Myth vs fact

Testosterone treatment usually suppresses sperm production, so it is not suitable for men trying to conceive. 'Automatically' and 'permanently' go too far, though.

Testosterone taken as a medicine signals the brain to reduce the hormones that drive the testicles. As a result, sperm production often falls sharply, sometimes to zero. This is why guidelines advise against testosterone treatment for men who want children in the near future.

The effect is not the same in every man, and in many men sperm production recovers after treatment stops, although this can take months and recovery is not certain for everyone. Men who may want children should discuss fertility-sparing alternatives with a specialist before starting.

Medical review: Prof. Dr. Bülent Alıcı, awaiting sign-off.

1. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432.

Read more: Does testosterone naturally decline after 40?

A penile implant restores rigidity so that intercourse is possible. It is not a lengthening operation.

An implant fills the erection chambers of the penis from the inside, so the erection it creates reflects the length of those chambers. It does not stretch them further. Some men feel the erect penis is shorter than it was in earlier years, often because erections had already weakened before surgery.

Surgeons discuss expectations about size carefully before an operation. Men with Peyronie's disease or significant shortening may have additional procedures considered alongside an implant, but outcomes vary and should be discussed individually.

Medical review: Prof. Dr. Ateş Kadıoğlu, awaiting sign-off.

1. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health.

Read more: Penile implants explained · How inflatable prostheses have changed

Anxiety and stress are common factors in younger men, but physical causes are found too, and ED at any age deserves a proper assessment.

Performance anxiety, stress and relationship factors are common contributors to erectile problems in younger men, and they are very treatable. But research from everyday clinical practice has shown that young men make up a substantial share of new ED patients, and that some have physical risk factors such as smoking, raised cholesterol, hormonal problems or the effects of medicines and recreational drugs.

Assuming the cause is 'all in the head' can mean something treatable is missed. A doctor can help work out what is going on, which often involves both body and mind.

Medical review: Prof. Dr. Ege Can Şerefoğlu, awaiting sign-off.

1. Capogrosso P, Colicchia M, Ventimiglia E, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man: worrying picture from the everyday clinical practice. J Sex Med. 2013;10(7):1833–1841.

Read more: Erectile dysfunction: causes and treatment · Why ED can be an early health warning

Men do not go through a sudden menopause, but average testosterone falls gradually with age, and other hormones change too.

Long-term studies that measured the same men over many years found a slow, gradual fall in average testosterone levels with age, together with a rise in the protein that binds testosterone in the blood. The change is usually gradual and varies greatly between men.

Only a minority of older men have both clearly low testosterone and typical symptoms. Weight, long-term illness, sleep and medicines all influence hormone levels, and some of these can be changed.

Medical review: Prof. Dr. Bülent Alıcı, awaiting sign-off.

1. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87(2):589–598.
2. Wu FCW, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–135.

Read more: Does testosterone naturally decline after 40?