Testosterone and Erectile Dysfunction (ED)

Low Testosterone can lead to Erectile Dysfunction.

Testosterone is the primary male hormone in the body. There are many possible causes of Low Testosterone. When the Testosterone is low, a person can also have problem getting an erection.

Read on to learn more.

What is Testosterone?

Testosterone is the hormone in the body that is responsible for all male characteristics. It is produced by the testis.

What is ED?

ED stands for Erectile Dysfunction. It is a medical condition where a man’s erection is unsatisfactory. It ranges from mild ED (able to achieve erection but not full hardness) to severe ED (unable to achieve erection for penetration).

This is different from Premature Ejaculation which is when you have no problems getting hard but ejaculate much faster than you would like to.

How does Testosterone affect ED?

Testosterone is responsible for many sexual characteristic like sexual desire (libido) and erection. A low Testosterone level may lead to ED.

However, many other diseases such as Obesity, Diabetes, High Blood Pressure and High Cholesterol can also cause ED.

How do I know if a low Testosterone Level is causing my ED?

See your Doctor for a Testosterone Test. If your Testosterone is low, it is very likely one of the factors causing your ED.

You may also want to do this AMS (Aging Male Symptoms) Questionnaire. A score of more than 37 means you likely suffer from low Testosterone.

What are the treatments available?

There are several methods to treat low Testosterone including pills, gels and injections.

The most popular treatments for ED are the PDE5 Inhibitors. There are currently 3 brands available, Levitra, Cialis and Viagra.

Can Testosterone Treatment be taken together with PDE5 Inhibitors?

Yes. In fact, these 2 treatments are synergistic and work very well together.

Aside from working very well together to give a strong and hard erection, Testosterone and PDE5 Inhibitors have also been shown to have many holistic health benefits. These include increase in general wellbeing, concentration and energy levels. As well as making the inner lining of your blood vessels more healthy.

Testosterone Treatment. Testosterone Replacement.

What is Testosterone Treatment?

Testosterone Treatment is the replacement of Testosterone into the body.

Who needs Testosterone Treatment?

The majority of people who require Testosterone Treatment are those who suffer from Andropause.

There are also rare diseases that children do not produce Testosterone and require Testosterone Treatment for normal development.

What are the different types of Testosterone Treatment available?

There are currently 3 popular ways of Testosterone Treatment.

Testosterone Gels are painless and easy to use. It is applied twice a day onto the shoulders or thighs. After application you must not bathe or swim for 6 hours to give the gel time to absorb. You must also be careful not to transfer any of this gel onto a female person.

Testosterone pills are taken 2 to 3 times a day. They should be taken with food, preferably slightly greasy food. This is because Testosterone is soluble only in oil. Taking Testosterone pills on an empty stomach might reduce the absorption by up to 50%.

Testosterone injections are very convenient. The latest preparations require only 1 injection every approximately 3 months. The absorption into the body is very constant and there is no need for you to do anything in between the injections.

Are there any side effects of Testosterone Treatment?

Testosterone should NOT be given to someone with Prostate Cancer. Your Doctor will do an examination and blood test for you to rule out Prostate Cancer before giving you Testosterone.

However, Testosterone DOES NOT cause or increase the risk of Prostate Cancer in normal men. In fact, Testosterone treatment has been shown to reduce the level of PSA (Prostate Specific Antigen) which is a marker for Prostate Cancer.

Testosterone might also increase the number of red blood cells in your body. This does not cause any problems unless the increase is tremendous. You Doctor will monitor you red cell count with a blood test.

What are the benefits of Testosterone Treatment?

Testosterone Treatment has many benefits. It increases overall wellbeing, energy levels and concentration levels. It increases libido and helps in erectile function. It helps with weight loss, increase in bone strength and increase in muscle mass. It also helps prevent lifestyle diseases such as High Blood Pressure, High Cholesterol and Diabetes.

What can I expect if I decide to undergo Testosterone Treatment?

Once your Doctor has done the necessary tests and decided that you require Testosterone Treatment, he will discuss with you which method is best for you.

Testosterone Pills and Gels are prescribed for you to use by yourself at home. Make sure you follow your Doctor’s advice carefully.

Testosterone Injections are administered by a trained medical professional.

The 3 monthly Testosterone Injections are given into the Gluteus Muscle (Backside). The Testosterone preparation is very thick and has to be given slowly over several minutes. During the injection you might feel mild discomfort but no pain.

You might feel some discomfort in your backside for 1 to 2 days after the injection.

What follow ups will I need?

