Erectile Dysfunction: Causes that affect treatment!
Erectile dysfunction is much more common than you would imagine and there are multiple and compounding causal factors. Over the age of 40 it is insanely common to see erectile dysfunction, and different health ailments increase that risk drastically. Age is a factor we cannot control, but other factors like depression, hypertension, low testosterone or hypogonadism, hyperlipidemia, and diabetes all lead to increased likelihood of a man experiencing erectile dysfunction.
Our body as a machine has complex multi step pathways at a biochemical level as to how each and every little thing works. In terms of erectile dysfunction, there are many steps of which we don't need to focus on for this specific topic. But, it's important to understand that HOW an erection is formed at a biological level is and can be WHY certain other problems or health situations/disease processes - cause or lead to the development or worsening of erectile dysfunction (ED). Understanding the possible root causes or factors affecting erectile dysfunction makes this topic all more complex because there is not always one simple answer to treatment.
If our goal is to improve or eliminate erectile dysfunction, we want to help. if we just throw pills out it without asking any other investigative questions, there is a large chance that it won't help and you will be left feeling frustrated and defeated. So, in order to facilitate the highest chances of improvement and success, we have to explore all root causes that commonly lead to or play a role in erectile dysfunction. What is even more amazing is that identifying that we have an issue with erectile dysfunction and going down the pathway of trying to find the root cause that could possibly be leading to that erectile dysfunction, not only can help resolve it faster and more effectively, but for some people we can prevent erectile dysfunction from developing or worsening by being aware of and addressing the common root causes.
Very important to note here that erectile dysfunction can actually be an early sign or red flag that a man may end up with cardiovascular disease or cardiovascular events including myocardial infarction or heart attack, and or stroke in the future.
Remembering that the pathway that allows blood flow into the penis to create an erection is so incredibly teeny tiny gives us a clue as to why that micro blood flow being blocked or decreased at that level is an early early sign of possibly developing cardiovascular disease somewhere down the line. As everybody says knowledge is power and the big goal here is to improve function and quality of life, but also being proactive about preventing even worse health problems from occurring for us down the line should also be at the top of our list of goals. Erectile dysfunction can be a downstream problem caused by many upstream dysfunctions, and if we don't move up the stream and think about the problems that can lead to erectile dysfunction we will have a difficult time preventing long term problems and effectively improving erectile dysfunction.
Hypogonadism:
Hypogonadism by definition is: “Hypogonadism is a condition characterized by low levels of sex hormones, primarily testosterone in men and estrogen in women. It occurs when the gonads (testes or ovaries) do not produce enough hormones or when the pituitary gland or hypothalamus does not properly signal the gonads to produce these hormones.”
Most of us have heard of low T or low testosterone, for men greater than or equal to the age of 40 hypogonadism is most common. Hypogonadism being the lack of testosterone is becoming more and more common not only due to aging naturally decreased production of testosterone, but also due to the westernized/industrialized lifestyle in general. A Western lifestyle often includes factors that can contribute to low testosterone. These include a diet high in processed foods, sugar, and unhealthy fats, a lack of exercise, chronic stress, poor sleep, excessive alcohol consumption, and exposure to environmental toxins. These factors can disrupt hormone balance and contribute to other health issues that may lower testosterone levels. Adopting a healthy lifestyle with a balanced diet, regular exercise, stress management, and adequate sleep can help support healthy testosterone levels.
We can improve and treat hypogonadism by checking labs, providing testosterone supplementation via injections, creams or other methods, in implementing lifestyle measures to improve testosterone production and absorption. However, testosterone improvement alone is generally an important part of the puzzle in the erectile dysfunction causality, but not the only issue at hand.
Traditional first line treatments for erectile dysfunction, you know — the little blue pill — used in combination with testosterone replacement therapy (TRT) increases the chances of erectile dysfunction improvement drastically. But these are not the only problems and root causes that lead to erectile dysfunction presenting itself or worsening.
Depression:
Many if not all I've also experienced some level of depression at some point in our lives. Erectile dysfunction can lead to depression, and depression can lead to erectile dysfunction. This really creates a chicken or egg situation. To further exacerbate the problem, many antidepressant medications commonly thrown around like candy in mainstream medicine, also have a side effect of causing erectile dysfunction or worsening erectile dysfunction. I say this lightly as to not downplay the importance of oral antidepressant medications. There is a time and a place and many of us, myself included, function a lot better in life at certain times with some antidepressant pharmaceutical medication support.
