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Erectile Dysfunction

Erectile Dysfunction (ED) affects 27-33% of 18 to 40-year-old men, and it’s becoming an increasingly common problem for younger men. Erectile dysfunction is an inability to get and maintain an erection, and there are several possible causes, but being unable to have full erections creates complex sexual, social and fertility issues for all men and their partners.

A lack of libido (LoL) is the absence or significant reduction in sexual desire, which is different from erectile dysfunction (ED) as there’s desire with ED but problems with erections. With a lack of libido, nothing may be inhibiting erections other than disinterest in sex, but many men will understandably experience both issues at the same time.

The causes of ED are described as either “organic” or “psychogenic” causes, but there are cross-overs between them as one can cause the other.

Psychogenic causes

These are problems with men’s emotional engagement with their sexuality and sex. When this is the main issue, the man usually has a sudden onset of symptoms. His libido is low, and his erections are poor or absent. This diagnosis is usually:

  • Depression
  • Anxiety
  • Partner-related difficulties

The risk factors for Psychogenic Erectile Dysfunction are:

  • Exposure to episodes of stress (acute or chronic)
  • Dysfunctional lifestyles
  • Dysfunctional relationship patterns, including pornography and masturbation
  • Anxiety, mood and personality disorders
  • Neurotic or submissive temperamental traits

The impact of the psyche on sexual performance is significant. An interesting example is that men’s perception of how their genitals look can cause ED. A study of young (under 40) presumably fit and healthy military personnel found that over 30% had sexual anxiety, which caused ED.

Porn is widely available, graphic and often disturbing. Many young men watch it, and it affects their psyche, distorting their perception of what’s normal. A distorted perception applies to genital shape and size as well as performance. The evidence is that watching porn is a powerful driver of ED in young men.

  • The more a man watches porn, the more likely he is to have ED
  • The more he watches porn, the worse his ED is likely to be

Young men are developing concepts of relationships independent of real-life experiences, and they become dulled to increasingly graphic material and unable to get aroused by typical sexual experiences. The ED rates in young men have traditionally been around 2-3%, but currently:

  • ED affects 27-33% of teens to 40-year-old men
  • Low libido affects 16% of teens to 25-year-olds and 37% of 25-40-year-old men

Porn and ED

Most boys in their early teens watch pornography, and the human brain hasn’t fully developed until about 25. There’s a genuine concern that graphic porn could be changing brain development on a fundamental level.

Even without fundamental changes to the brain, watching porn is a bit like going to the gym and training next to an Olympic athlete (on performance drugs). The chances of feeling good about your body and sexual ability are low!!

Some of the behaviours that come with psychogenic causes drive organic causes of ED. Men masturbate to achieve sexual enjoyment, and the more they do this, the less likely they are to perform with a sexual partner.

Excessive masturbation is a significant issue as:

  • It’s associated with feelings of guilt for many men
  • Causes the loss of precious genetic material
  • It’s linked to higher rates of ED in scientific studies

Organic causes

Poor health is a significant cause of male infertility and having a general health condition reduces male fertility, with:

  • Lower sperm concentration
  • Lower testosterone levels
  • Higher FSH levels

Improving general health improves fertility for both sexes and a man’s performance. When men have ED for organic reasons, there’s usually a gradual onset of symptoms, and libido is unchanged. The leading causes are:

  • Vascular disease
  • Hormonal imbalances
  • Neurological conditions
  • Structural issues
  • Side effects of medications, treatments or investigations

Many medications cause ED, and we recommend checking the reference list at webmd.com. Additionally, statins reduce testosterone levels, shrink the size of testes, increase FSH levels, and reduce prolactin levels, all of which reduce male sexual performance.

The risk factors for Organic Erectile Dysfunction are:

  • Ageing
  • Uro-genital abnormalities
  • Cardiovascular disease
  • Diabetes mellitus
  • Hormonal disorders


  • 30% of men in their 30’s
  • 40% of men in their 40’s
  • 50% of men in their 50’s etc

However, a recent review estimated that 30% of young men had the condition, and rates are rising in young men. These abnormally high levels are probably due to the psychogenic issues discussed above.


ED is strongly linked to lower urinary tract symptoms (benign swelling of the prostate), and the advice for men with either condition is to get assessed for the other one. Unfortunately, the standard treatment for enlarged prostate is 5α-Reductase inhibitors like finasteride, and they happen to increase the risk of persistent ED by 5x.

Cardiovascular disease

Cardiovascular disease affects blood flow around the body, including the penis, which increases the risk of ED. However, it’s a two-way relationship, and ED is an independent predictor of future cardiovascular events as it almost doubles their risk.


Diabetes has a profound impact on erectile function, which is surprising given it’s essentially a blood sugar regulation condition. However, diabetes also affects circulation and causes damage to blood vessels. Research shows:

  • 37.5% of men with Type 1 diabetes have ED
  • 57.7% of men with Type 2 diabetes have ED
  • Overall, men with diabetes are 3.6x more likely to have ED

Type II diabetes is linked to lower semen volumes and higher DNA fragmentation rates.

Low testosterone

Testosterone is produced by Leydig cells in the testes, and it stimulates sperm production and sex drive. Testosterone levels over 300 ng/dL are normal for adult men. There are several reasons why men have low testosterone:

  • Testosterone levels naturally fall with age. Teenage boys have the highest levels, and male testosterone drops by about 1% each year from about 25
  • Exposure to endocrine-disrupting chemicals (EDC) in the womb reduces the number of Leydig cells in the testes. The outcome is lower testosterone levels and sperm production in modern men
  • Exposure to endocrine-disrupting chemicals (EDC) as an adult also reduces testosterone production and libido

Testosterone gels and supplements are available from medics, and a range of herbal supplements stimulate the testes to increase testosterone production. Higher testosterone levels increase libido, improve mood and reduce abdominal fat.


A wide variety of medications reduce libido and erectile function, including:

    1. Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants like Prozac
    2. Tricyclic antidepressants such as Elavil
    3. Anti-anxiety Benzodiazepines such as Xanax
    4. Benign prostate hyperplasia drugs (e.g. Proscar)
    5. Hair-loss medications, including Propecia
    6. Antihistamines, especially diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton)
    7. Anabolic steroids
    8. Anti-epileptic drugs such as Tegretol
    9. Opioids such as Vicodin, OxyContin, and Percocet
    10. Beta-blockers such as Propranolol and Metoprolol
    11. Calcium channel blockers
    12. ACE Inhibitors
    13. Anti-arrhythmics (Disopyramide)
    14. Parkinson’s disease medications
    15. Antifungal medications like Ketoconazole
    16. Heartburn and reflux medication Cimetidine (Tagamet)
    17. Statins
    18. Marijuana
    19. Cocaine
    20. Chemotherapy and radiation drugs


Chronic illnesses tend to reduce sexual desire, especially:

  1. Chronic pain
  2. Type II diabetes
  3. Obesity
  4. Hypertension
  5. High cholesterol
  6. Metabolic syndrome
  7. Chronic organ failure (heart, lung, kidney and liver)

Erectile Dysfunction and PFPs

Variations in ED symptoms, causes, and treatments have connections to the morefertile Personal Fertility Profiles. Knowing which PFP affects you empowers you to change your health and lifestyle to improve erectile function.

    1. Hot
    2. Cold
    3. Energy (Two types)
    4. Blood
    5. Flow (Two types)
    6. Fluids
    7. Fluids & Hot

There’s extensive information on how to improve erectile function and fertility in Male treatments, but PFPs are the core strategy for raising health and fertility.