Low testosterone (hypogonadism) as a cause of erectile dysfunction (ED)

What is low testosterone?

Hypogonadism , or low testosterone, is a condition in which the body does not produce enough sex hormones to support natural physiological and sexual processes. In men, hypogonadism is caused by low levels of testosterone , the male sex hormone . It can also occur due to an imbalance of testosterone and estrogen. Hypogonadism can cause developmental delays, male infertility, and a range of other symptoms.

Signs and symptoms of low testosterone in men

In different men and at different periods of life, hypogonadism can manifest itself in different ways. At the stage of intrauterine development, hypogonadism can provoke the formation of female-like genital organs or the underdevelopment of male genital organs.

In boys and adolescents, low or no testosterone levels will inhibit the development of secondary sexual characteristics, which will manifest as decreased muscle mass, excessive height, weak bones, lack of penile and pubic hair growth, and a high pitched voice.

In adult men , low testosterone can lead to infertility , breast development (gynecomastia, or female breasts in men), loss of libido , and erectile dysfunction . There may also be a loss of muscle mass and a decrease in bone density. General malaise and lack of energy can be caused by low testosterone levels, as well as many other reasons.

Hypogonadism and erectile dysfunction

Hypogonadism can cause erectile dysfunction. This is a very important cause of impotence in men. Testosterone deficiency can also manifest itself as a decrease in libido, or sex drive.

Treatment of erectile dysfunction due to hypogonadism

To treat erectile dysfunction caused by low testosterone levels, the root cause, i.e. hypogonadism, must be treated. Additionally, you can start treating erectile dysfunction with drugs such as Viagra (Viagra) and Cialis (Cialis). Often, treating low testosterone can help reduce or eliminate symptoms of erectile dysfunction. In other cases, men require treatment for both erectile dysfunction and low testosterone levels.

Congenital hypogonadism, that is, received in the prenatal period, is not treated (this is a very rare disease).

Hypogonadism that appears in childhood or adulthood is effectively treated by removing the cause or by using hormone replacement therapy.

Low testosterone levels are diagnosed based on a blood test. It is recommended to take blood for analysis early in the morning, this will provide the most accurate result. If a low testosterone level is detected, the test must be repeated to confirm the results. The fact is that the content of testosterone in the blood fluctuates throughout the day. The highest level is observed in the morning, and the lowest - in the evening. It also changes from day to day. Therefore, if the first analysis shows a low level of testosterone, it must be taken again to make sure that this is really the case.

In secondary hypogonadism , treatment is aimed at correcting the disease in the pituitary gland and replacing the pituitary hormones that stimulate testosterone production by the testicles.

In primary hypogonadism , such as testicular insufficiency, treatment is aimed at replenishing the lack of testosterone in the body. Testosterone replacement therapy helps to eliminate erectile dysfunction, as well as a number of other symptoms associated with low testosterone levels in adults. In boys and adolescents, testosterone replacement therapy will ensure normal puberty and prevent infertility later in life. Testosterone replacement therapy is available as an injection, patch, gel, gum, and oral tablet.

Men who plan to have children need a special approach to testosterone replacement therapy (TRT) to avoid testicular suppression.

Injections are usually safe and effective and are given intramuscularly. As a rule, one injection every two weeks is enough to ensure normal testosterone levels in the blood.

Testosterone replacement therapy in the form of a patch or gel can be used once a day: glue / apply to the back, thigh, abdomen or arm.

Testosterone replacement therapy in men of reproductive age can lead to infertility. In this case, treatment with drugs that stimulate the production of your own testosterone, and not just supply it to the body, is recommended.

Biological explanation for ED in men with hypogonadism

Testosterone is a male sex hormone produced by the Leydig cells in the testes . Testosterone synthesis is controlled by luteinizing hormone, or LH , which is produced in the pituitary gland. LH is secreted from the anterior pituitary along with follicle-stimulating hormone, or FSH . FSH does not affect testosterone production, but it controls sperm maturation. During the embryonic stage, testosterone is responsible for the formation of the male sex organs. After birth, he plays a major role in the development of secondary sexual characteristics, such as hair growth, voice change and growth of male genital organs.In adult life, testosterone is responsible for maintaining libido, that is, sexual desire, thus playing a crucial role in sexuality.

Hypogonadism can be primary or secondary. Primary hypogonadism usually occurs when testosterone synthesis is impaired or androgen receptor insensitivity due to mutation. The mutation may occur in response to an autoimmune disease, infection, tumor, surgery, exposure to radiation, or a congenital disease such as Klinefelter's syndrome.

In secondary hypogonadism , the mechanism of testosterone biosynthesis works normally, but stimulation of its production is impaired, which is usually associated with a decrease in the production of FSH and LH . The problem may lie in the hypothalamus or, more commonly, the pituitary gland. Causes of secondary hypogonadism include trauma, tumors, infections, genetic causes, and nutritional deficiencies.

Hypogonadism may be present at birth, in which case it is known as congenital hypogonadism . Congenital hypogonadism can be caused by intrauterine developmental disorders or genetic changes in the mechanism of hormone biosynthesis. Acquired hypogonadism develops later, usually in adulthood, and can be caused by pathology in the hypothalamus or pituitary gland, as well as testicular failure. Varicocele is another treatable cause of primary hypogonadism.