Your Doctor might ask you to come back in 6 weeks for your 2nd injection instead of 3 months. This is to increase your Testosterone back to a normal level quickly so that you will start feeling better quicker.

Regardless of which method of Testosterone Treatment you are on, your Doctor will need to repeat a test of your Testosterone Level, PSA and red blood cell level after 6 to 9 months.

advise


Need more advice?

To find out more about Penile Rash or other Men’s Health issues , please visit your doctor or visit Men’s Health Clinic.

Dr. Tan and Partners @Novena (Men’s Health Clinic)

Address:

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#08-31, Novena Medical Centre
Singapore 307506

Telephone:
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Related Topics:

  1. Penile Discharge (Should I be Worried?)
  2. Frenulum Breve and Penile Frenulectomy
  3. Warts
  4. Molluscum
  5. HIV Symptoms
  6. Syphilis
  7. Herpes
  8. STDs General Info
  9. Premature Ejaculation
  10. Erectile Dysfunction

About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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71 Comments

  1. Hi

    I am 35 years old male. I have low libido and ED for several years. I went to Urologist recently, found out my testosterone only 8.92nmol/L. Prolactin, FSH, estradiol are normal. I was given and depo testosterone injection. It helps but the effect gone down after weeks. I went back again, testosterone level increased slightly to 12.49nmol/L, probably injection effect still there. No injection in second visit. But till now doctor still can’t find the real cause. Should I see an endocrinologist for further check up before or just continue the TRT ? How much is the TRY in your clinic? Thanks.

  2. What is the average treatment cost for Testosterone replacement therapy?

    • Medicines $100 to $200 per month
      Excluding consultation and blood tests
      Consultation $30 to $60
      Blood tests $40 to $160 (done intermittently)

  3. I’m 27 yrs old female, i would like to have male testoserone injected in me. But before that is there a clinic whr i can go to so i can get more information of the fees and procedures to be in placed.

    • You can see me at my clinic at Novena.
      Dr. Tan & Partners @ Novena
      Address
      Novena Medical Centre
      #08-31
      10 Sinaran Drive
      Singapore 307506
      Telephone:
      +65-63972095

  4. Hi Dr Tan,

    I am 42 years old and married with 2 children. I did a health screening in end May and doctor advised that my Testosterone is low (11.52 nmol/L)and to consider Testosterone Replacement Therapy (“TRT”). Further, I was often mistaken as a female when I talk over the phone and realized that TRT may help to deepen one’s voice. Thus I would like to have TRT (Nebido injection) at your clinic. Please advise if I could make an appointment to see you (at Novena clinic) to have the injection. OR do I need to undergo another blood test before commencing the treatment?

    Thanks and best regards,
    Sam

    • Hi Sam,

      You can see me at Novena and bring along your blood test results. We can make a decision to start treatment based on the tests you have already done. Most likely you will not need any additional tests. You can email us at doctor@drtanandpartners or call +65-63972095 for an appointment.

  5. I am 47 and my recent level is 15.20 nmol/L. (ref range: 4.94-32.01)
    Do I need testosterone boost?

    • Dr Justin Sim

      Levels between 15 – 20 are usually okay but treatment may also be based on symptoms you are having. So best to discuss this in person and decide upon a management plan from there.

  6. What are some dieseases that causes Low T I had rapid weight loss and maybe a month later I suffer from low T what could cause this?

    • It is important to differentiate what causes low T and what is associated with low T. For example, Diabetes can cause weight loss and is associated with low T. Diabetes does not cause low T per se. HIV/AIDS can also cause weight loss and directly cause low T. My personal take on your situation is you need to find out what is causing the weight loss. The low T is secondary. There are many different medical problems that can cause weight loss from Thyroid problems to worms.

  7. Should treatment be considered if I have a result of 11 on my testosterone test? Or is it possible to get treatment if I want it.

    Unit being nmol/L
    Ref.range (8.4 – 28.7)

    • Age 25 this year

      • At age 25 you should not be having a Testosterone of 11. I would definitely first look for other causes including hormonal axis abnormalities, genetic abnormalities etc. You should see an endocrinologist.

  8. i am 17 and i dont have a height and i feel tired. should i go for a check up on my testosterone level?

    • drtan

      You should see an endocrinologist. Especially if you have not developed secondary sexual characteristics.

  9. Hi Dr. Tan, I am 39yo male suffering from ED. I have tried generic sildenafil meds (not Viagra) with no effective result. I was wondering if my testosterone levels are a huge contributory factor. I have only had it checked once prior (around mid 2013). Results showed total testosterone of 385 ng/DL. I was told it was on low range for my age.

