Does testosterone therapy improve sexual stamina and ED?

Testosterone therapy in men with confirmed hypogonadism (total testosterone consistently below 300 ng/dL with symptoms) improves libido and subjective sexual function reliably, but improves erectile function only modestly and specifically in men whose ED is driven by hypogonadism rather than vascular disease, because erection requires both testosterone (for libido and NO synthesis support) and intact vascular function (for the hydraulic mechanics) (Isidori et al., Eur Urol, 2014).

The practical clinical implication: a man with ED whose testosterone is low may improve partially with TRT. A man with ED whose testosterone is normal and whose vascular health is poor will not see meaningful improvement from testosterone therapy. The cardiologist's position is to evaluate both: confirm hypogonadism or rule it out, and assess vascular disease independently. These are not either-or diagnoses, many men over 45 have both components operating simultaneously, requiring parallel treatment.

Honesty Scale: Solid (1) for TRT improving libido in hypogonadal men. Promising (2) for TRT improving erectile function in men with mild hypogonadal-related ED. Early (3) for TRT improving ED when the primary etiology is vascular disease.

What to do: If you are considering TRT for sexual stamina improvement, ensure your physician has confirmed hypogonadism with two early-morning testosterone measurements and has done a cardiovascular pre-screen. Do not pursue TRT from a telehealth service that requires no cardiovascular evaluation.

For the full picture, read The Stamina Deep Dive