TRT and Erectile Dysfunction

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Can you improve erections with testosterone replacement therapy? Should you just take medications such as sildenafil and tadalafil or should you try to find out what the cause of the issue is? Erectile dysfunction can occur for several reasons. Low testosterone is one of the main causes. This can be treated by the use of testosterone replacement therapy. Other causes include blood flow and other health conditions. Improving your health through diet and exercise may help if you are overweight. Improving sleep and reducing stress may also have an impact.

How to Improve Erection Quality?

Erections are a hugely important part of a man’s health and confidence. If they aren’t working properly it can cause a lot of issues, not just in the bedroom.

You may be surprised at what can improve erection quality and the causes of this issue. Here we look at some of the main causes and way to treat this problem.

What is Erectile Dysfunction?

Erectile dysfunction is when a man cannot achieve an erection or the quality of his erection is not as good as he would like, particularly if it means he cannot have sexual intercourse.

Whilst most men may experience ED at some point in their lives, due to stress, intoxication or not being in the mood, when a man has it frequently it becomes an issue that can be caused by physical and psychological issues.

How do I get an Erection?

If we can understand how an erection is produced then we can understand the potential causes, as there are several things that need to happen for a man to produce an effective erection.

The first stage is arousal.

When a man is sexually excited this causes chemicals to be released in and around the penis which relaxes the muscles at the base of the penis. This relaxation increases blood flow to the area by allowing blood to flow in. The increased blood flow causes the chambers in the penis to inflate (or engorge) with blood (almost like an inflatable canoe). The relaxation of the muscles also stops blood from exiting the penis through veins as easily. This increases the pressure in the penis, making it more rigid.

When a man is no longer aroused, or after ejaculation, the muscles contract and release blood from the penis. This causes the penis to shrink and become soft.

What causes Erectile Dysfunction?

There are lots of potential causes of erectile dysfunction. These include:

  • cardiovascular disease
  • high cholesterol
  • obesity
  • low testosterone levels or high oestrogen levels
  • high prolactin
  • diabetes
  • hypertension, or high blood pressure
  • renal (kidney) disease
  • alcohol consumption or drug abuse
  • some medications
  • anxiety and stress
  • depression
  • relationship problems
  • sleep disorders
  • tobacco or nicotine products
  • health conditions, such as Parkinson’s disease or multiple sclerosis (MS)
  • damage to the pelvic or pubic area
  • Peyronie’s disease (where scar tissue develops in the penis)

These issues can be separated into these categories:

  • Psychological reasons (such as anxiety)
  • Hormonal reasons (such as low testosterone or high oestrogen levels)
  • Biochemical reasons (such as medication use or drug abuse)
  • Physical reasons (such as a blocked artery reducing blood flow to the penis)


Testosterone Replacement Therapy and Erectile Dysfunction

Low testosterone and ED

ED and testosterone levels are correlated. Low testosterone can cause men to have a reduced sex drive/libido by reducing sexual thoughts and arousal levels. Men with lower levels of testosterone have less frequent, less rigid and shorter-lasting erections compared to men with normal or high testosterone levels. Men who are castrated are often unable to achieve erections. These erections then increase in frequency and rigidity when the same men are given testosterone replacement therapy.

Men with less severe hypogonadism (low testosterone but with some production) also suffer from erectile dysfunction. We see a lot of patients who suffer from this issue before starting TRT. It may be that they no longer get sexually aroused or that they want to have sex but struggle to get or maintain a sufficiently hard erection.

In these patients, testosterone replacement therapy is often very effective at improving both sexual arousal (which leads to better erections) and erection quality in men who are struggling with this problem.

If you have erectile dysfunction and haven’t had your hormones tested, then this is certainly something worth looking into as it a largely underdiagnosed cause of ED.

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Treatment for Erectile Dysfunction

Treatment for this condition depends on the cause of the issue.

If you have low testosterone then as explained above, TRT is the best treatment to improve this problem.

Some men suffer from blood flow issues, these will require surgery or intervention from a specialist doctor.

Medications for Erectile Dysfunction

There are a few main medications that are commonly used for erectile dysfunction:

  • Sildenafil (also known as Viagra)
  • Tadalafil (also known as Cialis)
  • Vardenafil (also known as Levitra)
  • Avanafil (also known as Stendra)

Vacuum penis pump

The penis pump produces negative pressure around the penis which draws blood into the penis and causes it to become erect.

An elastic band is then placed around the base of the penis to prevent blood from leaving, thus maintaining an erection. This can be kept in place for up to half an hour.

Counselling or talking therapy

Patients with performance anxiety or stress may find that medications and other treatment methods don’t help with ED.

In these cases, the issue may be psychological and require a different approach.

Specialist sex therapists are often a very effective treatment option that can help to solve performance anxiety and reduce stress.

They will often focus on:

  • stress or anxiety factors affecting your ED
  • thoughts and feelings about sex that may be exacerbating the issue
  • subconscious thoughts that could be affecting your sexual life

Low testosterone can also cause men to experience more anxiety and stress, so it is important to rule out this issue when experiencing Erectile dysfunction.

Erectile dysfunction medications

What do the different types of ED medications do?


The original erectile dysfunction medication. It increases blood flow to the penis to produce hard erections for an hour or so.

It needs to be taken just before sexual activity and has a strong effect.


This newer medication option works in the same way as Viagra except it can either be taken up to a few hours before sexual activity, or it can be used at a lower daily dose which prevents the need for planning when taking the medication. It has the added benefit of being good for prostate health and improving general blood flow in the body.

These are the two main ED medications used and can be provided by Optimale at a low cost after filling in an online form.

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Supplements to Improve Erections

Some herbs have been used historically to treat erectile dysfunction. Other supplements listed below have been used more recently as their blood flow increasing properties have become more well known.

  • dehydroepiandrosterone (DHEA)
  • ginseng, such as Korean red ginseng
  • L-arginine
  • L-carnitine
  • zinc
  • Asparagus racemosus
  • Horny goat weed

The evidence for some of these working is moderate at best. Others, such as L-carnitine and L-arginine have been shown to improve erectile function.

Lifestyle Changes for Erectile Dysfunction

As with everything, your lifestyle and health are paramount to proper bodily function.

As erectile dysfunction is related to poor blood flow, one of the most important factors in improving ED is to increase blood flow in the body.

This is primarily done by regular exercise, maintaining a healthy body fat level and reducing your risk of diabetes by avoiding sugary and processed foods.

Maintaining good sleeping habits is also important as this can reduce anxiety and stress levels.

Optimale Comments

Contact Us

For more information

Contact us for more information on low testosterone or TRT.