Erectile Dysfunction

An erection is a vascular event that depends on healthy endothelium, adequate nitric oxide signalling, intact nerves and sufficient testosterone. When it stops working reliably, the most common reason in men over 40 is early vascular disease, because the penile arteries are narrow and show damage before the coronary arteries do. That makes erectile dysfunction a genuinely useful clinical signal rather than just a quality-of-life complaint, and it is why the first response should be a check of blood pressure, lipids, HbA1c, and morning testosterone rather than a supplement order. Medication and psychological factors matter too: SSRIs, beta blockers, thiazide diuretics, finasteride and heavy alcohol use are frequent contributors, and performance anxiety maintains the problem once it starts. Exercise, weight loss, smoking cessation and sleep apnea treatment produce measurable improvements. PDE5 inhibitors are effective and well studied. Supplement evidence is comparatively weak: Korean red ginseng has the most consistent small-trial support, L-arginine and citrulline have modest mechanistic rationale, and most proprietary blends sold for this purpose have been repeatedly found adulterated with undeclared prescription drugs.

• •Difficulty achieving an erection
• •Difficulty maintaining an erection through intercourse
• •Reduced firmness
• •Loss of spontaneous morning erections
• •Reduced libido when testosterone is low

• •Endothelial dysfunction and atherosclerosis
• •Diabetes and insulin resistance
• •Hypertension and its treatment
• •Low testosterone
• •Obstructive sleep apnea
• •SSRIs and other medications
• •Smoking and heavy alcohol use
• •Performance anxiety and relationship stress
• •Pelvic surgery or radiation

Impaired nitric oxide mediated vasodilation in the penile vasculature is the dominant mechanism, usually reflecting systemic endothelial dysfunction from metabolic and cardiovascular disease. Neurogenic, hormonal and psychogenic contributions layer on top.