    Thing is, I think I have a healthy libido. It’s just that I am not able to sustain rock-hard erections. As far as I know, I don’t suffer from high blood pressure, cholestorol, etc. I must mention that I had been diagnosed with varicocele on my left testicle. I have been considering surgery for the longest time and see if it alleviates my ED. I have fairly large veins in my legs and was thinking if it could be due circulatory problems. I’ve read some literature that associates varicocele with low testosterone and infertility but not ED.

    Appreciate the advice. Thanks.

    • You are right, varicoceles are not related to ED. Sounds to me like you need to replace the Testosterone and get on a more regular PDE5I dosing.

  10. My wife has a zero sex drive and she wants it back. She has read that testosterone treatment may be a solution. Do you test women?

    • Yes we do. And yes I have treated women with Testosterone to restore their libido. We must be careful to first rule out any other possible causes before we conclude that Testosterone is indeed the problem.

  11. Hi Doctor Tan,

    Is there available treatment for women for low testosterone in Singapore?

    • Very interesting question. It is rather controversial. I sometimes give Testosterone to my female patients but extremely selectively. I am sure there are some ObGyns who specialise in anti-aging in Singapore who do it. I cannot name any off the top of my head though.

  12. Hi dr tan. I am male, 24 years old. I realized that my voice havent changed at all since puberty. Im still having a child like high pitch voice. And i am often mistaken as a female when i talk over the phone. Its rather embarrassing and annoying. I have been doing some research recently and realized that the intakes of testostetones will also deepen ones voice and create a lower voice. Would u recommend me to take it? And if i do, hw much will the intake cost?

    • First of all you need to make sure that you have developed all the other secondary male sexual characteristics. Basically we must be sure your high pitched voice is a isolated problem and not a symptom of something more serious. If so, we can consider using Testosterone to deepen it but before treatment you must be aware of all potential side effects. Please post any follow up questions on http://www.askdrtan.com

  13. Hey dr tan, i am male, 24 years old. I realized that my voice have not gone through any changes since puberty, and i am always mistaken as a female, when i have a conversation over the phone. Its rather embrassing and annoying i find.

    Ive done some research and believe that the intake of testosterone can lower ones voice and causes him to have a deeper sound. What is ur advise on this? I really would love to have a normal male voice. And if u recommend the dosage of tostesterones, hw much would it cost? Thank you.

  14. Radiohead

    Hi Dr.Tan .I am 19 years old ,a couple of my friends are taking a testosterone (testosterone-enanthate 300.) injections once a week .I have seen large muscle growth and strength amongst them. I am contemplating starting the injection ,but I’ve decided to take it just for 3 weeks .Can you give me any advice ?

  15. jamesbot

    i started testosterone treatment two months ago.. contrary to my expectation my libido has been going down gradually and lately finding it difficult to maintain erection even after taking viagra….

    • Your Estrogen levels are probably raised. The doctor giving you the treatment should know how to handle it. Please post any follow up questions on http://www.askdrtan.com

      • jamesbot

        Thanks. My doc has prescribed tablets to reduce my level of estrogen..
        Am taking following medications on long term:
        Diovan 40mg (for BP) per day and tetracycline 150mg (for foliculitis). Can either or both be impacting my libido if so what alternatives do u suggest… Thanks

      • jamesbot

        Am on TRT along with DHEA (100mg per day)and letrozole 2.5mg per day. Been on Viagra for two years and was amazingly effective at 50 mg but since TRT treatment its effectiveness even at 100mg is minimal. Also reaching ejaculation has now become a problem… should i stop the TRT treatment????

  16. Hi, I am 43yrs old and have been on Propecia for many years. My MPB has stabilised but has recently worsened slightly. Will TRT aggravate my hair loss?

    Thanks much man!

    • Yes it will. Testosterone is converted into DHEA which causes MPB. I control this with a low dose of Avodart. You can discuss with your doctor if this is an appropriate treatment for you.

  17. Those people who seeked treatment and required TRT, what are the success ratio? Assuming I go to see you for the test tomorrow for the two treatment, how long have I got to wait before I could get a strng erection

    • Low serum Testosterone levels are associated with ED but is rarely the main factor. In other words, even if you go on TRT, do not expect the erection to improve dramatically. The mainstay for treatment for ED is still PDE5Is. However, TRT certainly helps.

  18. Demetris

    Dear Dr Tan,

    A couple questions…

    1. Which lab tests you consider most accurate for the diagnosis of low testosterone, eg total serum testosterone measurement is enough?

