Can Hormone Therapy Cause Erectile Dysfunction? A Comprehensive Guide

October 8, 2025 •

5 min read

Up to 90% of men receiving androgen deprivation therapy (ADT) for prostate cancer experience erectile dysfunction. Understanding if and how can hormone therapy cause erectile dysfunction is crucial for anyone undergoing or considering such treatments, as the effects vary significantly depending on the type and purpose of the therapy.

Quick Summary

Hormone therapy can cause erectile dysfunction, particularly treatments that lower testosterone levels, though the effect depends on the specific therapy and patient.

Key Points

ADT and ED: Androgen Deprivation Therapy (ADT) for prostate cancer is a primary cause of erectile dysfunction and reduced libido, affecting a majority of men receiving the treatment.
Testosterone Levels are Key: Therapies that lower testosterone, like ADT and estrogen HRT for trans women, increase the risk of ED, whereas TRT for hypogonadal men can improve erectile function.
Medication Effectiveness Varies: Standard PDE-5 inhibitor medications (like Viagra) are often ineffective for ED caused by loss of libido from ADT but can be useful for other forms of hormone-related ED.
Recovery is Not Guaranteed: The return of erectile function after stopping certain hormone therapies, like ADT, is not guaranteed and depends on individual factors like age and duration of treatment.
Comprehensive Management is Needed: Managing hormone-related ED often requires a combination of strategies, including medication, non-oral therapies, counseling, and lifestyle adjustments.

The Dual-Edged Sword: Hormone Therapy's Impact on ED

Hormone therapy involves using medications to manipulate hormone levels in the body to achieve a therapeutic goal. While some forms of hormone treatment can cause erectile dysfunction (ED) by reducing testosterone, other types, such as testosterone replacement therapy (TRT), may actually improve erectile function in men with low testosterone. The relationship is not one-size-fits-all, and the outcome depends on the specific hormones being targeted, the dose, duration, and the individual's baseline health.

Androgen Deprivation Therapy (ADT) for Prostate Cancer

For men with prostate cancer, androgen deprivation therapy is a common treatment designed to lower the body's androgen levels, primarily testosterone. Prostate cancer cells often rely on testosterone to grow and spread, so reducing this hormone can help control the cancer.

Unfortunately, this reduction of testosterone comes with a high risk of sexual side effects, including ED and a loss of libido. The vast majority of potent men on continuous ADT will experience some form of sexual dysfunction. While the sexual side effects of ADT can be a difficult adjustment, it is an expected and well-documented consequence of this life-saving cancer treatment. The good news is that for some men, erectile function and libido may recover months after stopping treatment, though this is not always the case, especially in older men or those on long-term therapy.

Hormone Replacement Therapy (HRT) for Transgender Women

In transgender women receiving estrogen HRT, medications are used to suppress testosterone production while providing external estrogen. The goal is to induce feminizing effects. The reduction of testosterone in this population can lead to a decrease in libido and the ability to achieve and maintain an erection. While this change may align with the personal goals of some trans women, others may experience distress or desire to preserve their erectile function. Treatment options, including ED medications, are available and should be discussed with a healthcare provider.

Testosterone Replacement Therapy (TRT) for Hypogonadism

For men who have low levels of testosterone (hypogonadism), TRT is often used to restore hormone balance. In these cases, TRT can be an effective treatment for ED, particularly in men with mild dysfunction. For men with more severe ED, TRT can increase libido and improve the effectiveness of PDE-5 inhibitors (like Viagra). However, managing TRT is complex. Sometimes, the body's conversion of testosterone into estrogen can lead to elevated estrogen levels, which can also contribute to ED. An experienced provider can help manage these delicate hormone balances.

Mechanisms Behind Hormone Therapy-Induced ED

The physiological processes behind how hormone therapy influences erectile function are varied and complex, extending beyond simple hormonal fluctuations.

Decreased Libido: Testosterone plays a crucial role in regulating a person's sexual desire. Therapies that significantly lower testosterone, like ADT, can lead to a marked reduction in libido, which makes achieving an erection more difficult, regardless of the physical capability.
Penile Tissue Changes: Long-term hormonal deprivation can lead to physical changes in the penile tissue, such as a loss of volume and fibrosis. Maintaining regular sexual activity, if possible, can help mitigate this side effect.
Impaired Vascular Function: Testosterone is linked to promoting the expression of PDE-5, an enzyme important for the erection process. With lower testosterone levels, the vascular function necessary for a strong erection can be impaired, reducing the effectiveness of PDE-5 inhibitor drugs.
Psychological and Emotional Impact: Beyond the physical effects, the emotional toll of dealing with a medical condition, fatigue, body changes, and sexual side effects can also contribute to ED. Mood changes, depression, and stress are common side effects of hormone therapy that can dampen sexual interest and performance.

