Is It ED or Low Testosterone? How to Tell the Difference and Get the Right Treatment in 2026
If you’re experiencing issues in the bedroom, you might wonder: is it erectile dysfunction (ED), low testosterone (Low T), or both? Understanding the difference is crucial for finding the right solution. At Affinity Whole Health, we help men identify the root cause—so you can get back to feeling your best.
Hear directly from Dr. Koehler, Medical Director of Affinity Whole Health.
The relationship between erectile dysfunction and testosterone deficiency is complex and often misunderstood. While ED medications can provide temporary relief, they're essentially putting a band-aid on what might be a more significant hormonal issue. Understanding whether you're dealing with ED, Low T, or both is crucial for finding the right treatment approach that addresses the root cause rather than just the symptoms.
Understanding the Key Differences
What Is Erectile Dysfunction (ED) and What Causes It?
Erectile dysfunction is defined as the inability to achieve or maintain an erection firm enough for sexual activity. This can manifest as difficulty getting or keeping an erection, softer erections than desired, or a general reduction in sexual confidence. While ED can affect men at any age, it becomes increasingly common as men get older. The causes of ED are varied and can include problems with blood flow, nerve function, psychological factors such as stress or anxiety, and, importantly, hormonal imbalances like low testosterone. Medications such as sildenafil (Viagra®) or tadalafil (Cialis®) can provide temporary relief by increasing blood flow, but they do not address the underlying reasons for ED.
What Are the Symptoms of Low Testosterone?
Low testosterone (“Low T”) happens when your body isn’t producing enough of a key hormone for energy, drive, and sexual function. Symptoms often build slowly over time.
Common Low T symptoms include:
Lower sex drive (libido)
Persistent fatigue or low stamina
Brain fog or trouble focusing
Mood changes (irritability, low mood, anxiety)
Reduced motivation/drive
Difficulty building muscle or losing fat (even with exercise)
Sleep disruption or feeling unrefreshed
A general sense that you’re “not yourself”
Many men assume these changes are normal aging, but Low T is often treatable when properly diagnosed.
ED vs Low Testosterone: What’s the Difference?
Distinguishing between ED and low testosterone can be challenging because the symptoms often overlap. If you are experiencing only erection issues but maintain normal energy, mood, and sex drive, you may be dealing with ED alone. However, if you notice erection problems alongside decreased libido, fatigue, mood changes, or changes in body composition, low testosterone is likely involved. Research shows that up to 47% of men with ED have underlying testosterone deficiency. In these cases, treating Low T can resolve both sexual and overall health issues, providing a more comprehensive solution than ED medications alone.
How Does Low Testosterone Cause Erectile Dysfunction?
Testosterone supports erections in several ways, not just libido.
Low testosterone can contribute to ED by:
Reducing nitric oxide production (nitric oxide helps blood vessels relax for stronger blood flow)
Decreasing penile tissue health and responsiveness
Affecting nerve signaling involved in arousal and erection quality
Lowering libido, which can create a cycle of stress and performance anxiety
For some men, optimizing testosterone improves both desire and erection quality, especially if ED meds haven’t worked well.
How Do You Know If It’s ED, Low Testosterone, or Both?
The only way to know for sure whether you’re dealing with ED, low testosterone, or both is through comprehensive blood testing. The American Urological Association recommends that all men presenting with ED have their testosterone levels checked. If your testosterone is normal and you only have ED, targeted ED treatment may be best. However, if you have low testosterone and multiple symptoms, testosterone therapy can address the root cause and lead to improvements in both sexual and overall health.
Treatment Options for ED and Low Testosterone
If ED is the main issue, treatment can often be simple and fast, especially for men who want privacy and convenience. If Low T is involved, treatment usually requires a more complete workup and ongoing monitoring.
For ED alone, options may include:
Online intake questionnaire
Provider review
If appropriate, ED medication shipped discreetly
Direct-pay options that can offer privacy and streamlined access
For Low T, the process is typically more comprehensive:
Lab testing (total + free testosterone and related markers as appropriate)
Health review + medical consultation
Personalized treatment plan if clinically indicated
Ongoing monitoring and follow-ups for safety and optimization
Many men report improvements in:
Sex drive and sexual confidence
Erection quality (especially when Low T is a factor)
Energy, mood, and motivation
Muscle mass and fat management (with lifestyle support)
Sleep quality and mental clarity
What Are Common Misconceptions About ED and Low Testosterone?
Many men believe they are too young to have low testosterone, but research shows that testosterone deficiency can affect men of any age. In fact, one in four men over 30 have low testosterone levels. Another common misconception is that ED medications are easier or more effective than addressing hormonal issues. While these medications can provide temporary relief, they do not address the underlying cause if low testosterone is involved. Some men worry that testosterone therapy is complicated, but modern telemedicine and at-home treatments have made the process simple and convenient. Finally, while it’s true that testosterone naturally declines with age, symptomatic deficiency is not inevitable and is highly treatable.
The Science: Why Testosterone Therapy Often Solves Both Problems
Testosterone therapy works by increasing nitric oxide production, which improves blood flow to the penis and supports healthy erections. It also helps maintain the structural integrity of penile tissue and enhances blood vessel function. By boosting libido and sexual response, testosterone therapy addresses both the physical and psychological aspects of sexual health. This comprehensive approach often eliminates the need for ongoing ED medications.
The Science: Why Testosterone Therapy Often Solves Both Problems
Testosterone therapy works by increasing nitric oxide production, which improves blood flow to the penis and supports healthy erections. It also helps maintain the structural integrity of penile tissue and enhances blood vessel function. By boosting libido and sexual response, testosterone therapy addresses both the physical and psychological aspects of sexual health. This comprehensive approach often eliminates the need for ongoing ED medications.
Latest Developments in Men’s Sexual Health (2026)
The landscape of men’s sexual health is rapidly evolving. New diagnostic tools now allow for more precise and faster testosterone measurement, making it easier to identify and treat hormonal imbalances. Telemedicine has revolutionized access to care, enabling men to receive diagnosis and treatment from the privacy and comfort of their own homes. This increased accessibility has led to earlier intervention and better outcomes for many men who might have otherwise delayed seeking help.
Frequently Asked Questions
Q: Can I take ED medications and testosterone therapy together?
A: Yes, although some men find they no longer need ED medications once testosterone levels normalize. Always consult your healthcare provider about combining treatments.
Q: How quickly does testosterone therapy improve erectile function?
A: While some men notice improvements within 3-4 weeks, optimal results typically occur after several months as testosterone levels stabilize.
Q: What if my testosterone levels are "normal" but I still have symptoms?
A: "Normal" ranges are broad. Some men experience symptoms at different levels. A thorough evaluation considers symptoms alongside lab values to determine the best treatment for your unique situation.
Q: Are there risks to testosterone therapy?
A: Like all medical treatments, testosterone therapy has potential risks. Regular monitoring ensures safe, effective treatment tailored to your individual needs.
Q: Will insurance cover testosterone therapy?
A: While coverage varies, most men find insurance either doesn't cover treatment or limits them to ineffective protocols from doctors without hormone training. Dr. Koehler trained directly under Harvard's Dr. Morgentaler through the exclusive Morgentaler Method™ Fellowship, developing protocols that include preventive measures like HCG and estrogen management often ignored in standard care. Our compounded medications typically cost less than insurance copays while delivering personalized results backed by 12+ years of experience.
Taking the Next Step
Don’t settle for temporary fixes. If you’re struggling with ED or suspect low testosterone, get tested and find the right treatment for lasting results. At Affinity Whole Health, we specialize in personalized care for men’s sexual health, helping you feel like yourself again.