Testosterone Series Part 3. Libido and Sexual Dysfunction

Testosterone Series Part 3. Libido and Sexual Dysfunction

Sexual dysfunction is possibly the commonest reason men visit their doctors for those who think beyond the viagras and cialis; and are keen on understanding their testosterone levels.

Some common manifestations of low T sexually in men:

  • decrease in frequency of morning erections

  • decrease in strength of morning erections

  • takes more concentration to get an erection

  • takes more concentration to then keep it going

  • decrease in the volume of ejaculate

  • losing an erection halfway or not able to maintain an erection

  • decrease interest in sex and low libido

  • little to no erection ie sexual dysfunction

  • secondary premature ejaculation (as concerned that one may lose erection)

  • a sense that the penis feels smaller when fully erect than before

In women, it mostly manifests as a decrease in libido and loss of interest in sex. Some women will find it harder to orgasm or that it takes longer to stimulate than they used to remember.

It’s one of those situations that generally creeps up on people with daily life stresses playing a big part. As more and more raw materials are required to keep our stress hormones (that are necessary to survival, unlike testosterone) in good supply, a ‘steal’ situation occurs that reroutes materials so that less is available to make up hormones at the bottom of the hormonal cascade.

In many cases, it becomes a situation where the the couple simply prefer the TV to doing anything more physical and slowly start avoiding ‘sexy’ situations without even realising it. Or one partner may perceive a sense of decrease in attention from their partner, occasionally even leading to accusations of cheating.

The impact of low testosterone on libido

Dealing with these situations can be fairly complex with no easy one size fits all formula. The longer it is left, the worse it can become as it may come to a point where there is psychological impact (much harder to deal with!). Also, a more holistic approach is generally required to prevent so much ‘stealing’ and to balance the other hormones at the same time for optimum performance.

On the whole, it is still manageable, preventable and treatable in majority of people. It also adds tremendously to the release of ‘feel good’ neurotransmitters, which then decreases the stress hormones, and gives rise to deeper sleep. So quite frequently a win-win situation!


  1. Araujo, Andre B et al. “Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis.” The Journal of clinical endocrinology and metabolism vol. 96,10 (2011): 3007-19. doi:10.1210/jc.2011-1137

  2. Basaria, Shehzad, and Adrian S. Dobs. “Testosterone Making an Entry Into the Cardiometabolic World.” Circulation, vol. 116, no. 23, 2007, pp. 2658–2661., doi:10.1161/circulationaha.107.740365.

  3. Bhasin S, Woodhouse L, Casaburi R, Singh AB, Bhasin D, Berman N, Chen X, Yarasheski KE, Magliano L, Dzekov C, et al Testosterone dose-response relationships in healthy young men. American Journal of Physiology: Endocrinology and Metabolism 2001. 281 E1172–E1181. (10.1152/ajpendo.2001.281.6.E1172)

  4. Bolour, S and G Braunstein. “Testosterone therapy in women: a review.” International Journal of Impotence Research. May.17 (2005): 399–408. Print

  5. Borst, Stephen E et al. “Cognitive effects of testosterone and finasteride administration in older hypogonadal men.” Clinical interventions in aging vol. 9 1327-33. 12 Aug. 2014, doi:10.2147/CIA.S61760

  6. Cherrier MM, Craft S, Matsumoto AH. Cognitive changes associated with supplementation of testosterone or dihydrotestosterone in mildly hypogonadal men: a preliminary report. Journal of Andrology. 2003;24(4):568–576.

  7. Clayton, Anita H et al. “Evaluation and Management of Hypoactive Sexual Desire Disorder.” Sexual medicine vol. 6,2 (2018): 59-74. doi:10.1016/j.esxm.2018.01.004

  8. Corona, Giovanni, Giulia Rastrelli, Matteo Monami, André Guay, Jaques Buvat, Alessandra Sforza, Gianni Forti, Edoardo Mannucci, and Mario Maggi. “Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study”. European Journal of Endocrinology 165.5: 687-701. Web. 8 Aug. 2019.

  9. Elisabeth Hak A., Jacqueline C. M. Witteman, Frank H. de Jong, Mirjam I. Geerlings, Albert Hofman, Huibert A. P. Pols, Low Levels of Endogenous Androgens Increase the Risk of Atherosclerosis in Elderly Men: The Rotterdam Study, The Journal of Clinical Endocrinology & Metabolism, Volume 87, Issue 8, 1 August 2002, Pages 3632–3639.

  10. Emmelot-Vonk MH, Verhaar HJJ, Nakhai Pour HR, et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. The Journal of the American Medical Association. 2008;299(1):39–52.

  11. Fletcher, Jenna and Daniel Murrell MD. “What are the symptoms of low testosterone?.” Medicalnewstoday.com. Medical News Today, 1 Aug 2018. Web. 1 Jun 2019.

  12. Ghelani BPharm, MRPharmS, Rita. “Sustanon 250 injection (testosterone): a treatment to boost low testosterone levels.” Netdoctor.co.uk. Netdoctor, 22 Jul 2019. Web. 1 Aug 2019.

