What To Know About Telehealth for Erectile Dysfunction

Telehealth doctor talking with patient

Erectile dysfunction is awkward. And not just in the bedroom—it can feel uncomfortable to talk about in your doctor’s office, too.

I get that. I’m a board-certified urologist, so ED is one of the most common reasons why men come to see me. Even though I talk about it every day, I know it can still be incredibly uncomfortable for my patients.

And while there have been very few silver linings to the COVID pandemic, there has been one: people are much more willing to engage in telehealth or online doctor visits. And, interestingly, that has made men more comfortable speaking to a professional about ED. 

In this article, I want to walk you through what telehealth for erectile dysfunction looks like. I want to dispel some of the myths around it, and emphasize that an online visit with your doctor really can be an effective way to address ED. 

It’s accessible, it’s more comfortable, and it can be effective.

Can Telehealth Work for ED Therapy?

Telehealth for Erectile Dysfunction

Right off the bat: are online ED consultations an effective way to get treatment?

Yes! They certainly can be. Virtually all of the things that I would do in an in-person visit at my clinic to evaluate and diagnose ED, I can do over the phone or via Zoom. 

Several studies have even found that online telehealth platforms aimed at treating erectile dysfunction can be effective. Of course, you always want to make sure you’re having your telehealth consultation with a board-certified physician. 

Benefits of Telemedicine for ED

There are many benefits for telemedicine:

  • Access. Telehealth makes getting ED help much more accessible and less embarrassing than in-person visits. 
  • Comfort. Telehealth consultations done from the comfort of your home helps you feel more at ease and comfortable talking about ED. 
  • Convenience. You can have your doctor’s visit from anywhere on your phone or laptop!
  • Quality of doctor. I’m based in Sarasota, Florida, but telehealth allows men who want VIP-level service to see me from anywhere.
  • Less waiting. No more sitting around for 45 minutes in the waiting room—you’ll know exactly when your consultation starts, and they’re always on time!
  • Same high-quality service. According to research, telehealth patients get the same length and quality of consultation as in-person patients do.

What Can a Doctor Do for You Online?

During an online visit, doctors can order any additional testing needed to manage erectile dysfunction. They can:

  • Conduct a thorough evaluation of erectile dysfunction signs and symptoms
  • Order blood tests to evaluate your hormone levels
  • Provide prescriptions for common ED treatment options like Viagra and Cialis that can be delivered to your home. 
  • Provide information on other treatment options for ED and lifestyle changes that support sexual health
  • Offer follow-up visits to evaluate the efficacy of ED treatments

What Can’t a Doctor Do Online?

There are some cases when you will need to see your doctor in person. If you are experiencing any pain, swelling, or discomfort, an in-person consultation may be necessary so that your doctor can do a proper physical inspection. 

And, if you’re experiencing any of the following symptoms, you should seek emergency treatment:

  • Inability to urinate together with swelling and pain in the lower abdomen
  • A sudden onset of pain in the scrotum, or swelling in the testicles
  • A prolonged, painful erection that lasts more than 4 hours

Those issues require in-person emergency care. But if you’re concerned about difficulty getting or maintaining an erection, telehealth is a perfect option for you.

How To Prepare for Your Telehealth Appointment

Prepare for a telehealth appointment in the same way that you would for an in-person visit. Have a pen and paper handy to take notes if you need to. Make a list of questions that you have beforehand. And make sure you don’t have any appointments right after so that you don’t feel rushed.

Make sure your internet connection is strong and that your camera and microphone work so that we can both hear and see each other. And make sure you have a quiet, private space where you can speak freely.

How it Works: What Will My Telehealth Appointment Be Like?

What Will My Telehealth Appointment Be Like?

When I’m assessing erectile dysfunction, I’m going to ask you to tell me what you’re experiencing and about your medical history. Then I’ll ask some follow-up questions like:

  • How long have you been struggling with trouble getting an erection?
  • What have you tried so far in terms of ED treatments?
  • What are your diet, sleep, and exercise habits like?

