Premature Ejaculation And Low Testosterone: Is There A Link?

If you regularly climax earlier than intended during sex, you may be suffering from premature ejaculation — a condition that affects an estimated 1 in 5 men. [1] But what’s the cause? Can testosterone play a role? Let’s explore the possible triggers and find out the best solutions available for your sexual health.

First off, what is premature ejaculation (PE)?

As we’ve explained, it’s a common condition you’re likely to have heard of before. Typically, it’s defined as ejaculation that occurs within one minute of penetration. [2] However, it’s up to you and your sexual partner to decide how long sex should last, and what feels right for you.

What causes premature ejaculation?

There are a number of potential causes of premature ejaculation, from psychological factors like stress, performance anxiety and depression, to physical factors like sensitivity in the penis, changes to serotonin levels, and other health issues.

Treatments for premature ejaculation

Thankfully, there are also many effective treatment options available for premature ejaculation, including both behavioral techniques and medical interventions. Here are some common approaches:

Oral Treatments

Sertraline

Some SSRIs — like sertraline — are prescribed off-label to treat premature ejaculation. [3] Although it’s not designed for PE, sertraline could help you last up to seven times longer during sexual activity. [4] To learn more, start a quick online consultation here.

Sildenafil (generic Viagra)

Sildenafil is generally used for erectile dysfunction but has been found to sometimes help with premature ejaculation. [5] By improving blood flow, it could indirectly help with confidence and ejaculatory control. [6]

Numbing creams and sprays

Numbing creams give a mild numbing effect that can reduce sensitivity in the penis, which might help delay climax. [7] Ask your doctor to recommend a suitable cream with anesthetics like lidocaine or prilocaine. Similar to creams, ‘delay sprays’ can also create a mild numbing effect and may be more convenient for some users. [8]

Behavioral Therapy

Cognitive Behavioral Therapy (CBT)

If premature ejaculation may be triggered by stress, anxiety, or other mental health issues, CBT can help. [9] Contact a healthcare provider to find local options.

Psychosexual Therapy

For some people, premature ejaculation might be connected to relationship issues or past sexual experiences. [10] Therapy can help address these factors.

Manual Techniques

Pelvic Floor Exercises

Also called Kegel exercises, these strengthen muscles that help control urination and ejaculation. [11] To try, tense your pelvic muscles for 3-5 seconds and then rest. Repeat up to 10 times every few days. [12]

Squeeze Technique

This involves squeezing the head of the penis for 10-20 seconds when you feel close to climax, which can help delay ejaculation. Repeat as needed during sex. [13]

Stop-Start Technique

This technique involves stopping movement just before climax, then starting again once the feeling passes. Although long-term results are mixed, some studies show short-term success. [14]

Other Options

Healthy Diet and Weight

A balanced diet and healthy weight support blood circulation, hormone regulation, and energy levels, which help with sexual performance. 

Masturbation Before Sex

Masturbating before sex can help delay ejaculation by taking advantage of the ‘refractory period’, where arousal levels naturally drop. [15] The refractory period varies by age, hormones, and health, so experiment with timing to see what works best.

Changing Positions

Switching positions during sex, or using positions that provide less stimulation, may help delay ejaculation by lowering arousal and engaging different muscles. [16]

Can low testosterone lead to premature ejaculation?

It’s uncertain whether low testosterone is a direct cause of premature ejaculation, as studies have shown both high and low levels to be associated with this. However, low testosterone can play a crucial role in general sexual health, in ways that might contribute to the problem.

The role of testosterone in sexual function

Low sex drive

If you have low testosterone, you may feel less interested in sex (low libido). [17] This lack of desire can lead to performance anxiety, which some studies indicate can lead to premature ejaculation. [18]

Erectile dysfunction (ED)

Low testosterone can make it harder to get or keep an erection. [19] Some men with both low testosterone and erectile dysfunction may struggle with ejaculation control, though this is not the same as having premature ejaculation caused by low testosterone.

As well as the sexual health issues, you may notice these symptoms if you have low testosterone:

• Tiredness
• Feeling depressed, anxious, or irritable
• Needing to shave body hair less often
• Reduced fitness levels, such as lower strength or tolerance for exercise
• Night sweats or excessive sweating and night sweats
• Memory issues and difficulty concentrating [20]

Improve your sexual health

If you’re dealing with premature ejaculation or other issues like erectile dysfunction, remember it’s up to you and your partner to decide what feels right for your sex lives. To learn more about effective treatments for your sexual health concerns, consider an online consultation with a healthcare professional at ZipHealth.