  13. Giorgi, A, RP Weatherby and PW Murphy. “Muscular strength, body composition and health responses to the use of testosterone enanthate: a double blind study.” Journal of Science and Medicine in Sport. 2.4 (1999): 341-55.

  14. Haring, Henry Völzke, Antje Steveling, Alexander Krebs, Stephan B. Felix, Christof Schöfl, Marcus Dörr, Matthias Nauck, Henri Wallaschofski, Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20–79, European Heart Journal, Volume 31, Issue 12, June 2010, Pages 1494–1501.

  15. Islam PhD, Rakibul, Robin Bell MBBS and Sally Green PhD. “Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data..” The Lancet Diabetes and Endocrinology. (2019).

  16. Jackson, Testosterone deficiency syndrome (TDS) and the heart, European Heart Journal, Volume 31, Issue 12, June 2010, Pages 1436–1437.

  17. Jones, T. H., et al. “Testosterone Replacement in Hypogonadal Men With Type 2 Diabetes and/or Metabolic Syndrome (the TIMES2 Study).” Diabetes Care, vol. 34, no. 4, 2011, pp. 828–837., doi:10.2337/dc10-1233.

  18. Kelly, Daniel M, and T Hugh Jones. “Testosterone: a metabolic hormone in health and disease”. Journal of Endocrinology 217.3: R25-R45. Web. 8 Aug. 2019. 

  19. Khaw, Kay-Tee, et al. “Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men.” Circulation, vol. 116, no. 23, 2007, pp. 2694–2701., doi:10.1161/circulationaha.107.719005.

  20. Kyriazis, Ioannis Tzanakis, Kostas Stylianou, Irene katsipi, Demitrios Moisiadis, Antonia Papadaki, Vasiliki Mavroeidi, Stella Kagia, Nikolaos Karkavitsas, Eugene Daphnis, Low serum testosterone, arterial stiffness and mortality in male haemodialysis patients, Nephrology Dialysis Transplantation, Volume 26, Issue 9, September 2011, Pages 2971–2977.

  21. Laughlin, Gail A et al. “Low serum testosterone and mortality in older men.” The Journal of clinical endocrinology and metabolism vol. 93,1 (2008): 68-75. doi:10.1210/jc.2007-1792

  22. Lehtonen, Risto Huupponen, Jaakko Tuomilehto, Sirkku Lavonius, Seija Arve, Hannu Isoaho, Ilpo Huhtaniemi, Reijo Tilvis, Serum testosterone but not leptin predicts mortality in elderly men, Age and Ageing, Volume 37, Issue 4, July 2008, Pages 461–464.

  23. Maggio, Marcello et al. “Relationship between low levels of anabolic hormones and 6-year mortality in older men: the aging in the Chianti Area (InCHIANTI) study.” Archives of internal medicine vol. 167,20 (2007): 2249-54. doi:10.1001/archinte.167.20.2249

  24. Maggio, M, and S Basaria. “Welcoming low testosterone as a cardiovascular risk factor.” International journal of impotence research vol. 21,4 (2009): 261-4. doi:10.1038/ijir.2009.25

  25. Mathur A, Malkin C, Saeed B, Muthusamy R, Hugh Jones T, Channer K. Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men. European Journal of Endocrinology. 2009;161(3):443–449.

  26. Middleton, T., L. Turner, C. Fennell, S. Savkovic, V. Jayadev, A J Conway, and D J Handelsman. “Complications of injectable testosterone undecanoate in routine clinical practice”. European Journal of Endocrinology 172.5: 511-517. Web. 6 Aug. 2019.

  27. Moffat, S. D., et al. “Free Testosterone and Risk for Alzheimer Disease in Older Men.” Neurology, vol. 62, no. 2, 2004, pp. 188–193., doi:10.1212/wnl.62.2.188.

  28. Molly M. Shores, Nicholas L. Smith, Christopher W. Forsberg, Bradley D. Anawalt, Alvin M. Matsumoto, Testosterone Treatment and Mortality in Men with Low Testosterone Levels, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 6, 1 June 2012, Pages 2050–2058.

  29. Morris, Paul D, and Kevin S Channer. “Testosterone and cardiovascular disease in men.” Asian journal of andrology vol. 14,3 (2012): 428-35. doi:10.1038/aja.2012.21

  30. Muraleedharan, Vakkat, and T Hugh Jones. “Testosterone and the metabolic syndrome.” Therapeutic advances in endocrinology and metabolism vol. 1,5 (2010): 207-23. doi:10.1177/2042018810390258

  31. Muraleedharan, Vakkat, Hazel Marsh, Dheeraj Kapoor, Kevin S Channer, and T Hugh Jones. “Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes”. European Journal of Endocrinology 169.6: 725-733. Web. 8 Aug. 2019.

