The Men’s Health and Wellness Conference of 2015 offered a session named “Testosterone, Hormones, and Erectile Dysfunction.” While most people can name treatments for this problem, no one should base medical decisions on advertising.

Instead, people should talk with medical providers, and search out multiple sources of information. Below is a summary of that presentation by Clinical Sexologist, Lawrence Siegel, except where noted otherwise.

Siegel criticized testosterone therapy as the default treatment for erectile dysfunction (ED) or male aging issues. While hormones drive animal sexual behavior, for humans cultural and psychosocial factors have greater importance. Increasing the testosterone levels in a “normal” male fails to improve sexual response. Lifestyle changes (diet and exercise) have better results than testosterone therapy.

Testosterone therapy would benefit men with low testosterone and any of these four other conditions: HIV infection and weight loss, taking high dose glucocorticoids, clinical symptoms of testosterone deficiency, and men with low sexual drive. Siegel would only recommend testosterone therapy for men with low testosterone and ED, after he had ruled out other causes of ED and considered other treatments.

Prescription, over-the-counter, and criminalized drugs can contribute to erectile dysfunction. More importantly, ED may be an early sign of serious conditions, such as cardio-vascular disease. Those same arterial blockages that restrict blood flow to the penis could also restrict blood flow to the heart.

ED differs from male hormone deficiency. The symptoms of male hormone deficiency include the following: decreased sexual desire and activity, fewer spontaneous erections, breast/pectoral discomfort, decreased body hair, decreased testes size, decreased sperm counts, decreased height, bone mass, muscle bulk, or strength, and hot flashes.

Siegel gave a brief primer on male sexual hormones. Five hormones contribute to sexual response: Testosterone, DHEA (dehydroepiandrosterone), oxytocin, PEA (phenethylamine), LH (luteinizing hormone), and FSH (follicle stimulating hormone). Contrary to popular belief, men produce both testosterone and estrogen, but men produce more testosterone than estrogen.

As the body processes cholesterol, the body transforms some of it into DHEA. Among males, DHEA production peaks at age 25 and then begins to decline. The pituitary gland produces FSH and LH, which helps to produce sperm and testosterone from DHEA. The testes transform DHEA into testosterone, which maintains muscle bulk, well-being, and sexual functioning. More testosterone exists in bound form than as bio-available “free”-testosterone. During erotic touch, the pituitary gland secretes oxytocin, creating a sense of attachment. With molecular similarities to amphetamines and psychedelics, PEA creates euphoria and increases empathy.

Seigel warned against ordering drugs online. When people order online, no one can monitor for potential drug interactions. Brick and mortar pharmacies have the responsibility to monitor prescriptions for possible drug interactions. This has particular importance for people taking many prescription drugs.