Masturbation and Testosterone: Clinical Evidence
Masturbation produces only transient, clinically insignificant changes in testosterone levels that do not affect overall hormonal status or health outcomes. The evidence shows brief hormonal fluctuations immediately after sexual activity that normalize within hours, with no sustained impact on baseline testosterone concentrations or muscle growth potential.
Acute Hormonal Response
The immediate hormonal changes following masturbation are modest and short-lived:
A 2021 randomized controlled cross-over study found that masturbation may counteract the normal circadian drop in free testosterone over the day, but produces no significant changes in total testosterone or testosterone-to-cortisol ratios 1. This suggests any effect is limited to preventing normal daily decline rather than creating supraphysiologic increases.
A 1976 study demonstrated significant increases in multiple steroid hormones (pregnenolone, DHEA, androstenedione, testosterone, DHT, estrone, estradiol, and cortisol) immediately after masturbation, with the most marked changes in pregnenolone and DHEA rather than testosterone 2. Importantly, LH levels remained unchanged, indicating the pituitary-gonadal axis was not stimulated 2.
These hormonal elevations are transient and return to baseline within hours, as the circadian pattern of testosterone remains the dominant factor in daily testosterone fluctuations 1.
Clinical Implications
The practical significance of these findings is minimal:
The belief among some athletes that masturbation before training increases testosterone for muscle growth is not supported by evidence 1. The brief free testosterone changes observed do not translate to sustained elevations that would affect protein synthesis or performance.
In men with erectile dysfunction, masturbation frequency correlates with higher baseline testosterone levels, but this reflects overall sexual health rather than causation 3. Men with higher testosterone are more likely to masturbate, not the reverse.
For fertility assessment, blood sampling must precede semen collection by masturbation, as the acute hormonal changes can confound laboratory interpretation 2. This is the only clinically relevant consideration regarding masturbation's hormonal effects.
Context for Sexual Health Assessment
When evaluating male sexual function, masturbation patterns provide diagnostic information:
Masturbation frequency is inversely related to age and directly associated with testosterone levels, stress, and relationship status 3. This makes it a useful marker of overall sexual health rather than a modulator of hormones.
The quality of erection during masturbation helps distinguish organic from psychogenic erectile dysfunction, with poor masturbatory erections suggesting vascular or neurologic pathology 3.
Guilt during masturbation associates with psychological disturbances, low prolactin, low testosterone, and relationship problems 3, indicating the need for broader psychosexual assessment.
Comparison to Other Sexual Activity
Coitus produces larger ejaculate volumes with increased prostaglandin E and polyamines compared to masturbation, but conventional hormonal parameters remain similar 4. This indicates the method of sexual release has minimal differential impact on testosterone.
In women, orgasm produces sustained prolactin elevation lasting over 60 minutes, with only small transient increases in LH and testosterone 5. This pattern suggests prolactin, not testosterone, is the primary endocrine marker of sexual arousal and orgasm across sexes.
Clinical Bottom Line
For men concerned about testosterone levels, masturbation is neither beneficial nor harmful to hormonal status. The focus should instead be on established factors affecting testosterone: age, obesity, chronic illness, medications, sleep disorders, and testicular or pituitary pathology 6. Morning total testosterone measurement using an accurate assay remains the appropriate initial test for suspected hypogonadism 6, with sexual activity having no clinically meaningful impact on results if blood is drawn before ejaculation 2.