Which Lab Tests Can Detect Erectile Dysfunction?

Testosterone is needed for a healthy libido.¹ Low testosterone levels are frequently connected with a decreased desire in sexual engagement, which can contribute to erectile dysfunction.

Testosterone assists the physiological process of obtaining and sustaining an erection.² While the direct process is complicated and includes several components (such as the neurological and circulatory systems), good testosterone levels are required for proper erectile function.

Testosterone is thought to regulate the body’s synthesis of nitric oxide, a chemical that plays an important part in the relaxation of smooth muscle in the penis, allowing for greater blood flow and erection.³

Testosterone affects mood and general well-being.⁴ Low levels can cause sadness, anxiety, and a diminished sense of well-being, which can impair sexual performance.

Chronic low testosterone levels might cause structural changes in the penile tissue, potentially exacerbating erectile dysfunction over time.⁵

Elevated prolactin levels, also known as hyperprolactinemia, can cause ED.⁶ High prolactin levels can restrict the release of gonadotropin-releasing hormone (GnRH), resulting in lower testosterone production. Because testosterone is essential for sexual function, this decrease may contribute to erectile dysfunction.

Increased prolactin levels can also reduce sexual desire or libido.⁷ This is because prolactin inhibits dopamine, a neurotransmitter involved in sexual desire and function. Reduced libido can be a major contributor to ED.

Aside from altering libido and testosterone levels, excessive prolactin can have an indirect impact on erectile function. For example, men with hyperprolactinemia may suffer anxiety or sadness as a result of their disease, which can worsen ED.⁸

Elevated prolactin levels may suggest pituitary gland diseases, such as a prolactinoma. These disorders can have a variety of impacts on the body, including changes in sexual function.

LH is essential for the generation of testosterone in the testes.⁹ It causes the Leydig cells in the testes to create testosterone. Because testosterone is an important hormone for male sexual function, including desire and the capacity to develop and sustain an erection, variations in LH levels can have a direct influence on erectile function. Low LH levels can cause low testosterone production, which contributes to ED.

FSH is largely important for regulating spermatogenesis, or sperm production. While FSH levels are more directly tied to fertility than erectile function, FSH imbalances might suggest larger abnormalities with the testes or pituitary gland, which may affect sexual health and performance.

The pituitary gland produces both LH and FSH. Abnormal levels of these hormones can suggest a problem with the pituitary gland or hypothalamus, which can impair the synthesis of other hormones involved in sexual function.

Testing for LH and FSH is very important in detecting various kinds of hypogonadism. Primary hypogonadism, caused by a testicular issue, is characterized by elevated levels of LH and FSH as a result of decreased testosterone feedback. Secondary hypogonadism, caused by a problem with the hypothalamus or pituitary gland, is characterized by low or normal LH and FSH levels. Both disorders can cause low testosterone levels and ED.

LH and FSH levels can provide insight into the male body’s overall hormonal health and balance. Hormonal abnormalities can play a key role in erectile dysfunction.

In males, estradiol is produced by the conversion of testosterone. The balance of testosterone and estradiol is very important for sexual function.¹⁰ High estradiol levels in relation to testosterone can impair sexual performance and lead to ED.

Estradiol affects libido in males as well as women. Abnormally high levels can reduce sexual desire, which is an important aspect of sexual health and may indirectly lead to ED.¹¹

Some research suggests that estradiol may play a function in the health of erectile tissue.¹² However, high quantities of estradiol may have a deleterious influence on this tissue, limiting the capacity to produce or maintain an erection.

Elevated estradiol levels in males may be related with other health issues such as obesity, liver illness, or thyroid diseases, all of which can impair sexual performance and contribute to ED.

High levels of estradiol in males may suggest increased activity of the enzyme aromatase, which transforms testosterone to estradiol.¹³ This might lead to a reduction in accessible testosterone, affecting sexual function.

SHBG binds to testosterone, affecting its bioavailability.¹³ Only a tiny amount of testosterone in the bloodstream is “free” or unbound, which means it is physiologically active and may enter cells to exercise its effects. High levels of SHBG can bind more testosterone, lowering the amount of free testosterone available for the body to use. Because testosterone plays an important role in sexual function, including desire and erectile function, elevated SHBG levels can lead to ED.

SHBG also binds to estradiol, which is a kind of estrogen.¹⁴ Changes in SHBG levels can disrupt the equilibrium of testosterone and estrogen in the body, which is very important for sexual wellness. Abnormal SHBG levels can upset the equilibrium and contribute to sexual dysfunction.

Abnormal SHBG levels may suggest problems with general hormonal health. Several variables can affect SHBG levels, including liver function, thyroid hormones, and obesity. High SHBG levels are commonly found in hyperthyroidism and liver illness, whereas low levels are related with obesity, insulin resistance, and hypothyroidism.

In the context of ED, SHBG testing is frequently combined with total testosterone testing. The total testosterone to SHBG ratio can assist in determining whether a man has low bioavailable testosterone, which can lead to a diagnosis of hypogonadism, a cause of erectile dysfunction.