How common is ED?
In a large national US health survey, about 18% of men aged 20 and older reported erectile dysfunction. Among men with diabetes, the rate was about 51%. [1]
What is the main cause of erectile dysfunction?
Research most strongly points to heart and blood vessel health. Erections depend on healthy blood flow, so the conditions that affect your blood vessels are some of the biggest erectile dysfunction causes.
Blood vessel and heart health
Diabetes, high blood pressure, heart disease and not getting enough physical activity are all strongly linked to ED. [1] Unhealthy cholesterol and blood fat patterns are linked to higher odds of ED as well. [2]
How well your blood vessels relax
The inner lining of your blood vessels helps them relax and open, partly by making a molecule called nitric oxide. Men with ED tend to have blood vessels that don’t relax as well, and thicker artery walls, compared with men without ED. [3][4] This is one reason ED can be an early warning sign of heart disease.
Hormones and erectile dysfunction
Testosterone
Testosterone plays a central role in sex drive and erections. [5]
Thyroid
Thyroid problems are linked to sexual difficulties in men, especially an underactive thyroid. [6]
Sleep apnea and testosterone
Sleep apnea is linked to lower testosterone. [7]
Inflammation and muscle
Higher levels of inflammation in the body are linked to higher odds of ED. [8][9] Men with more muscle mass tend to have lower odds of ED. [10]
Depression, anxiety and erectile dysfunction
Depression
Depression and ED are closely linked. A review of 49 studies found that men with depression had higher odds of ED, and men with ED had higher odds of later depression. [11] A large study of middle-aged US men found the same link, even after accounting for age, overall health and hormones. [12] It isn’t always clear which comes first, and the link appears to run both ways.
Anxiety
Anxiety disorders, including PTSD, panic disorder and social anxiety, are often seen alongside ED. But the studies are small and their results vary, so more research is needed. [13]
If you’re struggling with low mood or anxiety, please talk with your primary care doctor or a mental health professional. Support for your mental health can be an important part of improving erectile health.
Can toxins cause erectile dysfunction?
Some research has linked certain environmental exposures to ED, but this research is still early. It shows links, not proof that these exposures cause ED.
Cadmium
In a national US survey, men with the highest blood levels of cadmium, a heavy metal, had about twice the odds of ED compared with men with the lowest levels. [14]
Where does cadmium exposure come from? According to US federal health and environmental agencies:
- For nonsmokers, food is the main source. Foods that tend to contain more cadmium include leafy vegetables like lettuce and spinach, potatoes, grains, peanuts, soybeans, sunflower seeds, and organ meats such as liver and kidney. [15] Cadmium levels in some foods can be higher when phosphate fertilizers or sewage sludge are used on farm fields. [16]
- For smokers, cigarette smoke is a major source. Smokers have about twice as much cadmium in their bodies as nonsmokers. [15][16]
- Some jobs carry higher exposure, especially work that involves heating cadmium-containing materials, like smelting and electroplating, as well as making batteries and pigments. [15][16]
Many of these foods are healthy, so this isn’t a reason to stop eating them. Talk with your healthcare practitioner before making big changes to your diet.
Other metals and pesticides
Higher levels of some other metals and certain pesticides have also been linked to ED in a few studies. [17][18]
Phthalates (plastics-related chemicals)
Research has not shown a clear link between phthalates and ED. [19]
Mold toxins
No studies have yet looked at whether mold toxins affect erections in people.
Why a whole-body approach matters
Because ED is so often connected to blood vessel health, hormones, metabolism, inflammation, mental health and possibly your environment, Dr. Madeira looks at how these pieces fit together. That can include a detailed health history, lab testing, and a personalized plan covering nutrition, exercise, sleep, stress and supplements.
Erectile dysfunction help: where to start
Talk with your primary care doctor
ED can be an early sign of heart disease, so it’s important to let your primary care doctor know if you’re experiencing it. Dr. Madeira is a naturopathic physician and works alongside, not in place of, your primary care doctor. All patients are required to have their own primary care doctor.
Prescription medications such as Viagra (sildenafil) can help with erections, but on their own they aren’t a root-cause solution, because they don’t address why ED is happening. Evaluating and addressing those root causes is a key part of the answer. Please don’t stop or change a prescribed medication without talking with the doctor who prescribed it.
Ways to work with Dr. Madeira
- 3-Month Health Optimization Program: for men who want to look at hormones, energy and vitality.
- 10-Week Metabolic Reset: for men focused on weight, body composition and blood sugar.
Not sure where to start? Take the energy & vitality quiz.
Concerned about your home environment? Take the environmental health quiz.
The discovery call is a free, non-clinical 30-minute Zoom conversation about your goals and whether working together is a good fit.