Evidence question
Evidence / Men's Sexual Health
Bottom line
Testosterone improves sexual desire and some erectile function endpoints in men with confirmed hypogonadism, but effects are smaller than PDE5 inhibitors for vascular erectile dysfunction. Treat documented deficiency when indicated; do not rely on testosterone alone for moderate-to-severe ED without evaluating PDE5 therapy.[1–6]
Evidence confidence
Evidence Confidence
HighMultiple high-quality studies directly address this question, with generally consistent findings.
Key uncertainty. Benefit in men with normal testosterone and isolated ED is not supported.
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Testosterone improves sexual desire and some erectile function endpoints in men with confirmed hypogonadism, but effects are smaller than PDE5 inhibitors for vascular erectile dysfunction. Treat documented deficiency when indicated; do not rely on testosterone alone for moderate-to-severe ED without evaluating PDE5 therapy.
Testosterone improves sexual desire and some erectile function endpoints in men with confirmed hypogonadism, but effects are smaller than PDE5 inhibitors for vascular erectile dysfunction. Treat documented deficiency when indicated; do not rely on testosterone alone for moderate-to-severe ED without evaluating PDE5 therapy.
Testosterone improves sexual desire and some erectile function endpoints in men with confirmed hypogonadism, but effects are smaller than PDE5 inhibitors for vascular erectile dysfunction. Treat documented deficiency when indicated; do not rely on testosterone alone for moderate-to-severe ED without evaluating PDE5 therapy.
Testosterone improves sexual desire and some erectile function endpoints in men with confirmed hypogonadism, but effects are smaller than PDE5 inhibitors for vascular erectile dysfunction. Treat documented deficiency when indicated; do not rely on testosterone alone for moderate-to-severe ED without evaluating PDE5 therapy.
Testosterone improves sexual desire and some erectile function endpoints in men with confirmed hypogonadism, but effects are smaller than PDE5 inhibitors for vascular erectile dysfunction. Treat documented deficiency when indicated; do not rely on testosterone alone for moderate-to-severe ED without evaluating PDE5 therapy.
Testosterone improves sexual desire and some erectile function endpoints in men with confirmed hypogonadism, but effects are smaller than PDE5 inhibitors for vascular erectile dysfunction. Treat documented deficiency when indicated; do not rely on testosterone alone for moderate-to-severe ED without evaluating PDE5 therapy.
Landmark studyPMID 27355400
In older men with low libido and low T levels, improvements in sexual desire and activity in response to T treatment were related to the magnitude of increases in T and estradiol levels, but there was no clear evidence of a threshold effect.
Landmark studyPMID 28434676
TTh significantly improves erectile function and other sexual parameters as measured by IIEF in hypogonadal men. These results argue that sexual dysfunction should be considered a hallmark manifestation of T deficiency, since those symptoms can be significantly improved with normalization of serum T.
Landmark studyPMID 37589949
In middle-aged and older men with hypogonadism and low libido, TRT for 2 years improved sexual activity, hypogonadal symptoms, and sexual desire, but not erectile function.
Testosterone therapy in hypogonadal men: a systematic review and network meta-analysis.
Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group.
Interleukin 2 treatment does not modify hepatitis B or C replication in human immunodeficiency virus-infected patients: results from a randomized control trial.
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More in this focus area
Other structured clinical questions in Men's Sexual Health.
How effective are PDE5 inhibitors for erectile dysfunction?
PDE5 inhibitors substantially improve erectile function versus placebo across broad ED populations, with landmark trials showing clinically meaningful IIEF improvements. On-demand dosing before sexual activity is standard; response rates are high though not universal.
12 linked studies
Is daily low-dose tadalafil better than on-demand dosing for erectile dysfunction?
Both daily low-dose and on-demand tadalafil improve erectile function. Daily dosing may improve spontaneity and lower urinary symptom scores in men with comorbid LUTS, while on-demand dosing minimizes drug exposure for men with infrequent sexual activity.
12 linked studies
Are PDE5 inhibitors safe for cardiovascular disease in men with erectile dysfunction?
In stable cardiovascular disease, PDE5 inhibitors do not appear to increase major adverse cardiac events when used appropriately and nitrate co-administration is avoided. Sexual activity itself carries modest cardiovascular demand; individualized assessment remains important after recent events.
12 linked studies
Why are PDE5 inhibitors contraindicated with nitrates?
Combined PDE5 inhibition and nitric oxide donor therapy can produce profound synergistic vasodilation and symptomatic hypotension. Nitrates and PDE5 inhibitors should not be used together; allow appropriate washout intervals when switching between agents in acute coronary care.
12 linked studies
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