New Jersey, Pennsylvania, and Connecticut, and over 30 countries worldwide.

What do Penile Problems Look Like?

You can find pictures of penile problems including before and after treatment images in our image gallery.

What You Need to Know:

Why Choose New York Urology Specialists for Treatment of Erectile Dysfunction?

  • All treatment is performed by a board-certified urologist experienced in treating men with symptoms of ED, premature ejaculation, and other sexual problems using medical therapy, minimally invasive therapies, lasers, and surgery.
  • We are one of the few practices in the region to offer a full range of options for the treatment of sexual, and erection problems in men.
  • We offer diagnostic testing in our office, which avoids hospital costs.
  • Extensive Experience: Thousands of men have been treated successfully using medical therapy, shockwave therapy for ED, penile injections with Trimix, and penile implant surgery.
  • Confidential and Understanding Care. We understand that most of our patients desire privacy.  We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
  • We are one of the few practices in the region to offer a full range of options for the treatment of sexual and erection problems in men.
  • We are conveniently located within a 30-60 minute commute to men who are seeking ED treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.

Scheduling Appointments for ED Treatment at New York Urology Specialists

If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5211.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office

We offer affordable prices with or without insurance.  Low-cost Viagra (sildenafil) and Cialis (tadalafil) are available to our patients.

We offer weekday, weekend, and evening office hours.

Dr. Alex Shteynshlyuger is a board-certified urologist, who specializes in all aspects of care for sexual problems in men including ED, premature ejaculation, and other sexual concerns.  He has successfully treated hundreds of men with sexual problems including ED and poor libido.

Patients Reviews

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Urology by Alan on Jul 04, 2022Dr. Alex and all members of his staff are very attentive and professional. They are always willing to adjust to patient requests regarding scheduling and time. I’ve never had a negative experience when visiting the office and would highly recommend Dr. Alex and staff!


Circumcision and vasectomy by Hector Nieves on Feb 22, 2022Todo muy bien con el personal, la cirugia, el seguimiento, etc. Lo unico que podria decir un poquito negativo es el tiempo de espera despues de la hora de la cita fue bastante, pero con relacion a todo lo demas es excelente.


Review by Armando Santos on Dec 16, 2021Great experience

best urology doctor by Winston – via Healthgrades.com on Feb 14, 2021Dr Alex Shteynshlyuger is the best urology doctor there is. He is attentive, analytical, knowledgeable and skillful. Very confidential with a masterfully professional staff. I would not hesitate in recommending Dr Shteynshlyuger to the world because I am a satisfied patient of his.

solved my problem with ED by via HealthGrades.com on Jan 29, 2021Dr. Shteynshlyuger helped to solve my problem with ED

100% perfect circumcision by via HealthGrades.com on Jan 21, 2021Dr. Shteynshlyuger did what I would call an 100% perfect circumcision on me. I can’t even find my scar. He cut the precise right amount of skin. I now feel extremely happy, confident, and proud of how it looks. I am 100% satisfied with my results and I would recommend him to any guy seeking an adult circumcision. I healed in 5.5 weeks but his recommendation is 6 weeks to heal so that means zero “activity” for 6 weeks to avoid damaging the stitching. The surgical glue I pulled off at 5.5 weeks. It is important to not remove it before! The lower posterior of my shaft did not look good at first, especially w/ the surgical glue on it, but over weeks it looked better and better w/ the final results by 5.5-6 weeks being excellent When the doctor injected the anesthetic, it was painful since he must inject it deep ~6-8times. During the surgery my discomfort was maybe a 1/10, so tolerable. Make sure to buy lots of bandages/gauze before/after for daily change for 5-6 weeks

What went well

Appointment scheduling Office environment Staff friendliness Appointment wasn’t rushed Listened & answered questions Explained conditions well Trusted the provider’s decisions

What could be improved

Long wait times 

Very Pleased by A. Pereira via Vitals.com on Jan 21, 2021Very Pleased, I couldn’t have asked for more from Dr. S as well as everyone in the office, The procedure and after was a dream with Dr. S. If you are on the fence, I can tell you, that you will love your experience with Dr. S


treatment from New York Urology by Anthony via Healthgrades.com on Jan 07, 2021My problem with ED is gone with my treatment from New York Urology!