    2. With testosterone replacement therapy is there a possibility that the patient may develop high estrogen levels and any side effects that may arise from them (such as gynecomastia, low libido)? Should the patient be regularly tested for other hormonal imbalances while on testosterone?

    Thank you very much!

    Kind regards,

    Demetris,
    med student from Greece

    • 1. Total testosterone is never enough. The key figure is actually the free testosterone which can be calculated by measuring the Albumin and Sex-Hormone Binding Globulin levels or measured directly in which case, the National University Hospital in Singapore has the best facilities. 2. You are absolutely right. Testosterone is converted to Estrogen by the body via aromatisation. This can lead to worsening of the patient’s symptoms. Ideally, a patient on TRT should be monitored with FBC, PSA, Serum Testosterone, Serum Estrogen, IGF-1. Very insightful questions from a med student. If you are planning to work in Singapore after graduation, please look me up.

  19. Dear Dr Tan

    My father is 56 years old, and recently we saw change in his mood and memory, we suspect it to be depression and after testing, his testosterone level is only 6.4nmol/L, so we are considering testosterone replacement as his quality of life is severely affected by this.

    However he is taking Hypertension medication, what we want to know whether this therapy is suitable for someone with high blood pressure before we make a trip to visit you.

    Thanks and hope for your advise. Thank you.

    • Change in mood and memory could be due to a lot of things. I would not so readily blame it on low Testosterone. He needs to be screened for Dementia, Strokes, Syphilis, Diabetes etc etc. As for Testosterone replacement, Hypertension is not a contraindication. I would be happy to see him for that but I think you should bring him to your Family Doctor and make sure he does not have any other diseases that can be causing his symptoms first.

  20. Patrick

    Hi Dr Tan,
    I did a testosterone test at your clinic 1 week ago. I went down to pick the result while you are not in earlier this week. So another doctor explained to me what the result stands for. I’m still concerned, however, about some thing regarding of the result. Would like to have a conversation with you if convenient. Can I come down someday when you are in?

    Cheers
    Patrick

    • Hi Patrick,

      Apologies. I was away on a medical conference. Sure, please come see me anytime. I am in all day everyday except for Tue and Thur mornings.

      rgds

      Dr Tan

  21. kuputek

    Dear Dr Tan,
    I am 43 and have lost my sex drive for couple of years. I had my T test done more than 5 yrs ago and levels were low then.
    What treatment would you recommend for TRT? Are there Specialists in Singapore for TRT?
    Can you also advise on the side effects and any other things I need to be aware of?
    Does the treatment stop once T levels are normal or the medication/gel has to continue for long.

    Really appreciate your response to above few queries. thank you in advance

    Kuputek

    • drtan

      Hi kuputek,

      I cannot recommend you anything over the internet. You need to see a doctor for proper medical advice. Most GPs in Singapore provide TRT or you can see an Endocrinologist or Urologist.

      Rgds

      Dr Tan

  22. Dear Dr. Tan,

    I am 43 yo male. I have been suffering from ED for a couple of years. The ED was mild and the aid of viagra (quarter table) helps from time to time. Some time ago, I was diagnosed for low testosterone but that seems to have cleared. I was historically on testosterone replacement (i believe the meds are called Androial or something).

    Lately, I find my sex drive waning and have not had a hard-on for a while. The effects of viagra also seem to have a less than desired result.

    What can be done? Are there test to determine what is actually wrong? it is physical or psychological or both?

    Please advise.

    Regards

    Wong

    • Hi wong,

      Sounds like low testosterone. You need to see a doctor and get a proper consult with tests to rule out other issues eg low thyroid levels etc

      Rgds

      Dr Tan

  23. larry

    please am 26 i have low testosterone and i have met two different doctors the first one told me to use injection and the other one said i should use gel because of my age,now am confuse i don’t know the one to use….again i was told to use cialis and have not noticed any change…i took cialis yesterday but yet i don’t have good erection…please what do i do

    • Hi larry,

      Low testosterone at 26 is very rare. You need to rule out secondary causes before embarking on treatment.

  24. scott

    Hi Dr.
    I am already 3o and think i need Testosterone Theraphy. Doctor see that it might be klinefelter.

    how much is the treatment for it

    • Hi Scott,

      Depends on which treatment you decide on. You need a genomic test to confirm Klinefelters first.