There are many different possible causes of ED including vascular problems, low testosteronepoor diet, medications, or even high stress. I’ll ask several questions to try to determine the potential causes. 

Depending on the situation, I may recommend some blood tests so we can check your hormone levels, cardiovascular function, or other key markers. These test results can help identify certain causes of ED and can lead to more effective treatments than a one size fits all pill. 

What Are My Erectile Dysfunction Treatment Options?

Once we understand the cause of your ED, we’ll be able to discuss treatment options. Treatment options for ED can include:

  • Lifestyle changes
  • Hormone Replacement Therapy (HRT Therapy)
  • Oral ED medications like sildenafil (Viagra) and tadalafil (Cialis)
  • GAINSWave
  • The Priapus P-Shot
  • Peptide therapies
  • Stem cell Injections
  • And more. 

Remember that not all treatment options are appropriate for every person. That’s why it’s so important to understand your situation before we decide on a treatment plan—we want to choose the treatments that are most likely to work, and that don’t have unnecessary side effects.

If we choose prescription medications as the best option to treat your ED, we have the ability to discreetly and conveniently ship medications to your home, avoiding a trip to the pharmacy entirely.

How Is a Telehealth Appointment with an Erectile Dysfunction Expert Different From Mail-Order Services?

You can find many online ED clinics that offer you a quick consultation, which is usually followed by a healthcare provider writing you a prescription for viagra. Unfortunately, with those clinics, the provider is almost never an expert in urology with specialty training in erectile dysfunction

The other issue with these online clinics is that, because they make large profits selling oral medications, that’s the only solution they tend to provide. While oral medications like Viagra and Cialis certainly can be effective treatment options, they’re not appropriate for everyone. 

Sometimes ED can be a signal of more sinister medical conditions—diabetes, heart disease, high blood pressure, high cholesterol, and others. Quick visits with online mail-order services may not be thorough enough to catch warning signs of these more serious health conditions that require further testing.

Many of these companies are only in the business of selling you medications. They’re not necessarily providing high quality personalized healthcare. Work with a men’s health expert to  ensure you get the most effective and appropriate treatment options available.

Telehealth Can Help You Combat ED

Telehealth for ED | Gapin Institute

Erectile dysfunction is a legitimate health concern that affects millions of men in the US. We take women’s sexual and reproductive health incredibly seriously, but often ED is trivialized in the public eye.  Erectile dysfunction can take a significant toll on the mental health, drive and self-esteem of guys who struggle with it. It can also signal that something else is going on with your health. 

That’s why it’s so important to get evaluated and treated for ED. You don’t have to suffer from ED or feel marginalized as a result. 

Telehealth is a great option for busy men. It’s private, it’s comfortable, and it’s a convenient way for men to get assessed and treated quickly. Best of all, it is effective. If you need help with ED, reach out and book a call with me today. 


Badkhshan, S., Ernst, M., Maiers, T., Shapiro, M., & Chevli, K. (2020). Erectile Dysfunction in Telemedicine: The Standardized Patient Experience. The Journal of Sexual Medicine, 17(1), S14.

Ellimoottil, C., Skolarus, T., Gettman, M., Boxer, R., Kutikov, A., Lee, B. R., … & Morgan, T. (2016). Telemedicine in urology: state of the art. Urology, 94, 10-16.

Hsiang, W. R., Honig, S., & Leapman, M. S. (2020). Evaluation of Online Telehealth Platforms for Treatment of Erectile Dysfunction. The Journal of Urology, 205(2), 330-332

Manage ED with Cutting-Edge Science: New Therapies for Erectile Dysfunction

ED therapies | Gapin Institute

Manage ED with Cutting Edge Science | Gapin Institute

Erectile dysfunction (ED) is an old problem. It’s been around for a long time.

But treatment options are fairly new. The first effective oral ED medication—sildenafil (Viagra)—was discovered in 1989 and was only made available by 1998. Then came tadalafil (Cialis) and more recently vardenafil (Levitra, Staxyn) and avanafil (Stendra). 

But our understanding of the causes of erectile dysfunction and how to treat it have grown tremendously since the discovery of sildenafil. These days, we’re able to manage ED with cutting-edge science and new technology.

