Men's health — testosterone and erection concerns

The honest version, not the advertised one

Two of the most common questions men bring to a GP — quietly, often after a long delay — are “can I get my testosterone topped up?” and “what can I do about erection problems?” The internet has loud, confident answers to both, usually attached to something for sale. The clinical answers are more useful, and in one important way more reassuring: erectile dysfunction in particular is worth taking seriously as a health signal, not just a bedroom inconvenience.

This guide lays out how each of these is actually weighed in Australian general practice, so the questions you bring are the ones that fit your situation — and so you can skip the “low T” clinic.

Testosterone: the bar is genuine deficiency, not age

The single most important thing to know is that, in Australia, testosterone treatment is for genuine androgen deficiency — a real problem with the testes or the pituitary gland — and not for the gradual dip that comes with getting older, gaining weight, sleeping badly or feeling flat. As Australian Prescriber puts it, prescribing testosterone for non-specific symptoms or the lower levels associated with ageing is poorly validated and may be harmful. There is no recognised “male menopause” that warrants routine testosterone, and a healthy older man usually keeps normal levels, as Healthy Male explains.

In fact, a low-ish reading is often a marker of poor health — obesity, diabetes — rather than a problem to be fixed with a hormone, per Healthy Male. That changes the question from “how do I raise this number?” to “what’s driving it, and what actually helps?”

What the diagnostic bar really looks like

Because of that, the diagnosis is deliberately rigorous. A diagnosis of androgen deficiency should never rest on a single test: it needs more than one low result, taken on early-morning blood samples (testosterone is naturally highest in the morning), together with evidence of a genuine cause in the testes or pituitary, as the RACGP and Healthy Male set out.

The subsidy rules mirror this. The PBS subsidises testosterone only below defined thresholds and, for many men, requires the involvement of a specialist — an endocrinologist, urologist or sexual-health physician, per the RACGP. This is exactly the territory where commercial “low T” clinics and over-the-counter testosterone boosters operate outside Australian guidance — and where the supplements are described as unproven, unhelpful and potentially unsafe, per Healthy Male. The testosterone (‘low T’) decision aid below helps you understand where you sit against the real diagnostic bar and prepare the conversation with your GP. It doesn’t diagnose you or tell you to start anything.

Erectile dysfunction: a symptom worth listening to

The second question deserves a reframe of its own. Erectile dysfunction (ED) does become more common with age — but it shouldn’t be shrugged off as simply inevitable, because it can be an early warning sign of cardiovascular disease. ED and heart disease share the same underlying process, the narrowing of blood vessels, and because the arteries supplying the penis are small, they can show the problem first — sometimes years before a heart attack or stroke, as Healthy Male and the RACGP describe.

So the smart response to ED isn’t only to treat the symptom — it’s to use it as a cue for a cardiovascular risk check. Seeing your GP about it is one of the more useful health moves a man can make, not an embarrassing one.

The options for ED — and what comes first

There’s a clear ladder of treatment, set out by Healthy Male and the RACGP:

• Address the causes first — heart and metabolic risk factors, smoking, weight, certain medicines, and treating any confirmed low testosterone.
• PDE5-inhibitor tablets (such as sildenafil or tadalafil) are first-line for many men, effective and well-tolerated — but they are prescription-only in Australia, work only with sexual stimulation, and must never be combined with nitrate heart medicines, per HealthDirect and the Better Health Channel.
• Other options exist if tablets don’t suit.

The erectile dysfunction options decision aid below helps you see this ladder and prepare the conversation, including the cardiovascular angle. It’s there to help you ask, not to prescribe.

The questions worth taking in

• Could my symptoms have a cause other than testosterone — and what would actually help them?
• If testosterone is checked, what do my results and their timing really mean against the proper diagnostic bar?
• Given my ED, what’s my cardiovascular risk, and should we assess my heart?
• What are my ED treatment options, and which fits my health and the medicines I’m on?

These are questions, not conclusions. The aim is to decide with your GP.

What this is, and is not

This is general information to help you prepare for your GP — not a diagnosis, and not personal medical advice. It doesn’t tell you to start, stop or change any medicine; those decisions are made with your own doctor, who can weigh your actual results and history. For trustworthy Australian background, see Healthy Male and the Better Health Channel.

Related on this site: the erectile dysfunction explainer covers that symptom in more depth — including its value as an early warning of heart and vascular disease — and the prostate and lower urinary tract (BPH) explainer covers a common overlapping men’s-health concern.

If you want a thorough, unhurried work-up of your own men’s-health picture, you can work with Dr Lo.

Author: Dr Hoe Bing Lo — AHPRA MED0001212640 · FACRRM. Fun Doctors Pty Ltd · ABN 83 404 436 330.