From the Guidelines
The optimal testosterone level for erectile function is generally considered to be within the normal adult male range of 300-1000 ng/dL (10.4-34.7 nmol/L), with levels below 300 ng/dL often associated with erectile dysfunction.
Key Considerations
- Many men may experience optimal erectile function when their testosterone levels are in the mid to upper part of this range, around 500-700 ng/dL 1.
- Testosterone supports erectile function by maintaining libido, promoting nitric oxide production which is essential for penile blood flow, and supporting the structural integrity of penile tissue.
- While adequate testosterone is necessary for normal erectile function, many other factors including cardiovascular health, psychological well-being, and neurological function also play crucial roles, and testosterone replacement alone may not resolve erectile dysfunction if other underlying issues exist 1.
Treatment Options
- If testosterone deficiency is diagnosed, treatment typically involves testosterone replacement therapy (TRT) in forms such as injections (testosterone cypionate or enanthate, 50-200mg every 1-2 weeks), daily transdermal gels (AndroGel, Testim, 50-100mg), patches (Androderm, 2-6mg daily), or pellets implanted subcutaneously every 3-6 months.
- Clinicians should consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar 1.
Important Notes
- No well-defined, universally accepted threshold of testosterone levels exists below which symptoms of androgen deficiency and adverse health outcomes occur.
- Uncertainty exists as to whether nonspecific signs and symptoms associated with age-related low testosterone, such as sexual dysfunction, decreases in energy and muscle mass, mood disturbances, changes in bone mineral density, cardiovascular disease, depression, decreased libido, erectile dysfunction, decreased volume of ejaculate, loss of body and facial hair, weakness, and mortality, are a consequence of age-related low testosterone or whether they are a result of other factors, such as chronic illnesses or concomitant medications.
From the Research
Optimal Testosterone Level for Erectile Function
The optimal testosterone level for erectile function is not explicitly stated in the provided studies. However, the studies suggest that testosterone replacement therapy (TRT) can improve erectile function in hypogonadal men.
- A study published in the Journal of pharmacy practice 2 discusses the potential roles of testosterone in erectile physiology and the relationship between testosterone deficiency and erectile dysfunction.
- A study published in The journal of sexual medicine 3 found that men with sexual symptoms of hypogonadism respond well to TRT across a wide range of initial total testosterone (TT) values, including men with low-normal TT levels.
- Another study published in Journal of andrology 4 found that testosterone therapy improves erectile function in hypogonadal patients with venous leakage, with mean testosterone plasma levels increasing to 520-625 ng/dL after treatment.
- A study published in The journal of sexual medicine 5 found that low TT levels at baseline did not negatively influence response to tadalafil in men with concomitant lower urinary tract symptoms and benign prostatic hyperplasia and erectile dysfunction.
- A study published in The journal of sexual medicine 6 found that 12-month treatment with a testosterone gel improves sexual function in hypogonadal men, with mean total testosterone levels increasing to 500.6 ± 248.2 ng/dL after treatment.
Key Findings
- TRT can improve erectile function in hypogonadal men 2, 3, 4, 6.
- The optimal testosterone level for erectile function is not explicitly stated, but studies suggest that levels above 300 ng/dL may be beneficial 3, 4, 5, 6.
- Low TT levels at baseline do not negatively influence response to phosphodiesterase type 5 inhibitors in men with concomitant lower urinary tract symptoms and benign prostatic hyperplasia and erectile dysfunction 5.