  32. Ng Tang Fui, Mark et al. “Effects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial.” BMC medicine vol. 14,1 153. 7 Oct. 2016, doi:10.1186/s12916-016-0700-9

  33. Potenza, Matthew, and Mona Shimshi. “Male Hypogonadism: The Unrecognized Cardiovascular Risk Factor.” Journal of Clinical Lipidology, vol. 2, no. 2, 2008, pp. 71–78., doi:10.1016/j.jacl.2008.01.011.

  34. Redmond, GP. “Hormones and sexual function..” International Journal of Fertility and Women’s Medicine. 44.4 (1999): 193-7. Print

  35. Sartorius, Gideon et al. “Factors influencing time course of pain after depot oil intramuscular injection of testosterone undecanoate.” Asian journal of andrology vol. 12,2 (2010): 227-33. doi:10.1038/aja.2010.1

  36. Seidman SN, Spatz E, Rizzo C, Roose SP. Testosterone replacement therapy for hypogonadal men with major depressive disorder: a randomized, placebo-controlled clinical trial. Journal of Clinical Psychiatry. 2001;62(6):406–412.

  37. Selvin, E., et al. “Androgens and Diabetes in Men: Results from the Third National Health and Nutrition Examination Survey (NHANES III).” Diabetes Care, vol. 30, no. 2, 2007, pp. 234–238., doi:10.2337/dc06-1579.

  38. Shifren J.L. Testosterone for midlife women: the hormone of desire? Menopause. 2015;22:1147–1149

  39. Singh, Rajan. “Testosterone inhibits adipogenic differentiation in 3T3-L1 cells: nuclear translocation of androgen receptor complex with beta-catenin and T-cell factor 4 may bypass canonical Wnt signaling to down-regulate adipogenic transcription factors.” Endocrinology. January.147 (2006): 141-54.

  40. Surampudi, Prasanth N et al. “Hypogonadism in the aging male diagnosis, potential benefits, and risks of testosterone replacement therapy.” International journal of endocrinology vol. 2012 (2012): 625434. doi:10.1155/2012/625434

  41. Toma, Mustafa, et al. “Testosterone Supplementation in Heart Failure.” Circulation: Heart Failure, vol. 5, no. 3, 2012, pp. 315–321., doi:10.1161/circheartfailure.111.965632.

  42. Traish, A. M., et al. “The Dark Side of Testosterone Deficiency: II. Type 2 Diabetes and Insulin Resistance.” Journal of Andrology, vol. 30, no. 1, 2008, pp. 23–32., doi:10.2164/jandrol.108.005751.

  43. Van der Meij, L, A Demetriou, M Tulin and I Mendez. “Hormones in speed-dating: The role of testosterone and cortisol in attraction..” Elsevier Hormonal Behaviour. (2019).

  44. Vingren, Jakob. “Testosterone physiology in resistance exercise and training: the up-stream regulatory elements.” Sports Medicine. 40.12 (2010): 1037–1053.

  45. Vlachopoulos, Nikolaos Ioakeimidis, Dimitrios Terentes-Printzios, Konstantinos Aznaouridis, Konstantinos Rokkas, Athanassios Aggelis, Alexandros Synodinos, George Lazaros, Christodoulos Stefanadis, Plasma Total Testosterone and Incident Cardiovascular Events in Hypertensive Patients, American Journal of Hypertension, Volume 26, Issue 3, March 2013, Pages 373–381.

  46. Wang C, Alexander G, Berman N, et al. Testosterone replacement therapy improves mood in hypogonadal men—a clinical research center study. The Journal of Clinical Endocrinology & Metabolism. 1996;81(10):3578–3583.

  47. Wang C, Swerdloff RS, Iranmanesh A, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism. 2000;85(8):2839–2853. 

  48. Wehr, Elisabeth, et al. “Low Free Testosterone Is Associated with Heart Failure Mortality in Older Men Referred for Coronary Angiography.” European Journal of Heart Failure, vol. 13, no. 5, 2011, pp. 482–488., doi:10.1093/eurjhf/hfr007. 

  49. Weiss, Rita V., Hohl, Alexandre, Athayde, Amanda, Pardini, Dolores, Gomes, Larissa, Oliveira, Monica de, Meirelles, Ricardo, Clapauch, Ruth, & Spritzer, Poli Mara. (2019). Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism. Archives of Endocrinology and Metabolism, 63(3), 190-198. Epub July 18, 2019.

  50. Wieselman, Brie. “Adrenal Fatigue Part 4: The “Cortisol Steal”—or, How Increased Stress Creates Female Hormone Imbalance.” Briewieselman.com. 1 Jan 2018. Web. 1 Aug 2019.

  51. Zoë Hyde, Paul E. Norman, Leon Flicker, Graeme J. Hankey, Osvaldo P. Almeida, Kieran A. McCaul, S. A. Paul Chubb, Bu B. Yeap, Low Free Testosterone Predicts Mortality from Cardiovascular Disease But Not Other Causes: The Health in Men Study, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 1, 1 January 2012, Pages 179–189.

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