With that said, it has been proven in research time and time again that the most powerful treatments for depression and managing depression are lifestyle measures including nutrition and physical activity as well as exposure to nature, social support, preventing and addressing loneliness, dealing with past traumas and so much more. So, I know that you came here for an erectile dysfunction conversation, but it's important to paint the picture that there is usually not just one cause and when we go into the topic of depression it can be so complex and personal there is not one quick fix for anyone.
If depression is causing erectile dysfunction, an antidepressant medication is a good choice to help as part of the puzzle of treatment. However, knowing that erectile dysfunction is present is very important because it makes a difference in which antidepressant medication we may choose period
If the erectile dysfunction (ED) itself is causing the depression the depression is not usually caused by 1 singular thing, we can understand that treating the depression may improve the erectile dysfunction.
Hypertension:
Erectile dysfunction is a hot and important topic surrounding any discussion about hypertension management, prevention or treatment. 30 to 50% of males with hypertension are affected by erectile dysfunction or sexual dysfunction of some flavor. At a pathophysiological level, the way things work biologically, there are so many different pathways and little pieces to the puzzle of causing erectile dysfunction. But right off the top it's important to note that hypertension itself can lead to decreased blood flow to the penis which can lead to erectile dysfunction. And also, medications used to treat hypertension can themselves cause erectile dysfunction.
As always we must focus on the root cause of any problem, and if you have hypertension we can't ignore it and we need to treat it, but knowing that you have erectile dysfunction or that you develop erectile dysfunction at some point in time throughout the treatment of hypertension is imperative to improving treatment outcomes and quality of life.
Hyperlipidemia:
Erectile dysfunction can most certainly be a mechanical issue if you think about the anatomy of the penis and how blood flows into it in order to create an erection, it is important to understand and visualize the fact that we are talking about a one to two milliliter width of Hwy. for blood to flow into the penis to create this erection. Hyperlipidemia that can be familial or genetic though less likely can also be and most commonly is caused by nutrition and lifestyle factors.
Hyperlipidemia among other factors can lead to the formation of plaque inside of your blood vessels. Also the inner lining of your blood vesslels, known as the endothelium or endothelial lining, can I have damage or dysfunction, Endothelial dysfunction, a condition where the lining of blood vessels doesn't function optimally, can stem from various factors. These include unhealthy lifestyle choices like smoking, lack of exercise, and a diet high in processed foods, which can lead to high blood pressure, high cholesterol, and diabetes, all of which damage the endothelium. Additionally, medical conditions like hypertension, obesity, and diabetes directly contribute to endothelial dysfunction. Furthermore, chronic stress, aging, and genetic predispositions can also play a role. Addressing these factors through lifestyle modifications and appropriate medical management is crucial for preventing and treating endothelial dysfunction.
on the topic of erectile dysfunction hyperlipidemia can be a factOn the topic of erectile dysfunction hyperlipidemia can be a factor that leads to cardiovascular disease for one and ultimately the decreased blood flow to the penis which causes erectile dysfunction.
Diabetes and Metabolic Syndrome:
Truly, each topic discussed in this article potentially interact with one another in a negative synergistic way. Diabetes or metabolic syndrome could have been the first topic we discussed because it really is the big grand pappy of much madness that happens within our body. Diabetes significantly impacts the health of our blood vessels and metabolism, leading to complications like endothelial dysfunction, hypertension, and erectile dysfunction. High blood sugar levels in diabetes damage the delicate endothelial lining of blood vessels, reducing their ability to dilate and leading to decreased blood flow. This impaired blood flow contributes to hypertension (high blood pressure) and erectile dysfunction, as the penis requires adequate blood flow for erections.
Metabolic syndrome, a cluster of conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, is closely linked to diabetes and erectile dysfunction. The shared underlying factor is often insulin resistance, where the body doesn't respond properly to insulin, leading to elevated blood sugar and a cascade of negative effects on blood vessels and overall health. This contributes to both diabetes and erectile dysfunction, as well as other complications like heart disease and stroke.