Here are some of the newest therapy options for treating ED and the science behind how they work.


GAINSWave is the process associated with a revolutionary new therapy for ED called low intensity shockwave therapy.

How it works: Low-intensity shockwave therapies like GAINSWave treat ED by sending pulses of energy into the target tissue—in this case, tissue in the penis. The low-intensity shock waves induce angiogenesis, which is the creation of new blood vessels. This increases blood flow to the penis, making it easier to get an erection. 

The therapy may also help regenerate penile nerve tissues by activating key regenerative signaling pathways (PERK/ATF4).

Is GAINSWave effective? The published literature provides good evidence to suggest that it really works. 

In one meta-analysis that included data for 607 patients, researchers found a statistically significant improvement in erectile function in men who received the treatment with no reported adverse side effects.

Platelet-Rich Plasma (PRP)

Platelet-Rich Plasma, or PRP ( sometimes referred to as The Priapus shot or P-shot), involves injecting a concentration of platelets from your own blood into your penis.  

How it works: PRP therapy works by injecting platelet-rich plasma from your own blood directly into the penis. Blood has four components: red blood cells, white blood cells, plasma, and platelets. By removing the red blood cells and white blood cells, doctors can concentrate the platelets and plasma and administer it directly in the penis. 

Platelet-rich plasma contains proteins and growth factors that stimulate stem cells in the penis to promote repair, regeneration, and remodeling of the blood vessels and normal healthy tissue of the penis. After all, remember that an erection is simply increased blood flow to the penis!  The idea is that, by injecting PRP into the penis, it helps restore normal, healthy tissue function and improve blood flow. 

Is the P-shot effective? The research is ongoing but looks promising. In one recent review of several studies on PRP therapy, researchers found mostly good effectiveness with no major side effects or adverse reactions. 

Most of the research on this treatment has been through small studies with low sample sizes, so it’s certainly still in the research phase. More studies are needed so we can better understand how effective this treatment is and for which men it’s best suited.


Peptides are simply short proteins – nothing more than short chains of amino acids. But they’re amazing! 

Peptides are signaling molecules that your body recognizes for very precise functions. Peptides can be quite effective in turning back the clock on aging in a number of ways. And some peptides also appear to be helpful for treating ED. 

How it works: Two peptides that have been found to be useful for ED are Melanotan 2 and PT-141. These can be given by subcutaneous injection or by nasal spray and can immediately enhance erectile function. These peptides improve sexual performance by stimulating melanocortin receptors, which are involved in sexual desire and erectile function.

Are peptides effective? Yes! The research on Melanotan and PT-141 suggests that both can dramatically improve erectile function. In one study, Melanotan 2 caused erections in 85% of the individuals, even in the absence of sexual stimuli. 

Side effects can include yawning and nausea. 

Stem Cell Injections

Stem cell injection | Gapin Institute

Stem cells are ‘progenitor’ cells that are not yet specialized and can develop into any other cell in your body.

For ED treatment, stem cells can be used to regenerate normal healthy erectile tissue. Stem cells are harvested from your bone marrow – typically from the iliac crest (the back of your bony pelvis) – and then injected into the penis.

How does it work? Stem cells are used in a variety of therapies because they have been found to regenerate, remodel, and repair damaged tissues. It’s believed that they contribute to regeneration by secreting bioactive chemicals that boost healing. 

Are stem cell injections effective? They appear to be. One recent review that summarized 8 clinical trials in humans found that stem cell therapy could be effective for long-term improvement in erectile function. Stem cell therapy is one of the few regenerative treatments that is specifically FDA-approved for the treatment of ED.

Vacuum Therapy

Vacuum therapy is used both to create erections suitable for sexual intercourse as well as to stimulate growth and recovery of penile tissue to support healthy erectile function.

How it works: With vacuum therapy, a tube-like device is placed around the penis and connected to a manual or battery-operated pump that creates a pressure vacuum. The negative pressure brings blood into the penis and creates an erection. When used for sex, often a constriction ring is placed at the base of the penis to keep the blood in and to maintain the erection.

