Drug therapy: Drugs like sildenafil (Viagra) and tadalafil (Cialis) address the symptom. They relax the smooth muscles of the blood vessels and make erection possible. There are a few problems with this approach.

  • Possible side effects include headache, flushing, upset stomach, abnormal vision, such as changes in color vision (like having a blue color tinge) and blurred vision, stuffy or runny nose, back pain, muscle pain, nausea, dizziness, or rash. Priapism, which is an erection that does not go away, is possible. It is a serious condition that can damage the penis.
  • Many patients with erectile dysfunction (ED) also have cardiovascular problems since both are caused by circulation issues. Many of these patients take nitrates, but the combination of the two drugs can cause a dangerous (even fatal) drop in blood pressure.
  • These drugs merely treat a symptom (albeit an inconvenient symptom), and do not address the long-term health of the patient. Taking steps to improve circulation and any hormonal deficits can produce benefits that go beyond symptom control.

Addressing the Core Issues

Symptoms are the body’s way of telling us something is wrong. Erectile dysfunction is often a sign that there is a problem with circulation. It may be a sign of atherosclerosis. Drugs can alleviate the symptom but do nothing for the cardiovascular issues that ED may be warning us about.  

Inflammation: Inflammation is a key component of atherosclerosis, which may be the real health issue. Studies (Biomolecules. 2018 Aug 23;8(3):80; Annu Rev Pathol. 2006;1:297-329; J Diabetes Complications. 2017 Aug;31(8):1286-1292; Eur J Nucl Med Mol Imaging. 2017 Jan;44(1):141-150) show that inflammation is a key component to atherosclerosis. Since atherosclerosis is a likely cause of ED, reducing inflammation is a good strategy.

Circulation: There are herbs and nutrients that research has shown to improve circulation. These include Green Tea (leaf)1,2,3,4,5, Acetyl L-Carnitine6,7,8,9, Olive (Leaf)10, R-Alpha Lipoic Acid11,12,13,14,15, Trans-Resveratrol16,17,18,19, Coenzyme Q1020,21,22,23, and Astaxanthin24,25,26. Some supplement companies have combined ingredients like these to produce a product that will generally improve circulation. Other substances have also been studied and found to improve circulation. Vitamin A protects against the oxidation of LDL and slows the progression of atherosclerosis. Menauinone-7 (vitamin K2) helps prevent calcification of arteries and reduces their stiffness. Benfotiamine helps prevent damage to the arterial endothelium, especially in diabetics. Vitamin D deficiency can adversely affect the elasticity of arterial walls. Niacin reduces inflammation of the arterial lining, reduces LDL, and relaxes arterial walls. Magnesium lowers cardiovascular risk, reduces endothelial dysfunction, reduces arterial stiffening and reduces cardiovascular risk. Here is a link to a sample product sheet for a circulation supplement. It has scientific references supporting what was just mentioned.

Relax the walls of the blood vessels.  Nitric Oxide, which is produced by the lining of the blood vessels, causes them to relax, improving blood flow. The amino acids arginine and citrulline can help the blood vessel lining to produce nitric oxide. Enhancing the circulation in this way has many clinical benefits, including lowering blood pressure, enhancing exercise performance, relieving intermittent claudication, and even helping with erectile dysfunction.

Hormonal support: As we age, the production of steroid hormones (like testosterone) decreases. Testosterone levels do drop as men age. They decline around the age of 30, and by age 80 may be down to just 20% of the levels found in men in their 20s. Problems go beyond the obvious, like loss of libido, inability to perform sexually, and low sperm counts. Men with low testosterone tend to have less stamina, reduced muscle mass, depression/anxiety, and cognitive problems. 

Low testosterone can cause serious health problems. It is linked to obesity (and increased abdominal fat), Alzheimer’s disease, diabetes (33% of type 2 diabetics have low testosterone—[J Clin Endocrinol Metab 2004 Nov;89(11):5462‐8.)], and heart disease [(J Sex Med 2018 Sep;15(9):1260‐1271; Circulation 2007 Nov 20;116(21):2427‐34)]. The thing you really notice in men with low testosterone levels is a lack of initiative—they fit the stay‐at‐home, couch‐potato stereotype. They may say things like, “I used to like to work on the car (go on a hike, go dancing, work around the yard, etc.), but I really don’t feel like doing that anymore.” Click here to read more about low testosterone.

The medical approach, giving testosterone, can be dangerous. Testosterone replacement therapy may make sleep apnea worse. It may increase the number of red blood cells, which can increase the risk of clotting. Men using long-term forms of testosterone therapy appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. There is also concern that testosterone treatment can stimulate the growth of prostate cancer cells.

Rather than looking at erectile dysfunction as a symptom to be eliminated, think of it as your body telling you something. Addressing the underlying health issues will be much more beneficial than manipulating the symptom with drugs.

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  2. Ann Epidemiol. 2000 Aug;10(6):401-8 Relation between green tea consumption and the severity of coronary atherosclerosis among Japanese men and women Green tea protects against atherosclerosis
  3. Arterioscler Thromb Vasc Biol. 2010 Oct;30(10):2059-66 Coffee, decaffeinated coffee, caffeine, and tea consumption in young adulthood and atherosclerosis later in life: the CARDIA study Tea related to reduced coronary artery plaque
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  6. Biol Trace Elem Res. 2018 Aug;184(2):422-435. Acetyl-L-Carnitine Attenuates Arsenic-Induced Oxidative Stress and Hippocampal Mitochondrial Dysfunction
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