When erectile dysfunction or reduced libido shows up, the first instinct is usually hormones. And hormones may be part of it. But they're rarely the whole story.
ED and low libido can involve vascular function, nervous system regulation, pelvic floor health, sleep, stress, and habits. Sometimes several of these at once. Jumping straight to a testosterone test without considering the broader picture often means missing contributors that are more fixable than a hormone imbalance.
This isn't a treatment guide. It's an overview of the factors people explore and the blood work that gives you a starting point.
Bespoke Labs does not diagnose, treat, or provide medical advice. If you're experiencing erectile dysfunction or changes in libido, consult a healthcare provider.
The Factors Beyond Hormones
Before looking at blood work, it's worth understanding how many things can contribute to ED and reduced libido. Some are physical, some are behavioural, and some overlap.
Pornography and masturbation habits
Frequent pornography use can affect arousal patterns and sexual response. Pornography is performative. It doesn't reflect real-world sexual experiences, and relying on it can reshape expectations and arousal responses over time.
Masturbation technique also matters. Excessive grip pressure can reduce sensitivity and, over time, cause physical damage. If this is a factor, taking a break to allow healing is important. When resuming, using a toy designed to simulate normal sexual pressure can help you re-adapt to realistic levels of stimulation rather than reinforcing the same pattern.
Pelvic floor dysfunction
The pelvic floor muscles play a direct role in erectile function. Most people assume the problem is weakness, but a pelvic floor that's too tight (hypertonic) is just as problematic, and more common. Many men have both: tension they're not aware of combined with poor control. The result is a pelvic floor that can't contract or relax properly.
Vascular health
Erections are a vascular event. Reduced blood flow, whether from cardiovascular issues, high blood pressure, or metabolic dysfunction, can directly impair erectile function. In some cases, ED is the earliest sign of a cardiovascular problem.
Stress and anxiety
Chronic stress elevates cortisol, which suppresses testosterone production. Anxiety also activates the sympathetic nervous system, which works against the parasympathetic state required for arousal. This creates a feedback loop: stress causes the problem, and the problem causes more stress.
Sleep
Poor sleep doesn't just leave you tired. It directly suppresses testosterone production and raises cortisol. Most testosterone is produced during deep sleep. If you're not getting enough quality sleep, your hormones will reflect it, and so will your libido and erectile function.
Sleep, Sleep Phases, and Hormone Production
Sleep is one of the most underestimated factors in sexual health. Understanding why requires looking at what actually happens during sleep.
Sleep cycles through several phases, each lasting roughly 90 minutes. The two that matter most here are deep sleep (slow-wave sleep) and REM sleep:
- Deep sleep (slow-wave sleep) is when the largest pulses of growth hormone are released. It's also when the hypothalamic-pituitary-gonadal axis is most active, driving the testosterone production that peaks overnight. Deep sleep dominates the first half of the night. If you fall asleep late, wake frequently, or have disrupted early sleep, you lose the window where most of this production happens.
- REM sleep increases in the second half of the night and is associated with additional testosterone release. Nocturnal erections occur primarily during REM sleep and are considered a marker of healthy erectile function. Reduced REM sleep, often caused by alcohol, stress, or sleep deprivation, reduces both.
Chronic sleep restriction, even losing just one to two hours per night consistently, has been shown to significantly lower testosterone levels.
Temperature and sleep quality
Your body's ability to fall asleep depends on your core temperature dropping. A cooler bedroom supports this. Heavy blankets, warm rooms, or screens that keep you alert work against it. To wake up, your body temperature naturally rises, and morning light exposure helps trigger this increase.
If your sleep environment is too warm, you're more likely to have fragmented sleep, less time in deep sleep stages, and lower overnight hormone production.
Improving sleep quality is one of the most impactful things you can do for hormonal health. It's not just a lifestyle factor. It's a hormonal one.
Pelvic Floor: Kegels and Reverse Kegels
Most people have heard of kegels. Fewer have heard of reverse kegels. Both matter, and the balance between them matters more than most people realise.
Kegels strengthen the pelvic floor by contracting the muscles (the same muscles you'd use to stop urination midstream). Reverse kegels train the ability to consciously relax and lengthen those same muscles, the opposite movement.
A few important principles:
- Control matters more than intensity. The goal isn't to squeeze as hard as possible. It's to develop awareness and control: the ability to contract smoothly and release completely.
- Contract and relax slowly. Quick, forceful squeezes don't build the kind of control that translates to function. Slow, deliberate contractions with a full, slow release are more effective.
- Less is more. Overtraining the pelvic floor creates the same problem you're trying to fix. A hypertonic (too tight) pelvic floor with no control is the most common pattern in men with pelvic floor-related ED. If your pelvic floor is already tight, doing more kegels without reverse kegels will make it worse.
- Both directions matter. If you only train the contraction (kegels) without training the release (reverse kegels), you end up with a pelvic floor that's strong but can't relax. You need both.
If pelvic floor dysfunction is a factor, a pelvic floor physiotherapist can assess whether you're dealing with weakness, tension, or both.
Posture and How You Sit
If you sit for long hours, at a desk, driving, or otherwise, how you sit affects your pelvic floor, circulation, and nerve function in the pelvic region.
Two seating options worth considering:
- A split saddle stool with forward tilt. These stools open the hip angle and reduce pressure on the perineum (the area between the sit bones). A forward tilt encourages a neutral spine position and takes compression off the pelvic floor. Standard flat chairs place sustained pressure directly on the perineum.
- A chair with a waterfall edge and seat tilt. If a saddle stool isn't practical for all tasks, a chair with a waterfall (downward-curved) front edge reduces pressure on the backs of the thighs and improves circulation to the lower body. A slight forward seat tilt has a similar effect to the saddle stool: it opens the hip angle and reduces pelvic compression.
Rotating between the two throughout the day may be optimal. The saddle stool for focused desk work, the chair for longer periods or meetings. The goal is to avoid sustained compression in a single position for hours at a time.
These aren't treatments. They're ways to reduce mechanical stress on the pelvic region during the hours you spend sitting.
Hormones Worth Testing
If you want to start with data, these are the hormonal markers that are most relevant to erectile function and libido:
- Total and free testosterone: the primary driver of male libido and a contributor to erectile function
- LH and FSH: tell you whether the brain is signalling properly (see our guide on panels vs. individual tests for why these matter alongside testosterone)
- SHBG (sex hormone-binding globulin): binds testosterone and affects how much is available for your body to use
- Estradiol: yes, men produce estrogen. Elevated estradiol relative to testosterone can affect libido and function
- Prolactin: elevated prolactin can suppress libido and testosterone production
- TSH and free T4: thyroid dysfunction (both overactive and underactive) can affect libido and energy
- Cortisol: chronically elevated cortisol from stress and poor sleep suppresses testosterone
Testing these markers doesn't give you a diagnosis. It gives you data, a starting point for a conversation with your healthcare provider or practitioner.
Start with the Data
Erectile dysfunction and low libido involve more than hormones. But hormones are the part you can measure. If you want to see where your numbers stand, you can order the relevant tests directly.
Bespoke Labs provides access to lab testing and results delivery. We do not diagnose, treat, interpret results, or provide medical advice. Discuss your results with a qualified healthcare provider.