Obviously, each of these topics individually could be long learning lessons in and of themselves. But, we are talking about erectile dysfunction here today. All issues that we previously discussed including hypogonadism, depression, hypertension and hyperlipidemia are all potentially caused by or worsened by diabetes and metabolic dysfunction.
Metabolic dysfunction and diabetes can develop or worsen due to a combination of factors. An unhealthy lifestyle with poor diet and lack of exercise contributes significantly, along with genetic predisposition, aging, and hormonal imbalances. Chronic stress, sleep disorders, and certain medications can also play a role. Addressing these factors through lifestyle changes and medical management is crucial for preventing and managing metabolic dysfunction and diabetes.
Summary:
Hormonal imbalances are a significant contributor to erectile dysfunction (ED), a condition affecting a man's ability to achieve or maintain an erection. The endocrine system, responsible for hormone production, plays a key role in sexual function. Low testosterone, often associated with decreased libido and ED, can stem from various factors, including age, lifestyle, and other endocrine disorders. High prolactin levels can also suppress hormone production, leading to low testosterone and ED. Additionally, conditions like diabetes, thyroid dysfunction, and adrenal diseases can contribute to ED. Treatment options for hormonally-related ED include lifestyle changes (weight loss, reduced alcohol consumption, smoking cessation, increased exercise), medications, and psychotherapy to address underlying psychological factors. It's important to note that ED can also be caused by neurological, vascular, and chronic diseases, as well as mental health conditions like depression and anxiety.
CONCLUSION
With all of that said, we will certainly are not done exploring the topic of erectile dysfunction, but I hope that you have a better grasp on why erectile dysfunction treatment and management is not direct, simple, and to the point. First line treatment is erectile dysfunction medications of course, but if we are not addressing the multitude of root causes we are more likely to not have success in treatment and to see worsening long term outcomes with erectile dysfunction itself and the other things mentioned above that all lead to cardiovascular disease and earlier death.
If you or a loved one is interested in learning more about treatment of erectile dysfunction or treatment of anything discussed in this article, please book an appointment to come see us for a men's health evaluation or a deep dive integrative health evaluation. We do labs, we interpret labs, we come up with plans of action and we provide treatments. We would love to be a partner in care helping you become proactive about your whole personal Wellness.
As always, I love you already, and have a good day !!!
Jessica Veloza, APRN, FNP-C
CEO, Owner and Medical Director
Proactive Wellness, LLC
850-613-9534
Tallahassee, FL
Telehealth - all throughout Florida.
Resources
Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., ... & Endocrine Society. (2010). Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 95(6), 2536–2559. (This clinical guideline provides recommendations for testosterone therapy in men with hypogonadism.)
Corona, G., Rastrelli, G., Mannucci, E., & Maggi, M. (2014). Hypogonadism and erectile dysfunction: a systematic review of clinical studies. International journal of endocrinology, 2014. (This article provides a comprehensive overview of the link between hypogonadism and ED.)
Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. The Journal of urology, 151(1), 54-61. (This research delves into the medical and psychosocial factors associated with ED.)
Hormone Health Network: This website provides comprehensive information on various hormones, including testosterone, and their role in men's health.
Jackson, G., Rosen, R. C., Kloner, R. A., & Kostis, J. B. (2006). The impact of erectile dysfunction on quality of life: the Massachusetts Male Aging Study. The journal of sexual medicine, 3(1), 7-17. (This study explores the significant impact of ED on various aspects of quality of life.)
Kupelian, V., Page, S. T., Araujo, A. B., Travison, T. G., Bremner, W. J., & McKinlay, J. B. (2006). Low sex hormone–binding globulin, total testosterone, and symptomatic androgen deficiency are independently associated with erectile dysfunction in men aged 40–69 years. The Journal of Clinical Endocrinology & Metabolism, 91(7), 2483-2490. (This study examines the relationship between low testosterone, SHBG, and ED.)
Mayo Clinic: The Mayo Clinic website offers reliable information on erectile dysfunction, including causes, symptoms, and treatment options. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776
Urology Care Foundation: This foundation provides patient education resources on various urological conditions, including ED. https://www.urologyhealth.org/
