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2) Corpus Cavernosum Integrity. The research points to the fact that low testosterone can actually affect the connective tissue within the corpus cavernosum. While you are losing smooth muscle, you are also likely gaining more connective tissue, i.e. collagen.  The ECM (extracellelular matrix) changes for the worse, another structure implicated in erectile dysfunction.  This is a sort of "hardening" similar to what causes problems throughout your body. You need for the corpus cavernosum to be flexible and expandable in order to properly compress the outflow.
The bottom line is that researchers have found that in a low testosterone environment, the inside of the penis literally atrophies and is replaced with inelastic, fibrous tissue.
For some of you that have discovered that you lived in a hypogonadal state for years without knowing it, this may be a scary prospect. "Did it do permanent damage?" is the natural question to ask yourself.
The answer is probably 'yes' to some degree. However, the good news is that studies show that if testosterone is restored, normal erectile function usually goes with it. This means that the damage could not have been too severe from a long term low testosterone environment and indicates that a significant reversal is possible.
By the way, some of you who may not respond well to PDE5 Inhibitors, such as Viagra or Cialis, may find that restoring your testosterone restores your erections for the above reasons. One study looked at hypogonadal males who did not respond to Viagra and found a significant restoration of erectile function after HRT (Testosterone Therarpy).  Very similar results were found in a study of Cialis non-responders as well.  In other words, sometimes the problem is nitric oxide and sometimes it is low testosterone (or both).
So the bottom line is that many of you need to either Increase Your Testosterone Naturally or discuss with your doctor Hormone Replacement Therapy if you want your erections back. And, yes, Sex is Good For You.
1) J Sex Med, 2005, 2:759–770, "The Physiological Role of Androgens in Penile Erection: Regulation of Corpus Cavernosum Structure and Function"
2) Endocrinology, Apr 1 1999, 140(4)1861-1868, "Effects of Castration and Androgen Replacement on Erectile Function in a Rabbit Model"
3) J Urol, 2004 Aug, 172(2):658-63, "Randomized study of testosterone gel as adjunctive therapy to sildena?l in hypogonadal men with erectile dysfunction who do not respond to sildena?l alone"
5) Andrologia, 2006, 38:61–68, "Testosterone and erectile function in hypogonadal men unresponsive to tadala?l: results from an open-label uncontrolled study"
6) Braz. J. Morphol. Sci., 2008, 25(1-4):35-10, "Stereological study of extracellular matrix of penile body in felis domestica: experimental model applied to erectile dysfunction"
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