Testosterone is widely known as the cornerstone of a man’s sex drive and performance. However, testosterone levels diminish over time and make the body vulnerable to a variety of side effects. New research suggests that one out of four men over the age of 30 have low testosterone levels, and about one in five men experience associated symptoms.

Erectile dysfunction is one of the many problems correlated with low testosterone levels and aging. By understanding the mechanisms of erectile dysfunction and identifying the potential causes, men can seek the best treatments to restore their libido and confidence.

What Is Erectile Dysfunction?

In order for a man to sustain an erection, the body must undergo a complex process that involves interaction between the brain, nerves, muscles, hormones, and blood circulation. Any problem with just one of those components can threaten the body’s ability to achieve an erection.

When a man is continually unable to maintain an erection adequate for sexual intercourse, his condition is labeled as erectile dysfunction. This common issue affects 50% of men over the age of 40, yet only one in twenty men seek treatment for ED.

How Do Erections Change With Age?

As soon as a man becomes sexually aroused, nerves release chemicals that boost blood flow into the penis. Two chambers made of spongy muscle tissue in the penis absorb and trap the extra blood. This dramatically increases blood pressure in the chambers and causes the penis to become firm and develop an erection.

However, the nature of an erection changes with age:

  • Erections take longer to occur
  • Time between erections increases to between 12 and 24 hours
  • Erections are not as hard or firm
  • Erections cannot be sustained for an extended period of time

Though growing older is not a guarantee that sexual performance will decline, the body naturally experiences change as it ages. Some changes are inevitable and some can be prevented, but they all have the potential to alter the functionality of erections.

Potential Causes of ED

ED is a condition related to sexual health, so it is rarely viewed through the lens of physical health. Nevertheless, many of the most common causes of ED are connected to underlying medical conditions.

Low Testosterone

Testosterone is part of a group of male hormones called androgens. The testes produce testosterone while the brain and pituitary gland control production levels. Despite a steady rise in testosterone levels through adolescence and early adulthood, most males experience a decrease in testosterone by about 1% every year after the age of 30.

Research indicates that normal adult testosterone levels are not necessary to sustain normal and healthy erections, but hormonal imbalances still may play a role in erectile dysfunction. Low testosterone reduces a man’s sex drive and energy. This may prevent erections from occurring as quickly and spontaneously as they once did.

Reduced Blood Flow to the Penis

The most common cause of erectile dysfunction is reduced blood flow to the penis. There are many different chronic conditions that potentially limit blood flow to the penis:

  • High blood pressure
  • High cholesterol
  • Hardening of the arteries
  • Heart disease
  • Obesity

All of the above conditions are extremely common in men. In fact, heart disease is the leading cause of death for men in the United States, accounting for 25% of all male deaths. High blood pressure, high cholesterol, obesity, and hardening of the arteries are all risk factors that lead to heart disease.

The American Heart Association estimates that 1 out of every 3 adults have high blood pressure and/or high cholesterol. This indicates that reduced blood flow to the penis is a serious potential concern for at least 30% of men as they age.


Diabetes is rarely suspected to play a role in ED since it is a condition that relates to blood sugar, but research shows that men with diabetes are three times more likely to experience ED than men without diabetes! They may also begin showing symptoms of ED up to 15 years earlier than their peers without diabetes.

Diabetes and ED are linked because of the damage that uncontrolled blood sugar levels can cause to the nerves and blood vessels:

  • Diabetes leads to damage of the nerves that control sexual stimulation and response
  • Diabetes harms the small blood vessels needed to sustain blood flow to the penis

This is frustrating, but the good news is that diabetes can be effectively controlled through healthier lifestyle habits like proper diet and exercise.

How to Diagnose and Treat ED

Living with erectile dysfunction can feel frustrating, embarrassing, and disheartening, but with the right medical attention and lifestyle changes it can be addressed and treated.

Diagnosing Erectile Dysfunction

Erectile dysfunction can be diagnosed using the combined results of a physical evaluation, medical history, and variety of laboratory tests. Any or all of the following tests can be used to determine the underlying cause of ED:

  • Complete blood count
  • Lipid profile
  • Morning serum testosterone test
  • Blood glucose test
  • Serum creatinine test

These tests can rapidly identify signs of diabetes, heart disease, hormone imbalances, and other common root causes of ED.

How to Treat ED

There are many different treatments and methods available to reverse the effects of ED and embrace a strong sex life once again. Oral medications like Viagra and Cialis help the body produce nitric oxide, a natural chemical that relaxes muscles in the penis and increases blood flow. These pills produce results shortly after they are taken, but do not provide a permanent solution to ED.

Testosterone replacement therapy is a treatment option that may offer long-term results. If a man’s ED is directly related to significantly low testosterone levels, hormone therapy can restore healthy, balanced testosterone levels to encourage natural erections and stronger libido. Other benefits of testosterone therapy include higher energy levels, better quality sleep, and restored mental focus.

Improving cardiovascular health is another powerful way to address ED. Adopting healthier lifestyle habits, quitting smoking, and losing weight make it possible to reduce blood pressure and cholesterol levels and balance blood sugar levels. This in turn reduces the likelihood of heart disease or diabetes causing symptoms of ED.

The Bottom Line

If you are currently experiencing sexual problems as a result of erectile dysfunction, it is possible to uncover the root cause of your condition and improve your health accordingly.

Begin by undergoing the lab tests designed to help you identify whether cholesterol, blood sugar, hormones, or other factors are responsible for your ED. Your lab results will help you identify the best next steps in your quest for improved sexual wellness.