Can Too Much Testosterone Cause Erectile Dysfunction?

Many assume erectile dysfunction (ED) is linked to low testosterone levels. While low levels can certainly cause ED, too much testosterone won’t serve you well.

What is testosterone, and what does it do? 

Hormones¹ are chemical messengers naturally produced by the endocrine glands within the human body. Their primary purpose is to send signals to other areas of the body. Some signals trigger physiological processes, such as digestion or sleep. 

Hormones are a diverse group of biological molecules, and dozens of different types exist throughout the body. One hormone, testosterone,² is a male sex hormone. Testosterone is present in biologically female people, but people born male have more of it.

Hormones like testosterone play vital roles in the body and are crucial components of health. 

Testosterone has several roles, which include: 

• Regulating the development of male reproductive organs

• Regulating hair growth

• Regulating muscle growth, size, and strength

• Regulating bone growth and strength

• Regulating sex drive and erectile function

• Regulating sperm production 

Testosterone levels decline with age; many believe this drop could contribute to ED. Endocrine disorders such as hypogonadism³ (where the sex glands don’t produce enough sex hormones, including testosterone) are the most common cause of ED.

When the body lacks testosterone, hormone replacement therapiescan be used to restore the body's testosterone levels to a suitable range. However, while they can boost libido (sexual desire), hormone replacement therapy is unlikely to improve sexual function. 

Like low testosterone, high testosterone can lead to health problems. Sometimes, men who undergo hormone replacement therapy go from having too little to too much, and when this occurs, the dose will need to be adjusted. 

Athletes who use anabolic steroids⁴ to improve performance may inadvertently boost their testosterone levels. 

How can too much testosterone lead to erectile dysfunction?

There’s no concrete evidence that too much testosterone directly causes ED. In fact, some studies⁵ have shown that higher bioavailable testosterone (testosterone that’s weakly bound to albumin proteins or moving freely in the blood) may improve both ED and sex drive. 

Because of the connection between bioavailable testosterone and sex performance, people may be inclined to assume that more testosterone enhances erectile function, but that’s not necessarily the case.

Erectile dysfunction⁶ is the inability to achieve or sustain an erection long enough to engage in sexual intercourse. Many conditions can lead to ED, including: 

• High blood pressure

• Heart disease

• Atherosclerosis (build-up of fats and cholesterol in arteries)

• Diabetes

• Kidney disease

• Obesity

• Anxiety, depression, or stress

• Certain medications

• Lifestyle factors like drinking, smoking, or a lack of exercise

And that’s where elevated testosterone comes in. Too much testosterone can lead to some of the conditions associated with ED by: 

• Increasing blood pressure

• Increasing the risk of heart problems

• Causing mood changes and depression

• Leading to unexplained weight gain

• Shrinking testicles and enlarging the prostate

• Lowering sperm count

Therefore, it’s possible that high testosterone levels could indirectly cause ED.

In short, there does appear to be some link between testosterone and erectile function. If your testosterone levels are too high, you could try decreasing them to improve your sexual (and overall) health. 

What are the symptoms of high testosterone levels? 

High testosterone affects people differently, but common signs include:

Sexual health changes

Sexual health changes are a common sign of elevated testosterone. For example, too much testosterone can cause the testicles to shrink and the prostate to enlarge. This can affect sexual health by decreasing sperm count. 

Acne

Testosterone stimulates oil-producing glands. This stimulation can lead to acne.

Blood pressure changes

Testosterone can increase your blood pressure, raising your cardiovascular disease, heart failure, and stroke risk. 

Body hair 

Increased levels of testosterone are also linked to abnormal hair growth. As a result, excessive hair growth is typically observed in the face, chest, buttocks, and inner thighs. The hair tends to be darker and thicker than usual.

Mood

When testosterone levels are imbalanced, it can trigger severe mood issues. For example, some experience increased anxiety or depression, while others may notice they become aggressive. 

Other signs

More testosterone may alter your body composition and lead to weight gain.

How is high testosterone treated?

If you’re on hormone replacement therapy for testosterone, and your testosterone levels are too high, they could be lowered by reducing the dose. 

If your high testosterone is caused by anabolic steroid use, and you’re using steroids for performance enhancement and not a medical condition, speak with your doctor about stopping. While many people stop using anabolic steroids without treatment, they are addictive, and stopping suddenly can lead to serious withdrawal symptoms. 

 In rare cases, tumors in the adrenal glands or the testicles can also cause high testosterone. If you have a sex hormone-producing tumor,⁷ your doctor will arrange surgery to remove the tumor, as removing the tumor is a necessary part of treatment.

Along with surgery, your doctor may recommend chemotherapy, radiation therapy, and medications such as mitotane⁸ (an anti-cancer drug) or ketoconazole⁹ (which blocks the production of male sex hormones). 

Are there any natural ways to lower testosterone levels?

Regular exercise and a healthy diet may help alleviate some problems associated with high testosterone levels. However, discussing management strategies with a doctor is important, especially when high testosterone levels are linked to medications like those used in hormone replacement therapy. 

It's essential to identify why your testosterone levels are high in the first place. It will be challenging to treat if you don’t know what’s causing the problem.

How can you ensure that your testosterone levels are within a healthy range?

The best way to ensure that your testosterone levels are within a healthy range is through blood tests. Your primary healthcare provider may request one of two tests; the total testosterone test or the free testosterone test. A third test, called the bioavailable testosterone test, is less common.

Either of these tests can measure the amount of testosterone in your blood. Your doctor will compare your results to the expected healthy range. If your results are above the recommended range, your testosterone levels are too high, and you’ll need to consider ways to lower them.

When to see a doctor

If you have any signs of high testosterone or ED, or if something just feels “off,” see a doctor. Sometimes, seemingly mild issues are caused by serious underlying conditions. Without treatment, persistent health-related problems tend to get worse.

The lowdown

Many factors can lead to elevated testosterone, which may affect sexual health.

In some cases, abnormal testosterone levels can be managed through lifestyle changes, but if you’re worried your testosterone levels may be too high (or too low), schedule an appointment for a blood test with your primary healthcare provider to be sure.