Testosterone’s Connections to ED and Overweight

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By Eric Ramos, PA-C

The spectrum of low testosterone symptoms can be dizzying, let alone when you find yourself right in the middle of them all. Low testosterone itself can either exacerbate or be caused by other issues as well. A very common triad, if you will, is the combination of low testosterone, erectile dysfunction and being overweight or obese.

Erectile dysfunction (ED) is an important cause of decreased quality of life in men. 5 ED itself can have many drivers but oftentimes tends to incorporate an issue with the inner lining of the arteries also known as the endothelium. Endothelial dysfunction and ED share a similar pathophysiology such as the nitric oxide pathway and ED has been positively associated with endothelial dysfunction, especially in obese men. 4 Furthermore, testosterone deficiency is known to induce endothelial dysfunction, which can lead to erectile dysfunction and/or vascular dysfunction. 1

As mentioned, ED and low testosterone also tend to have commonality with being overweight or obese. Testosterone levels are reduced with increased waist circumference and obesity and approximately 40% of obese non-diabetic men aged 45 years have low free testosterone. 2 Overweight is a classification of having a body mass index, BMI, of 25.0 to 29.9. Obesity BMI ranges are 30 or greater with additional classifications the higher the BMI.

The above can pose some complex challenges to both patients and clinicians. Each of these factors has their own laundry list of potential common culprits but even a common one such as dietary contribution to all these factors tends to be multi-layered. However, testosterone therapy, done properly, can improve all of these issues.

Testosterone treatment of hypogonadal men produced increased quality of life with reduced fatigue, increased libido and erectile function and reduced waist circumference. 2 Long-term testosterone therapy in men with testosterone deficiency produces significant and sustained weight loss, marked reduction in waist circumference and BMI and improvement in body composition. 4 Furthermore, several randomized controlled trials have demonstrated that weight loss improved erectile function as assessed by IIEF-5 score, International Index of Erectile Function. 4

As we can see the interplay of low testosterone, being overweight and erectile dysfunction can be complex and multi-factorial and will likely only worsen if left untreated.

Whether you are experiencing all of them or only one or better yet if you are looking to prevent them, the experts at Revibe Men’s Health can help. As one patient very aptly described to me “ these things put me in a negative posture and mindset moving forward, or rather, a sense of inability to move forward”. With thousands of patients treated, decades of combined experience and the latest customizable options available; the team at Revibe Men’s health can help you move forward again.


  1. Hotta Y, Kataoka T, Kimura K. Testosterone Deficiency and Endothelial Dysfunction: Nitric Oxide, Asymmetric Dimethylarginine, and Endothelial Progenitor Cells. Sex Med Rev. 2019 Oct;7(4):661-668. doi: 10.1016/j.sxmr.2019.02.005. Epub 2019 Apr 12. PMID: 30987932.
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    Curr Opin Endocrinol Diabetes Obes. 2014 Oct; 21(5): 313–322.
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  5. Giugliano F, Maiorino MI, Bellastella G, Autorino R, De Sio M, Giugliano D, Esposito K. Adherence to Mediterranean diet and erectile dysfunction in men with type 2 diabetes. J Sex Med. 2010 May;7(5):1911-7. doi: 10.1111/j.1743-6109.2010.01713.x. Epub 2010 Feb 25. PMID: 20214716.