Erectile dysfunction – causes, consequences, and solutions

Prevalence

• Affects over 150 million men worldwide (pre-2020 estimates; current number may be higher).

Frequency increases with age:

• 20–30 years old: 5–10%
• 40 years old: ~20%
• 50 years old: ~40%
• 60 years old: ~50%
• Over 70 years old: ~70%

Major risk factors: diabetes, hypertension, dyslipidemia, obesity, smoking, stress, depression, cardiovascular diseases.

The role of testosterone

Testosterone is not the only factor but plays a key role in:

• Libido (sexual desire)
• Vascular endothelium function (cells produce nitric oxide – NO, essential for erection)
• Receptor sensitivity in erectile tissue

Testosterone deficiency (hypogonadism) can lead to decreased sexual desire and reduced efficiency of the erectile mechanism. However, many men with normal testosterone can have ED due to vascular or psychogenic causes.

The role of nitric oxide (NO)

• NO is the main mediator of erection.
• It is produced by the endothelium and nerve endings in the cavernous bodies → relaxes smooth muscle → vasodilation → increased blood flow and maintenance of erection.
• Factors that reduce NO synthesis: diabetes, smoking, obesity, oxidative stress.

Problems caused by erectile dysfunction

1) Medical problems

• May be a sign of cardiovascular disease – sometimes appears 3–5 years before a heart attack or stroke.
• Frequently associated with diabetes, hypertension, hypothyroidism, metabolic syndrome.
• Often represents the tip of the iceberg of hidden problems.

2) Psychological problems

• Lowered self-esteem and performance anxiety (vicious circle).
• Depression and isolation if the problem persists.

3) Relational problems

• Couple tensions: lack of communication, reproaches, suspicions of infidelity.
• Emotional distancing.
• Many men do not seek medical help out of shame, and real problems remain untreated.

Conclusion

Erectile dysfunction is a multidimensional problem: it is not just “lack of erection,” but also a health warning sign, an emotional and relational stress factor, and a social challenge.

What can be done?

1. Medical check-up – to discover and treat the underlying cause.
2. Medications (e.g., sildenafil, tadalafil) – increase NO levels/action (no details here).
3. Eliminating risk factors:
   • Quitting smoking
   • Weight loss (intermittent fasting, low carbohydrate intake – see my books)
   • Physical exercise
   • Stress reduction
4. Natural treatments – that support testosterone and/or nitric oxide.
   • Shilajit – may support both testosterone secretion and NO synthesis, useful as an adjunct in ED.