Why ED deserves a medical evaluation
ED shares risk factors with — and often precedes — cardiovascular disease. New-onset ED is an opportunity to assess blood pressure, lipids, glucose, sleep, and testosterone. Do not treat ED in isolation.
Cardiovascular and metabolic health
- Blood pressure control
- Lipid management
- Diabetes prevention or management
- Obstructive sleep apnea evaluation when snoring or daytime sleepiness is present
Lifestyle
Exercise
Aerobic and resistance training improve endothelial function and erectile response, with meaningful effect sizes in trials of men with ED.
Sleep and stress
Adequate sleep and stress management support testosterone and autonomic balance.
Smoking
Tobacco is directly toxic to penile vasculature; cessation improves outcomes.
Hormonal considerations
Low testosterone is one of many possible contributors. Testing should follow current clinical guidelines, and treatment — when appropriate — belongs in the hands of a clinician familiar with fertility, cardiovascular, and prostate implications.
Supplements that have been studied
Evidence is mixed. Options with peer-reviewed data include L-arginine and L-citrulline (nitric-oxide precursors), Panax ginseng, and vitamin D repletion when deficient. Supplements are not substitutes for evaluation of underlying cardiovascular or hormonal disease.
Caution: Avoid unregulated "male enhancement" products purchased outside a physician dispensary. These have repeatedly been found to contain undeclared prescription drugs.