Erectile dysfunction (ED) is the most common sex-related problem men report to their doctors. As many as 30 million men have ED, which is defined as trouble getting or maintaining an erection firm enough for sex.
It’s normal for all men to experience erection problems from time to time. ED, however, is progressive or happens frequently, mostly in middle aged and older men. The condition is linked to neurological, hormonal, and other causes, including:
- Heart/artery problems (heart disease, atherosclerosis, high blood pressure)
- Blood sugar issues (diabetes, metabolic syndrome)
- Neurological conditions (Parkinson’s disease, multiple sclerosis)
- Low levels of testosterone
- Use of certain medications, alcohol, and tobacco
ED can also result from injury to nerves or arteries that control erections, and certain medical treatments such as prostate surgery or radiation therapy. Even psychological concerns like anxiety, depression, or stress can affect erections.
Addressing underlying causes—and eliminating risk factors like tobacco, alcohol, and medications—can solve some cases of ED. If not, or if extra help is needed, erectile dysfunction drugs (Viagra, Cialis, Levitra, etc.) are available. These medications enhance the effects of nitric oxide—a compound naturally produced by the body that relaxes muscles, including those in the penis. When this happens, it allows blood flow to increase to the penis, which makes getting and maintaining erections a lot easier.
A Genetic Link
But what if there was more to ED than treating it after it’s already become a problem? What if you could prevent it from happening in the first place? New research indicates that for up to 1/3 of ED cases, prevention may be a viable option—because a genetic link has been discovered.
In a study published in the journal Proceedings of the National Academy of Sciences of the United States of America, researchers found that a variation near a specific gene called SIM1 was in fact associated with a 26% higher risk of ED.
The SIM1 gene is part of a signaling pathway that’s involved in sexual function, among other processes. Researchers believe that the variant linked to ED, located near the SIM1 gene, influences the expression of that gene.
A press release written about this study notes that the research “highlights the potential of SIM1 as a target for the development of new treatments for erectile dysfunction, which are needed because about half of all men who try currently available pharmaceutical treatments for erectile dysfunction don’t respond to them.”
This research is still in its infancy. In due time, we’ll hopefully have a solution that addresses this potential root cause of ED, in turn helping many millions of men. Until that time, though, what are the best, most reliable treatment options?
Well, you can certainly try the medications—but as the study authors noted, half the men who take them don’t respond. Plus, they’re very expensive (although generics are finally being released) and can come with side effects ranging from headaches and upset stomach, to fainting, vision and hearing loss.
If Viagra and the like don’t work for you, there are alternative treatments.
One is injecting similar drugs directly into the penis, which dilates local arteries to help promote erections. Yes, the thought of inserting a needle into the base of the penis is enough to make most men cringe, but it’s not nearly as painful as you’d think. For those who just can’t do it though, these drugs are also available as urethral suppositories, though they tend to be less effective.
Vacuum erection devices (“penis pumps”) are another option. You insert your penis in a cylinder, which sucks the air out of the tube and in turn draws blood into the penis. A constriction band around the base of the penis helps maintain the erection.
If testosterone levels are low, natural testosterone replacement therapy may also help. Erections depend on testosterone, and treating deficiencies can boost libido, mood, and confidence and renew interest in sex. This alone can enhance erections in some men. Testosterone replacement therapies require a prescription, so work with a doctor knowledgeable in hormone replacement therapy. Get your levels tested periodically, and adjust dosing as needed.
And finally, a few key supplements are worth a try. The following have been well studied in the treatment of ED and low testosterone:
- Ashwagandha is an adaptogenic herb that has been used traditionally to reduce the effects of stress and anxiety. Not only does it help relax the mind (which helps encourage stronger erections), it also has aphrodisiac properties. And studies show that it can boost testosterone levels by up to 127% in as little as 90 days. Aim for 675 mg daily.
- L-arginine is an amino acid that the body produces naturally. Sometimes called “the natural Viagra,” L-arginine works by increasing nitric oxide levels and as a result, relaxing blood vessels throughout the body, including the penis. L-arginine is found in red meat, poultry, fish, and dairy, but you can also take it in supplement form. You can also supplement with L-citrulline, another amino acid that the body converts to L-arginine. The recommended starting dosage of L-arginine is 2 grams daily. If you choose to take L-citrulline, start with 1.5 grams daily.
- Vitamin D is usually referred to as the sunshine vitamin because the body produces it with the help of ultraviolet radiation from the sun. However, most Americans are deficient in D. In men, low levels are linked to low testosterone and reduced sex drive. In a study that evaluated whether vitamin D supplementation influenced testosterone levels in 165 otherwise healthy men, researchers discovered that taking 3,332 IU daily for one year significantly increased levels of the vitamin and Dosing for D3 (the preferred form of vitamin D) varies depending on your blood levels, so work with your doctor to determine your current status and how much you should be taking. For severe deficiencies, you can safely take up to 10,000 IU daily, but for most people, 1,000–5,000 IU should suffice.
- DHEA (dehydroepiandrosterone) is a “precursor” hormone that contributes to the creation of other sex hormones, including testosterone. Levels of DHEA decline starting around age 30. Supplementing with DHEA can help boost testosterone. Try 25–50 mg daily, depending on your size, and aim for a lab test result of 250 mg in your system. Do not take DHEA if you have cardiovascular problems.
Intimacy is an important part of a healthy relationship. Of course, there are countless ways to express love and physical attraction, but most men would agree that sex is at the top of that list. Fortunately for those who suffer from ED, science is getting closer to discovering causes that lie deep within, which will hopefully lead to a permanent solution in the near future. For now, though, there are plenty of safe, natural, and effective supplements and treatments that can allow you to enjoy a healthy and satisfying sex life.
- Kaiser Permanente Press Release. 2018 Oct 8.
- Chen J, et al. Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized placebo-controlled study. BJU Int. 1999;83:269-73.
- Neuzillet Y, et al. A randomized, double-blind, crossover, placebo-controlled comparative clinical trial of arginine aspartate plus adenosine monophosphate for the intermittent treatment of male erectile dysfunction. 2013 Mar;1(2):223-8.
- Pilz S, et al. Effect of vitamin D supplementation on testosterone levels in men. Horm Metab Re.s 2011 Mar;43(3):223-5.