References

1. Veettil Raveendran A, Agarwal A. Premature ejaculation - current concepts in the management: A narrative review. International Journal of Reproductive BioMedicine (IJRM). 2021 Jan 25;19(1).
2. Crowdis M, Nazir S. Premature Ejaculation [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546701/
3. Primary Care guidance for prescribing SSRIs for premature ejaculation Background [Internet]. [cited 2024 Sep 30]. Available from: https://medicinesmanagement.doncasterccg.nhs.uk/wp-content/uploads/2022/09/Primary-Care-guidance-for-premature-ejaculationV1.0-Sept-2022-review-Sept-2025.pdf
4. McMahon CG. Treatment of premature ejaculation with sertraline hydrochloride. International journal of impotence research [Internet]. 1998;10(3):181–4; discussion 185. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9788108
5. NHS Choices. Ejaculation problems [Internet]. 2024. Available from: https://www.nhs.uk/conditions/ejaculation-problems/#:~:text=In%20the%20squeeze%20technique%2C%20you
6. McMahon CG, Stuckey BGA, Andersen M, Purvis K, Koppiker N, Haughie S, et al. Efficacy of Sildenafil Citrate (Viagra) in Men with Premature Ejaculation. The Journal of Sexual Medicine. 2005 May;2(3):368–75.
7. Ali D, Shah S, Nadeem Bin Nusrat, Zafar N, Assad Ur Rehman. Topical Anesthetics and Premature Ejaculation: A Systematic Review and Meta-Analysis. Cureus. 2023 Aug 3;
8. New Medicine Review Fortacin ® (Lidocaine / Prilocaine) Spray Treatment of primary premature ejaculation in adult men [Internet]. 2019 [cited 2024 Sep 26]. Available from: https://www.lancsmmg.nhs.uk/media/1087/fortacin-lidocaine-prilocaine-new-medicine-review.pdf
9. Mohammadi SD, Mohammadkhani P, Dolatshahi B, Dadkhah A. Effectiveness of cognitive behavioral therapy on the signs, symptoms and clinical consequences of premature ejaculation. Japanese Psychological Research. 2013 Jun 5;55(4):350–7.
10. Crowdis M, Nazir S. Premature Ejaculation [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546701/
11. Pastore AL, Palleschi G, Fuschi A, Maggioni C, Rago R, Zucchi A, et al. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. Therapeutic Advances in Urology [Internet]. 2014 Feb 20;6(3):83–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003840/
12. Male Pelvic Floor Exercises [Internet]. University Hospitals Sussex NHS Foundation Trust. 2022. Available from: https://www.uhsussex.nhs.uk/resources/male-pelvic-floor-exercises/
13. NHS Choices. Ejaculation problems [Internet]. 2024 [cited 2024 Sep 17]. Available from: https://www.nhs.uk/conditions/ejaculation-problems/#:~:text=In%20the%20squeeze%20technique%2C%20you
14. Mohee A, Eardley I. Medical therapy for premature ejaculation. Therapeutic Advances in Urology [Internet]. 2011 Oct 1;3(5):211–22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199591/
15. Levin RJ. Revisiting Post-Ejaculation Refractory Time—What We Know and What We Do Not Know in Males and in Females. The Journal of Sexual Medicine. 2009 Sep;6(9):2376–89.
16. Crowdis M, Nazir S. Premature Ejaculation [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546701/
17. Schubert M, Jockenhövel F. Late-onset hypogonadism in the aging male (LOH): definition, diagnostic and clinical aspects. Journal of Endocrinological Investigation [Internet]. 2005;28(3 Suppl):23–7. Available from: https://pubmed.ncbi.nlm.nih.gov/16042356/
18. McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJG. The pathophysiology of acquired premature ejaculation. Translational Andrology and Urology. 2016 Aug;5(4):434–49.
19. Mikhail N. Does testosterone have a role in erectile function? The American Journal of Medicine [Internet]. 2006 May 1 [cited 2021 Apr 7];119(5):373–82. Available from: https://pubmed.ncbi.nlm.nih.gov/16651047/#:~:text=Results%3A%20Animal%20and%20preliminary%20human