Longevity & Aging · Metabolic & Cardiometabolic
testosterone therapy improves sexual function
In plain terms: Does testosterone therapy improve sex drive and function?
Strong support Longevity & Aging 💰 Industry COI noted🔬 Includes disconfirming
Part of: 💊 Testosterone therapy (TRT)
RefutedContestedStrong support
consensus score 0.78
For men with genuinely low testosterone, yes — it's one of the most reliable benefits, especially for libido and sexual desire. The effect on erections specifically is more modest, so it's not a stand-alone ED treatment. It does little for men whose testosterone is already normal.
📅 Last reviewed: 2026-07-14 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
11 support 1 contradict 0 tested null 1 mixed · 13 sources, 11 independent groups
What the evidence shows
For men with genuinely low testosterone, TRT improves sexual function — this is among its most consistent benefits, backed by the Testosterone Trials, the TRAVERSE sexual-function study, and multiple meta-analyses.
The evidence (14)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Canal de Velasco LM, González Flores JE, Vargas L, Morales Arteaga JL 2026 · Cureus | RCT | supports | moderate | Systematic review synthesizing 11 RCTs (>600 men, including hypogonadal and eugonadal) found sexual function and quality of life 'consistently improved across studies' with testosterone therapy vs placebo/standard care. |
| Corona G, Isidori AM, Buvat J, Aversa A, Rastrelli G, Hackett G, Rochira V, Sforza A, Lenzi A, Mannucci E, Maggi M 2014 · Eur Urol | meta-analysis | mixed | moderate | Meta 41 RCTs: improved erectile function/libido in hypogonadal men, but effect strongest in industry-supported trials (publication-bias concern). |
| Corona G, Rastrelli G, Morgentaler A, Sforza A, Mannucci E, Maggi M 2017 · J Sex Med | meta-analysis | supports | high | Meta 14 RCTs (n=2298): improved IIEF erectile-function domain (MD +2.31) and libido; greater with more severe hypogonadism. |
| Amiaz R, Pope HG, Mahne T, Kelly JF, Brennan BP, Kanayama G, Weiser M, Hudson JI, Seidman SN 2011 · J Sex Marital Ther | RCT | supports | low | RCT (depressed men on SSRIs): testosterone gel improved IIEF sexual-function scores vs placebo. |
| Hackett G, Cole N, Saghir A, Jones P, Strange RC, Ramachandran S 2017 · J Sex Med | RCT | supports | moderate | RCT (T2DM men): improved sexual desire (6wk) and erectile function (30wk), greatest in severe hypogonadism. |
| Constantinou BT, Benedicto BC, Galligani L, Schiavon BN, Mendes CMO, Petri MMG, Uzueli B, Maia RS, da Sardenberg RAS, Fraietta R, Shiomi da Cruz JA 2026 · European journal of clinical pharmacology | meta-analysis | supports | moderate | Meta-analysis (11 studies, 1512 patients) of clomiphene vs TRT in male hypogonadism found TRT produced better post-treatment libido scores (ADAM 1-5) than clomiphene (MD -0.54, 95% CI -0.87 to -0.21, p=0.009), with low heterogeneity (I2=18. |
| Corona G, Torres LO, Maggi M 2020 · Andrology | mechanism | supports | low | Review: TRT improves erectile function/libido in men with total T <12 nmol/L. |
| Paduch DA, Polzer PK, Ni X, Basaria S 2015 · J Clin Endocrinol Metab | RCT | contradicts | moderate | 16-week multicentre double-blind RCT, 76 androgen-deficient men (two total T <300 ng/dL) with ejaculatory dysfunction, testosterone solution 2% (60 mg) vs placebo; 66 completed. Primary MSHQ-EjD-SF score rose +3.1 on testosterone vs +2.5 on placebo (P=.596), and 'no differences were seen in any of the secondary outcomes', including ejaculate volume and the IIEF orgasmic-function domain. A between-arm gap of 0.6 points at P=0.6 is a clean null, not a trend -> contradicts on the directional claim per CONVENTIONS §5. Endpoint is ejaculatory function, one domain of 'sexual function'; libido and erectile function were not primary endpoints. Two of four authors are Eli Lilly employees (maker of the study drug). |
