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

by Alex Shteynshlyuger MD

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call 1-(646) 663-5211.

Board certified urologists at New York Urology Specialists are subject-matter experts in the treatment of low testosterone and erectile dysfunction in New York City.   

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.

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 (gynaecomastia 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 a 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 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.

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 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 the 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 a 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.

Injections are usually safe and effective and given via 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 the 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 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 which 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.

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