Is vacuum therapy effective? Yes, the research finds that the method leads to more satisfying erections. It also seems to have a positive effect on the rehabilitation of penile tissue after prostate surgery.

Intracavernosal “Trimix” Injections

Intracavernosal “Trimix” Injections | Gapin Institute

Intracavernosal injections (ICIs), sometimes just called penile injections, involve injecting medication directly into the side of the penis to stimulate an erection. While several different kinds of medication can be used, the most commonly injected medications are papaverine, phentolamine, and prostaglandin E1. When these three drugs are combined, it’s called a “trimix”. 

How it works: These medications stimulate vasodilation of blood vessels and relaxation of smooth muscles in the penis to allow increased blood flow and thus make it easier to achieve an erection. 

Like oral medications like Viagra and Cialis, penile injection therapy is a short-term treatment that helps men get an erection immediately and lasts for a few hours after injection.

Are Intracavernosal injections effective? Yes. Research has consistently suggested that injection therapy can be as effective as PDE5 inhibitors like Viagra, Cialis, Stendra, Staxyn, or Levitra. Injection therapy is a great option for men who can’t take oral medications due to specific contraindications. Always make sure to take medication under the guidance of a doctor, since overdosing with injection therapy can cause major problems! 

New ED Therapies Aren’t Always Better

New ED therapies | Gapin Institute

While the newest, cutting-edge technologies are promising for those with hard-to-treat ED, the fact is that new treatments aren’t always better. Indeed, some of the classic advice on managing ED is as pertinent as ever.

That’s because treating ED requires a comprehensive, systems-based approach. In most cases, lifestyle changes can meaningfully contribute to better sex life.

Here is the less exciting—but still effective—advice I give my VIP clients for better sexual health:

Find the Appropriate ED Treatment for You

These days, ED is almost always treatable thanks to new technology and cutting-edge treatments. But don’t assume ED drugs like Viagra (sildenafil) and Cialis (tadalafil) are the only option for you. 

Instead, get a full evaluation to find the cause of your ED. You want to make sure that it isn’t a warning sign of more significant underlying cardiovascular disease.

As a men’s health expert with over 20 years of experience treating erectile dysfunction,I can recommend the most appropriate ED treatment option for your particular case. 

Schedule an appointment with me and get your ED treated today! 

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In Male 2.0™, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death.  Unfortunately, a man who tries to NOT get sick but isn’t really healthy either.  And a man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0!

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world-renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition, and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com

Want more tips to optimize your health?  Listen to the latest podcasts. Click HERE


Campbell, J. D., Trock, B. J., Oppenheim, A. R., Anusionwu, I., Gor, R. A., & Burnett, A. L. (2019). Meta-analysis of randomized controlled trials that assess the efficacy of low-intensity shockwave therapy for the treatment of erectile dysfunction. Therapeutic Advances in Urology, 11, 1756287219838364. https://doi.org/10.1177%2F1756287219838364

Epifanova, M. V., Gvasalia, B. R., Durashov, M. A., & Artemenko, S. A. (2020). Platelet-rich plasma therapy for male sexual dysfunction: Myth or Reality?. Sexual Medicine Reviews, 8(1), 106-113. https://doi.org/10.1016/j.sxmr.2019.02.002

Giuliano, F. (2004). Control of penile erection by the melanocortinergic system: Experimental evidence and therapeutic perspectives. Journal of Andrology, 25(5), 683-691. https://doi.org/10.1002/j.1939-4640.2004.tb02842.x

He, M., & von Schwarz, E. R. (2020). Stem-cell therapy for erectile dysfunction: a review of clinical outcomes. International Journal of Impotence Research, 33, 1-7. https://doi.org/10.1038/s41443-020-0279-8

ED Myths and Facts: What you need to know

ED Myths and Facts Blog | Gapin Institute

I’m a urologist. That means that I was specially trained in the management of men’s health issues, including low testosterone, prostate health, and erectile dysfunction. This is my passion. 

