Erectile dysfunction - causes, consequences and solutions

Prevalent

• It affects more than 150 million men globally (pre-2020 estimates; the actual number may be higher).

Frequency increases with age:

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

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

The role of testosterone

Testosterone is not the only factor, but it has a key role in:

• Libido (sexual desire)
• Function of the vascular endothelium (cells produce nitric oxide - NO, essential in 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 may have ED due to vascular or psychogenic causes.

Role of nitric oxide (NO)

• NO is the main mediator of erection.
• It is produced by the endothelium and nerve endings in the corpora cavernosa → relaxes smooth muscle → vasodilatation → vasodilatation → increases blood flow and maintains erection.
• Factors that reduce NO synthesis: diabetes, smoking, obesity, oxidative stress.

The problems of erectile dysfunction

1) Medical problems

• It can be a sign of cardiovascular disease - sometimes occurring 3-5 years before a heart attack or stroke.
• Frequently associated with diabetes, hypertension, hypothyroidism, metabolic syndrome.
• They often represent the tip of the iceberg of hidden problems.

2) Psychological problems

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

3) Relationship problems

• Tensions in the couple: lack of communication, reproaches, suspicions of infidelity.
• Emotional detachment.
• Many men don't seek medical help out of shame, and real problems go untreated.

Conclusion

Erectile dysfunction is a multidimensional problem: it's not just a "lack of erection", it's a health warning signal, an emotional and relational stressor and a social challenge.

What can be done?

1. Medical check-up - to find and treat the underlying cause.
2. Medications (e.g.: sildenafil, tadalafil) - increase NO level/action (no details here).
3. Elimination of risk factors:
   • Quitting smoking
   • Weight loss (intermittent fasting, reduced carbohydrate intake - see my books)
   • Exercise
   • Reducing stress
4. Natural treatments - that support testosterone and/or nitric oxide.
   • Shilajit - can support both testosterone secretion and NO synthesis, useful as an adjuvant in ED.