Sexual health

Does testosterone therapy improve sex drive? What the trials show

Two large placebo-controlled trials found testosterone improved sexual desire and activity in men with low testosterone. Erections are a different story.

Published · 2 min read

Low sex drive is one of the most common reasons men ask about testosterone. It's also one of the areas where the research is clearest, as long as testosterone is genuinely low.

The Testosterone Trials

The Testosterone Trials studied 790 men aged 65 and older with low testosterone and symptoms. For one year, they used either a testosterone gel or a placebo gel.

Compared with placebo, men on testosterone had:

  • More sexual activity
  • More sexual desire
  • Better erectile function

The researchers described the sexual benefit as moderate. Mood improved slightly. Energy, which the trials measured as "vitality," did not improve.

The TRAVERSE sexual function study

A larger, longer study came from the TRAVERSE trial. It included 1,161 men with low testosterone and low libido, aged 45 to 80, all with heart disease or a high risk of it.

Testosterone increased sexual activity compared with placebo, and the improvement lasted through 24 months. Sexual desire and overall symptoms of low testosterone also improved.

Erectile function, however, did not improve compared with placebo in this study.

What this means

Put together, the trials say:

  • If your testosterone is truly low, treatment is likely to help desire and sexual activity.
  • Testosterone alone is not a reliable treatment for erectile dysfunction.

Erections depend heavily on blood flow, nerves and blood sugar. Erectile dysfunction can be an early sign of heart disease or diabetes, so it deserves its own evaluation, including heart and metabolic labs. Many men need a different treatment for erections, sometimes alongside testosterone.

Getting the diagnosis right

None of these benefits apply if your testosterone is normal. Guidelines recommend diagnosing low testosterone only with symptoms and low levels on at least two separate early-morning tests. A single afternoon result can be misleading.

Read more about sexual health care at Ora, or how we diagnose and monitor TRT.

Sources

  1. Snyder PJ, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374:611–624. doi.org/10.1056/NEJMoa1506119
  2. Pencina KM, et al. Effect of testosterone replacement therapy on sexual function and hypogonadal symptoms in men with hypogonadism. J Clin Endocrinol Metab. 2024. doi.org/10.1210/clinem/dgad484
  3. Bhasin S, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. doi.org/10.1210/jc.2018-00229

This article is for general education and is not medical advice. Talk to a physician about your own symptoms and treatment options.

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