Comparison of Hormone Therapies and ED Risk


Therapy Type	Primary Goal	ED Risk	Common Management
Androgen Deprivation Therapy (ADT)	Lower testosterone to treat prostate cancer	High; reduced libido and erectile function expected	Psychosexual counseling, injections, vacuum pumps; PDE-5 inhibitors often ineffective
Estrogen HRT	Feminizing effects for transgender women	Variable; depends on baseline T levels and dosage	ED medications (Sildenafil, Tadalafil), vacuum pumps, adjusting dosage
Testosterone Replacement Therapy (TRT)	Raise testosterone for low T in cisgender men	Low; can improve ED, though balance is key	Adjusting dosage, adding PDE-5 inhibitors if needed, potentially aromatase inhibitors if estrogen levels rise

Managing Erectile Dysfunction during Hormone Therapy

Managing ED while on hormone therapy requires a multi-faceted approach and close communication with your healthcare team. The strategies depend heavily on the type of hormone therapy and the specific cause of ED.

Medical Consultation: Always discuss sexual side effects with your doctor or a urologist. They can help identify the root cause and determine the most effective treatment plan, including considering other potential causes of ED, such as cardiovascular disease or diabetes.
Medication Options: For ED related to estrogen HRT or TRT, PDE-5 inhibitors may be effective. However, they are often less successful for ED resulting from the loss of libido caused by ADT.
Non-Oral Therapies: Options like vacuum constriction devices, penile injections, or even surgical penile implants can be considered, especially when oral medications are ineffective or undesirable.
Psychosexual Counseling: Arousal and desire are influenced by many factors, including psychological well-being. Counseling for both individuals and couples can help navigate the emotional and relational challenges associated with sexual dysfunction.
Lifestyle Adjustments: Regular exercise, a healthy diet, reducing alcohol consumption, and quitting smoking can support overall health and potentially improve erectile function.
Partner Communication: Open and honest communication with your partner about feelings, expectations, and changes in intimacy is vital for coping with sexual side effects. Exploring non-penetrative forms of intimacy can also maintain closeness.

Prognosis and Recovery

The reversibility of hormone therapy-induced ED is highly variable. After discontinuing ADT for prostate cancer, some men, particularly younger individuals, may see a partial or full return of sexual function and libido. However, this is not a guarantee, and for older men or those on long-term therapy, the effects may be permanent. For transgender women on estrogen HRT, erectile function can often be managed with ED medications or, in some cases, by adjusting hormone dosages. Ultimately, managing expectations and focusing on what is possible with available treatments is a key part of the process.

Conclusion

Hormone therapy's effect on erectile dysfunction is not a simple yes or no answer. It is a complex issue with varied outcomes depending on the specific therapy used. Androgen deprivation therapy for prostate cancer is a major cause of ED due to reduced testosterone, while other therapies, such as TRT for low-T men, can be a treatment. For trans women, the effects depend on their goals and hormone balance. Regardless of the type, open communication with a healthcare team is essential for understanding the risks, managing side effects, and exploring the best treatment options. With the right approach, it is possible to maintain a satisfying intimate life despite hormonal changes. For more detailed information on managing sexual side effects related to cancer treatment, the National Cancer Institute offers comprehensive resources.

Frequently Asked Questions

No, hormone therapy does not always cause erectile dysfunction. The effect depends on the specific type of therapy. Treatments that lower testosterone, such as ADT for prostate cancer and estrogen HRT for trans women, commonly cause ED, but testosterone replacement therapy for men with low T can often improve it.

Androgen deprivation therapy (ADT) works by suppressing the body's testosterone, which is a major driver of sexual desire and erectile function. The significant reduction in testosterone levels is what primarily causes both a loss of libido and physical ED.

The effectiveness of PDE-5 inhibitors like Viagra and Cialis depends on the cause of the ED. They are often ineffective for ED caused by ADT because these drugs do not address the accompanying loss of libido. They may be more helpful for managing ED in trans women on HRT or in men on TRT.

The permanence of ED depends on the therapy and the individual. For some, especially younger individuals, erectile function may recover within months of stopping ADT. However, for older men or those on long-term therapy, the effects can be permanent.

Treatment options vary and can include vacuum constriction devices, penile injections, and implants. Psychosexual counseling can also be very helpful. It's crucial to discuss the best approach with a healthcare provider, as standard ED pills may not work for everyone.

Yes, estrogen HRT used by transgender women can cause or contribute to ED and reduced libido by suppressing testosterone levels. There are several treatment options available, including ED medication and dosage adjustments, which can help manage this.

Yes, lifestyle changes can help support overall sexual health. Regular exercise, a healthy diet, limiting alcohol, and stress management can help, though they may not be sufficient on their own to fully resolve ED caused by significant hormonal changes.