Hypogonadism: Testosterone and Erectile Dysfunction


Erectile dysfunction (ED) has many causes. On rare occasions, the endocrine system is at fault.

When this is the case, the most common cause of ED is hypogonadism, where the body does not produce enough testosterone, cannot produce sperm, or both.

It can happen during fetal development, during puberty, or in adulthood. The problem can be in the testicles or in the pituitary gland.

While hygonoadism can lead to other health problems and should be addressed, it is important to keep in mind that 1.) testosterone naturally declines with age, and 2.) normal male testosterone levels are not necessary for a normal erection.

Causes of Low Testosterone In Men

Here are some of the things that can affect testosterone production:

  • Diabetes, an elevated level of triglycerides, cholesterol and/or fat phospholipids, and chronic alcoholism and/or liver disease
  • Surgery on the pituitary or thyroid gland, Cushing syndrome, obesity, AIDS and malnutrition
  • Excess blood transfusions for certain hematologic diseases
  • Certain medications
  • Testicular disorders (trauma, torsion, cryptorchidism, testicular cancer

Low Testosterone Complications

If untreated, hypogonadism can result in a wide range of complications. If it happens while the fetus is growing in utero, the child may be born with unclear or abnormal genatalia.

If is occurs during puberty, the boy can have less beard or body hair, impaired penis or testical growth, longer arms and legs compared with his trunk, or enlarged breasts.

Complications in adulthood include infertility, ED, a lower sex drive, fatigue, weakness, enlarged breasts, decreased beard and body hair, and osteoporosis.

hypogonadism Diagnosis

The first step a doctor will take in determining if a person has hypogonadism is getting a medical history and doing physical exam. They will look at secondary sex characteristic like hair in the genital area and muscle size to make sure these are appropriate for the person’s age.

Blood tests may also be needed. These are usually done in the morning, when testosterone is highest. Further studies may be required, including blood tests, analysis of the semen, imaging of the pituitary, genetic tests, and/or a biopsy of the testes.

In boys, early detection can help prevent delayed puberty problems. Early diagnosis and treatment in men can help protect against osteoporosis and other conditions.


Hypogonadism treatment is dependent on the cause and if you plan to father biological children.

If testicular failure is the culprit, doctors use testosterone replacement therapy (TRT), to help increase strength, avert bone loss, increase energy, improve the sex drive, improve erectile function and add to the patient’s self-regard.

When the following conditions are present or have been experienced in the past, TRT is not recommended:

  • Breast or prostate cancer
  • High red blood cell mass
  • Severe heart insufficiency
  • High blood viscosity
  • Sleep apnea
  • Bladder obstruction

If a pituitary problem is indicated, hormones may raise sperm production and bring back fertility. A tumor in the pituitary might need to be removed, or additional medications may be required.

Assisted reproduction can also help couples conceive when hypogonadism is present.

In boys, TRT can bring on puberty. Pituitary hormones enhance testicle growth. A small dose of testosterone with measured increases helps prevent negative effects and mimics the rate of testosterone increase during puberty.

Delivery Methods and Risks

Delivery methods for TRT include injection, patch, gel, a putty-like substance that goes where your gum meets your upper lip, a nasal gel, and implants. Costs and side effects vary.

TRT carries risks such as sleep apnea, noncancerous prostate growth, enlarged breasts, lower sperm production, growth of existing prostate cancer and blood clots. It may also increase your risk of a heart attack.

If your doctor suspects hyogonadism, you will probably be referred to an endocrinologist. Be sure to ask the specialist about the side effects of each treatment, alternative approaches, and how to manage the condition along with your other health concerns.

Erectile Dysfunction is a very common subject during Sex Therapy sessions. If you’d like to schedule a Sex Therapy session with Kim Ronk, MA, LPCC, MED, RN in the Charlotte North Carolina area, please call 980.224.0235 or use the online contact form.