      Rgds

      Dr Tan

  25. han s

    I just did a regular blood test with a GP and my testosterone level is 10.7 nmol/L – within the range of 8.4 – 28.7. I’m 43 and feeling the onset of all the symptoms related to low T-levels since I turned 40. Should i be concerned?

    • Hi Han s,

      Testosterone levels should always be interpreted in the context of symptoms. This is because of high inter individual variability.

      Rgds

      Dr Tan

  26. ruwinda

    doctor ,i am 19 years old! i have ED problem! sometimes my testicles and penis geting shrink. and i don,t have any sexual desires like earlier. i want to know what is my problem?

    thanks!

  27. Doctor, I’m 52 this year and is diabetic for a few years already. And I has ED, so what is the 1st step to seek treatment for ED and how much would it cost. Can I use Medisave since ED is diabetic which is considered as chronic disease. Thanks Doc

    • Hi Tay,

      First step is to see a doctor. You need to get your DM under strict control and check for other chronic diseases. You might also want to test your testosterone levels. Finally you can discuss with your doctor the need for PDE5 inhibitors. I really doubt Medisave can be used for ED treatment.

      rgds

      Dr Tan

  28. Hi Dr. Tan,
    I heard your blog from my friend and have been reading it for a while. Want to appreciate for sharing your invaluable knowledge with all of us.
    Here’s a thing I want to consult you: My gym trainer recently recommends me to use Tribulus — which is believed can help to support healthy hormone production – to shape my muscle. Though the pros are easy to see, I want to find out that if you know any cons of using this kind of product, say, whether I’ll become reliable on it to produce testosterone?

    Thank you for your patience reading this. Look forward to your reply.

    Best regards

    Eric

    • Hi Eric,

      Thank you for your support. Isn’t Tribulus the one that killed some sheep in some studies? I am not an expert on alternative medicines but I can share with you my opinion. There is some scientific evidence to say that Tribulus enhances sexual performance and libido. However, there is no good evidence to prove that it increases testosterone production or aids in muscles building, definition or weight loss. Overdosing on Tribulus can make you edgy and hyperactive. All in all, I think most gym trainers tend to oversell its benefits. However, it is harmless enough for you to give it a try. Just stay within the recommended dosage.

      rgds

      Dr Tan
      Support our new forum at http://www.askdrtan.com

      • Shameer

        Hi Dr Tan

        I am 51 years old and has ED. I also feel very sleepy in the afternoon after lunch. My weight has increased from 78Kg to 81Kg. During the past 5 years my belly has become bigger.

        Do you think this is due to low T? What you suggest?

        Thanks.

        • Hi Shameer,

          It could be due to low T. However, it sounds to me like you could also be suffering from Obstructive Sleep Apnoea. You should see your doctor for an opinion.

          rgds

          Dr Tan

  29. Hi Dr.Tan,

    What are the chances of young men getting low testosterone? I am 26 and I have male breasts and problems with erection. After reading your article and googling a bit, I suspect I may have hormonal imbalance. I am very much worried now. What is your advice in approaching this issue? Is my problem curable?

    • Hi Vincent,

      Young men with low testosterone is a serious issue. It usually indicates a more serious underlying problem. Whether or not it is curable depends on what the underlying problem is. You should see a doctor and get some tests done.

      Rgds

      Dr Tan

  30. Hi Dr.Tan,

    Is Low testosterone levels curable or people who are affected by this need to undergo the treatment life long? What is the cost of the testosterone replacement treatment in Singapore?

    • Hi Jacob.

      It really depends on the cause of the low Testosterone. For the common age related low T, losing weight, regular excercise and a healthy diet low in fats can all contribute to increasing the level of Testosterone in the body.Cost of T replacement treatment really depends on the mode of replacement. To give you an idea, we sell 1 month’s supply of T gel at $184 and a T injection that can last up to 3 months for $400.

      rgds

      Dr Tan

      • Thanks a lot Dr.Tan.

        If required, how long one needs to take the Injection or Gel? Does it needs to be taken for life long or until the level goes up and becomes stable?

        • Hi Jacob,

          Testosterone replacement is long term unless there is a lifestyle or chronic disease issue which can be resolved. eg if a person is obese, losing weight and regular excercise might raise the Testosterone naturally therefore he will not require treatment anymore.

          rgds

          Dr Tan

          • Dear Doctor, I am diagonosed as a Hypgonadic male . I am from India and moving into India. I get 1000 ml of Cernos Depo Injection as part of the TRT. Can i come with this injection into Singapore and use local nurse services for injecting Cernos Depot Injection ?

          • I’m sorry we do not provide that service. However, I am sure you can find a clinic that does.

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