What went well

Appointment scheduling Office environment Staff friendliness Wait times Appointment wasn’t rushed Listened & answered questions Explained conditions well Trusted the provider’s decisions

What could be improved


recommend Dr. Shteynshlyuger by via HealthGrades.com on Jan 04, 2021Yes I would recommend Dr. Shteynshlyuger . Effective physician at all levels.

finally able to enjoy life again by Josh via Google.com on Dec 16, 2020Dr. Alex absolutely changed my life and restored my faith in doctors. When my condition first started I saw four different urologists over a period of about 6 months. All four either laughed me out of their office saying there’s nothing they could do to help, that my pain was normal, or prescribed me something that did not help or made everything worse. I prepared to live my life (22 years old now) with chronic pain that made participating in every day activities extremely difficult. Finally after getting the courage to start looking for new doctors again I found Dr. Alex Shteynshlyuger and decided to give his office a call. I proceeded to see him shortly after my call, and now a few visits and months later I am finally able to enjoy life again. Dr. Alex took the time to do the tests that other doctors did not even mention. He took different approaches, gave well explained answers to all of my questions, and made me feel like there are some doctors who really do care. On top of all of that he has some of the most helpful and kind staff I have come across. I cannot stress enough how thankful I am for Dr. Alex!

No pain at all by Elson via Google.com on Nov 25, 2020This was a very fast and easy process. No pain at all and the job was very well done. He stays on top of your progress and helps to heal faster. I will definitely recommend Dr Alex at all times!!!

Great place by Yannis via Google.com on Nov 09, 2020Very friendly staff, A great experience from the front desk to seeing the doctor. Dr.Shteynshlyuger is very professional and makes you comfortable when you’re in the room. He answers every question with detail. Great place..

I would highly recommend it to anyone by Javier – Via Google.com on Oct 11, 2020I saw the reviews about this place and was very hesitant to go but something was telling me to go with them and I don’t regret it at all, the doctor did a great job and helped me understand the process plus the staff was amazing I would highly recommend it to anyone! quick story after the procedure I was in soo much pain and called the office on a SUNDAY, the doctor gave me a call back within 15 minutes and prescribed a stronger medication, to me that meant a lot for the doctor to take time from his day on a Sunday to help me.

highly qualified diagnostician by Vladimir via Google.com on Sep 23, 2020I have been observed by Dr. Alex for many years and I must say that he is a highly qualified diagnostician, and also several times I have received qualified microsurgical assistance and very useful advice. The only reason I put 4 with a plus is a somewhat long wait for the reception.

successful procedure by Grant via Google.com on Aug 20, 2020To Dr. Shteynshlyuger and your assistants and aids, thank you guys for a successful procedure. I’d refer you to others for your compassionate, knowledgeable, attentive service and indepth follow up care.

I am very happy with this doctor. by Maria via Google.com on Aug 12, 2020I am very happy with this doctor. He is very patient and he understood all my problems. He also answered my questions and gave me some good advice.

very friendly staff by via HealthGrades.com on Apr 12, 2020excellent doctor and all very friendly staff

2 years free of any UTI by Lucretia via Vitals.com on Apr 09, 2020This urologist has helped me for my constant UTI’s He gave me a few tests, diagnosed the problem and now I’m 2 years free if any UTI. A kind, intelligent, caring doctor LucretiaLaMura

Doctor Shteynshlyuger provided me with the care I needed by Christopher via Google.com on Mar 11, 2020The staff is very professional. Doctor Shteynshlyuger provided me with the care I needed. The wait, visits, and instructions were brief. I followed his instructions and my issue was resolved. As a patient exercise patience. Follow the instructions and be honest about your condition and what you hope to accomplish be visiting. Thanks again Doctor.

