New Delhi: Hormones control erectile function, with testosterone and other androgens playing key roles in keeping penile tissue healthy and supporting sexual response. Made mainly in the testes, testosterone boosts sex drive, aids nitric oxide production for blood vessel relaxation, and maintains the corpus cavernosum—the spongy erectile tissue that enables firmness. Without enough levels, men face fewer, weaker, and less rigid erections, as studies confirm in men with low-androgen (hypogonadal) states.
In an interaction with TV9 English, Dr. Arun Kumar K., Senior Consultant – Urology, RG Hospitals – Chennai, explained how testosterone can play a role in helping men dealing with erectile dysfunction.
Testosterone plays a key role in erections by working on several parts of penile function. It helps grow the smooth muscle cells in the spongy erectile tissue (called trabecular smooth muscle). This muscle expands to trap blood during an erection, making it firm and lasting. Testosterone also blocks fibrosis, scar-like tissue buildup that stiffens the penis and weakens erections over time. Plus, it stops smooth muscle cells from turning into fat cells, which would reduce the tissue’s ability to respond. These actions keep the penis flexible, healthy, and ready for strong erections. Without enough testosterone, this tissue weakens, leading to poorer blood flow and rigidity.
Testosterone naturally drops about 1% per year after age 30. This decline matches rising erection challenges, from 20% in men under 40 to over 70% by age 70. Up to 24% of older men with erection issues have low testosterone, often overlooked. Low levels make erections less frequent, weaker, or shorter. Recognising these signs, like low energy, reduced sex drive, or mood shifts alongside erection troubles, encourages timely checkups.
Other Hormones in the Mix
Dihydrotestosterone (DHT) is a stronger form of testosterone that is made in the penis itself. It helps erections by supporting the tissue and keeping the blood vessels working well, so blood can flow in and stay there. If DHT is low, erections can be weak even when overall testosterone levels look normal.
Thyroid hormones also influence in an indirect way by altering the level of a protein called SHBG, which carries testosterone in the blood. When the thyroid is overactive, SHBG goes up, more testosterone gets “locked up,” and less is free and active, which can feel like low testosterone and lead to erection problems.
Estrogen and prolactin matter too. Too much estrogen, often seen with obesity, can interfere with male hormones and promote stiff, scar-like changes in penile tissue. High prolactin, sometimes due to stress or certain medicines, can lower testosterone, reducing sex drive and erectile firmness.
Treatment Options
Hormone therapy can restore erections in men with low testosterone, improving night-time firmness and overall well-being. However, not all erection problems come from low hormones—blood flow issues, nerve damage, or stress often cause them in men with normal levels. Doctors recommend morning testosterone tests for ongoing problems, especially with low sex drive, since early treatment prevents lasting tissue damage.
Testosterone therapy also supports men who do not respond well to medicines like Viagra, by improving tissue relaxation and restoring stronger night-time erections. When needed, doctors may combine hormone therapy with ED tablets, which often works better than either approach alone. A full hormone workup helps identify hidden imbalances early, reducing the risk of long-term changes such as persistent blood leakage from the penis. In the end, it is the overall balance between testosterone, DHT, thyroid hormones, estrogen, and prolactin that keeps erectile function strong and reliable.
Takeaway
Testosterone plays a central role in how erections work by keeping the penile tissues healthy and supporting proper blood flow. Improving hormone levels through lifestyle changes, medical hormone replacement, or a combination of treatments can bring targeted relief. Testosterone replacement improves erections in 60% of hypogonadal men unresponsive to Viagra. Strength training, balanced diets rich in zinc and healthy fats, and stress reduction support natural production. Regular exercise boosts levels by 15-20%, quality sleep adds another 10-15%, and maintaining a healthy weight prevents further drops. Men should know that morning blood tests reveal true levels. Talking openly with doctors normalizes screening, as balanced testosterone sustains not just erections, but vitality too.