| Ponce OJ, Spencer-Bonilla G, Alvarez-Villalobos N, Serrano V, Singh-Ospina N, Rodriguez-Gutierrez R, Salcido-Montenegro A, Benkhadra R, Prokop LJ, Bhasin S, Brito JP 2018 · J Clin Endocrinol Metab | meta-analysis | supports | moderate | Meta 4 RCTs (n=1779): small but significant gains in libido (SMD 0.17), erectile function (0.16), satisfaction (0.16). |
| Seminara G, Leuzzi M, Meduri L, Greco EA, Aversa A 2026 · Minerva endocrinology | RCT | supports | low | Pilot study (n=10) in obese hypogonadal men added testosterone undecanoate to tirzepatide in 'late responders'; combined group showed significantly better erectile function (IIEF-5 23.2±2.1 vs 18.0±1.5, p<0.001) than tirzepatide alone at 6 |
| Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, Gill TM, Barrett-Connor E, Swerdloff RS, Wang C, Ensrud KE, Lewis CE, Farrar JT, Cella D, Rosen RC, Pahor M, Crandall JP, Molitch ME, Cifelli D, Dougar D, Fluharty L, Resnick SM, Storer TW, Anton S, Basaria S, Diem SJ, Hou X, Mohler ER, Parsons JK, Wenger NK, Zeldow B, Landis JR, Ellenberg SS, Testosterone Trials Investigators 2016 · N Engl J Med | RCT | supports | high | Sexual Function Trial of the Testosterone Trials (NCT00799617): double-blind, placebo-controlled, intention-to-treat, 12 months of titrated testosterone gel vs placebo in men >=65y with mean serum testosterone <275 ng/dL who also had self-reported decreased libido, a DISF-M-II desire score <=20 and a partner willing to have intercourse twice a month. DENOMINATOR IS THE SEXUAL FUNCTION TRIAL, NOT THE 790 HEADLINE: 230 testosterone / 229 placebo on the primary, 234/236 on the secondary scales. PRIMARY OUTCOME POSITIVE: PDQ-Q4 sexual-activity treatment effect 0.58 (95% CI 0.38-0.78) on a 0-12 scale, effect size 0.45, P<0.001, concordant in the exploratory all-participants analysis (0.62, P<0.001), with a dose-response by achieved testosterone level (P<0.001 by instrumental-variable analysis). SECONDARY: 'Testosterone treatment was also associated with increased sexual desire according to the DISF-M-II (treatment effect, 2.93; P<0.001) and increased erectile function according to the IIEF (treatment effect, 2.64; P<0.001)' - effect sizes 0.44 and 0.32. MAGNITUDE IS MODEST AND THE AUTHORS SAY SO: 'The effect of testosterone on erectile function was less than that reported with phosphodiesterase type 5 inhibitors', and the benefit faded - 'The response was somewhat less at month 12 (P = 0.08 for the interaction between time and treatment).' APPLICABILITY: 'A major limitation, albeit an intentional one, is that the results apply only to men 65 years of age or older whose testosterone levels averaged less than 275 ng per deciliter.' Funding firewall stated verbatim: AbbVie funded the trial and donated the gel but 'did not participate in the design or conduct of the trials or in the analysis, review, or reporting of the data before the manuscript was submitted for publication.' |
| Cruickshank M, Hudson J, Hernández R, Aceves-Martins M, Quinton R, Gillies K, Aucott LS, Kennedy C, Manson P, Oliver N, Wu F, Bhattacharya S, Dhillo WS, Jayasena CN, Brazzelli M 2024 · Nat Med | meta-analysis | supports | high | IPD meta 35 trials (n=5601): TRT improved sexual function and QoL across almost all subgroups. |
| Pencina KM, Travison TG, Cunningham GR, Lincoff AM, Nissen SE, Khera M, Miller MG, Flevaris P, Li X, Wannemuehler K, Bhasin S 2024 · JAMA Netw Open | RCT | supports | high | TRAVERSE Sexual Function Study (n=1161): TRT improved sexual activity, desire, hypogonadal symptoms over 24 months; erectile function NOT significantly improved. |
| Isidori AM, Giannetta E, Gianfrilli D, Greco EA, Bonifacio V, Aversa A, Isidori A, Fabbri A, Lenzi A 2005 · Clin Endocrinol (Oxf) | meta-analysis | supports | moderate | Meta 17 RCTs: improved erections/sexual thoughts/intercourse success in men with baseline T <12 nmol/L; no effect in eugonadal men. |
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