Patient review by Jose A La Luz on Jan 24, 2020 

Buen doctor by Marcos perez on Jan 14, 2020Muy buen doctor. Y sobre todo el personal muy amable se preocupan por uno buen servicio

Thank you for your hlep by Ron on Dec 10, 2019Amazing doctor and staff. Thank you!

Shang Ring circumcision by via HealthGrades.com on Oct 29, 2019Overall, it was a good experience. Dr. Shteynshlyuger (Dr. Alex) was very nice, warm and helpful. He performed a Shang Ring circumcision for me and the procedure went well. I’m pleased with the results and there were no complications. If anyone is interested in the shang ring circumcision in the tristate area, then I’d recommend him. The whole procedure is $1850, which includes the initial consultation (provided that ther are no complications) and every follow up visit up to six months.

What went well

Appointment scheduling Office environment Staff friendliness Wait times Appointment wasn’t rushed Listened & answered questions Explained conditions well Trusted the provider’s decisions

What could be improved


Thank you doc !!! by via HealthGrades.com on Aug 14, 2019Great doctor, good bedside manner and always felt comfortable talking to him and the staff. Great location and affordable prices. Thank you doc !!!

What went well

Appointment scheduling Office environment Staff friendliness Appointment wasn’t rushed Listened & answered questions Explained conditions well Trusted the provider’s decisions 

Office very convenient location by via HealthGrades.com on Aug 13, 2019Office very convenient location Don’t have to wait for long Staff very friendly Dr shteynshyuer very experienced I had my serviced done in 3 visits now I feel good now Than you Dr. shteynhlyuger

positive experience by via HealthGrades.com on Aug 09, 2019Dr. Shteynshlyuger is professional, knowledgeable, and experienced. I had a positive experience with him.

Peronis Disease by Robert Clarke on Aug 04, 2019Dr Alex was both knowledgeable and concise with his diagnosis and advice which was well received. Dr was her knowledgeable in the subject and provided good advice.

Review by Jim on Jul 26, 2019The staff are very friendly and efficient. Appointment ease is excellent. Dr. S. is terrific diagnostician, answers your questions quickly tries to assess how you are doing and focus on the purpose(s) of our visit Treatment alternatives are discussed . The longer you are a patient, the better the experience is.

3P Removal by Karl Henry on Jul 24, 2019Went to get my penile papule remove. Got done same day, it was fast, great staff, and most importantly, pleased with the result.

Recommendation by JOHN on Jul 18, 2019Therefore I would like to recommend you to anyone who need your services.

Urology Visit by Oliver on Jul 18, 2019Staff were all very welcoming. Dr. Alex Shteynshlyuger was very knowledgeable and attentive during my time spent with him.

Outstanding by Allan B. on Jul 09, 2019Went in for a procedure with Dr. Alex and he was very calm and thorough about the the operation and the recovery. From the front desk to his assistants, everyone was very courteous, professional and polite. I highly recommend NY Urologist Specialist. They are outstanding!!!

Dr. Alex Shteynshlyuger MD
33 W 46th St 5TH FL, New York, NY

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Kyle Harris

2 months ago

ED is Treatable in Nearly Every Man

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction.  We understand the challenges that ED creates for our patients, their relationships, and their self-esteem.  We help you find a treatment for erectile dysfunction that fits your needs, lifestyle, and your preferences.

Urologists are doctors specializing in the treatment of men with erectile dysfunction. By virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED.  We offer medical and surgical treatment for erectile dysfunction.

We Treat Some of the Most Complex ED Problems Including:

Schedule an Appointment with Dr. Shteynshlyuger:

Call/text today: 1-646-663-5211 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in the evaluation and treatment of sexual and erection problems in men using modern, effective, and proven treatment methods.  We offer inflatable penile implant, shockwave therapy for ED, and treatment for Peyronie’s disease.

He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.

If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5211.

We have excellent reviews from patients and their partners.  Information for out-of-state and international patients.  Find out our office hours or directions to our office

We offer affordable appointment prices with or without insurance.  Low-cost Viagra (sildenafil) and Cialis (tadalafil) are available to our patients.

We offer weekday, weekend, and evening office hours.

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