It is one of those topics men rarely talk about, yet almost every one of them faces it at some point in life. The gradual decline of testosterone and the appearance of erectile dysfunction are not only medical issues; they affect self-confidence, the sense of “manliness,” and emotional well-being.
Afrim Saliu, a specialist in urological surgery, explains that men begin experiencing lower testosterone levels at an age as early as 30.
Testosterone in men starts to gradually decrease around age 30, and each year it drops by about 1%. This is called andropause. However, the changes begin manifesting over the age of 40–55.
But age is not the only factor that contributes to decreased testosterone. Saliu lists several causes and symptoms men face.
The most common causes of declining testosterone in men over fifty are: excess body weight (obesity), lack of physical activity, alcohol, tobacco, stress, and poor sleep. The first symptoms include: reduced sexual desire (libido); weaker or less frequent erections; decreased energy and muscle strength; fatigue; increased body fat, especially around the abdomen.
If most men experience declining testosterone levels, does that mean testosterone is the main factor behind erectile dysfunction, or sexual impotence? The urologist answers that testosterone does not actually play the key role in erectile dysfunction.
The lack of testosterone is responsible for only about 5–10% of erectile dysfunction cases, psychological factors account for 10–20%, while vascular factors are the main cause, contributing to roughly 80%.
According to Afrim Saliu, when men begin to face sexual impotence, they should seek help from adequate professionals.
The safest treatments are consultations with a urologist or andrologist, where, based on laboratory parameters, appropriate testosterone dosage is determined. Using testosterone supplements without consulting a urologist is not a wise step.
Erectile Dysfunction vs. “manliness”
Although at first glance erectile dysfunction may seem like just a medical condition, do social norms and gender roles influence how men cope with this situation?
Psychologist Abdulla Thaçi highlights the close connection between sexual impotence and the characteristics that patriarchal societies expect men to embody.
Many men associate sexual power with feelings of success, dominance, and control. When these aspects are threatened, they often experience anxiety, shame, a sense of failure, and reduced self-esteem. In some cases, this leads to emotional isolation, avoidance of intimate relationships, or communication problems with a partner. For some, the loss of sexual function can be perceived as a “loss of manhood” and trigger an identity crisis, affecting their entire self-perception. Socially, the pressure society places on men to be “strong,” “active,” and “sexually capable” makes this experience even more difficult.
When men face sexual impotence, due to their changed self-perception and what they feel they “should be,” the addition of this stress pushes them into a vicious cycle, says Thaçi.
When the body faces chronic stress, it begins producing high levels of the hormone cortisol, which suppresses testosterone production—the hormone that regulates sexual desire, energy, and erectile function. At the same time, stress negatively affects blood circulation, making it harder to achieve and maintain an erection. This directly impacts sexual confidence, creating a vicious cycle: fear of failure increases anxiety, anxiety worsens performance, and poor performance increases stress even further.
The societal image of masculinity has a profound impact on how men perceive themselves, their bodies, and their personal value, Thaçi explains. According to him, gender roles become deeply rooted in childhood and remain present throughout a man’s life.
From childhood, many men are socialized into a culture where masculinity is associated with physical strength, emotional control, sexual performance, economic success, and the ability to be a protector. These standards create an ideal model of a “whole” man, which is often unattainable and unrealistic. When a man confronts the natural changes that come with age, such as reduced physical strength, loss of muscle mass, wrinkles, hair loss, increased fatigue, or decreased sexual desire, these biological signs are often not experienced simply as aging, but as threats to the masculine identity.
At this stage, men who have not built their self-esteem based on inner qualities, such as wisdom, experience, sensitivity, and emotional connection, often experience anxiety, irritability, and a sense of loss. A healthier approach to masculinity means replacing the traditional concept of the “strong man” with the conceptof the “self-aware man”; a man who recognizes his emotions, accepts his physical limitations, and seeks help when he needs it. This psychological transformation is essential to avoid a midlife crisis and to maintain mental and emotional health during late adulthood.
There is light at the end of the tunnel! But Abdulla Thaçi says that a multidimensional approach and embracing reality are necessary.
Accepting bodily changes is an essential step. Men who accept these changes with understanding, rather than resistance or shame, are more likely to maintain emotional balance and avoid the feeling of losing control. It is also important to recreate a personal identity beyond physical or sexual performance. Effective treatment requires a combined approach that includes: medical diagnosis of hormone levels; psychological counseling to address insecurities and build self-esteem; and lifestyle changes (healthy diet, quality sleep, physical activity, stress reduction). When these areas are treated in a coordinated way, men often experience mood improvement, increased energy, renewed motivation, and emotional stability.
Erectile dysfunction, prostate cancer, testicular cancer, and mental health issues are some of the problems men face every day. Seeking help is the least that any man can do for his health and wellbeing, as well as for the wellbeing of those close to him.