In my 25+ year career, I have found that among all the men’s health issues I manage, erectile dysfunction is one of the most common complaints that brings men to see me. 

It’s the bread and butter of my work. 

Unfortunately, there’s a ton of misinformation around both what causes ED and how to treat it. Sometimes, that misinformation cause guys to needlessly suffer and avoid seeking guidance and support. 

So I want to take this opportunity to dispel some of the most common erectile dysfunction myths and give you the facts. And then I’ll tell you how to get treatment.

Myth #1. “ED isn’t a real health problem.”

Fact: ED can be a sign of much more significant health problems. 

Men tend to think of sexual issues as performance issues and not necessarily true health issues. But problems with sexual function are potentially a sign of much bigger issues. 

ED is often the initial symptom of vascular disease. The blood supply to the penis is quite small, so any atherosclerosis, or plaque in your arteries, can quickly affect normal blood flow and thus cause issues with normal erectile function. 

Erectile dysfunction can be a sign of underlying diabetes, high blood pressure, or other health problems. So think of ED as a “canary in the coal mine” for other potentially serious health conditions. ED can in fact also be associated with early mortality.

I consider ED to be a wake-up call. It should prompt a full evaluation to identify undetected cardiovascular disease or other health issues that need to be addressed.  

Myth #2. Erectile dysfunction only happens in older men

Fact: Erectile dysfunction is more common in older men, but it can happen at any age. 

Yes, ED is more commonly associated with older men. But younger men can absolutely experience erectile dysfunction, as well. In fact, about 25% of guys under 40 experience ED. 

In younger men, ED tends to be more often related to psychological issues or low testosterone, whereas ED in older men is more commonly associated with underlying medical issues such as cardiovascular disease or diabetes.

Myth #3. ED is a normal part of the aging process, so I shouldn’t worry about it

Fact: No one should “settle” for ED.

older man ED blog photo | Gapin Institute

While ED may be common,  we shouldn’t see it as a “normal” part of aging. 

It can be caused by a number of underlying health issues – poor blood flow, hormone imbalance, or nerve damage. But these are issues that can be prevented by prioritizing an optimal lifestyle.  It’s a health issue. And it can be treated. 

There’s no reason you can’t enjoy an active and satisfying sex life as you age. ED may affect lots of men, but that doesn’t mean we should consider it a normal part of the aging process.

Myth #4. ED means you’re not attracted to your partner

Fact: Some people experience ED even when they are very attracted to their partner. 

Erectile dysfunction is complex and can be caused by a number of factors. In addition to medical issues such as peripheral vascular disease and low testosterone, it can also be a result of psychological issues like stress and anxiety. Even lifestyle factors and some medications you’re taking can kill your sex life

So it’s important to realize that ED is not the same as sexual desire. ED doesn’t necessarily cause low libido and vice versa.

Myth #5. ED is caused by tight underwear

Fact: There is no evidence for a connection between your underwear and sexual function. 

It’s true that there is a link between tight underwear and infertility. This is because the testicles regulate their temperature by getting closer to, or further from, the body. Tight underwear can keep the testicles to close the body, which can increase their temperatures enough to reduce sperm production. 

But infertility is a separate issue from ED. There’s currently no evidence for a link between ED and your underwear. 

Myth #6. Any difficulty getting an erection means you have ED

Fact: It’s normal to occasionally have difficulty getting an erection. 

There’s a kind of social pressure to be “ready” all the time… but that’s not always how our body works. 

Sexuality is complicated and impacted by a lot of factors. Men who are sleep deprived, particularly stressed, or just “not in the mood” may not be able to get an erection on command. That’s actually normal—it doesn’t necessarily mean that they have ED.  

ED is diagnosed when a man consistently has difficulty getting or maintaining an erection satisfactory for intercourse. 

Myth #7. ED means you have problems in your relationship

Fact: While relationship issues can impact your sexual performance, there are many other potential causes as well.

ED Myths and Facts | Gapin Institute

Most cases of ED have physiologic causes, not psychological ones.

Sure, relationship issues can cause stress, anxiety, which could lead to ED. But relationship issues are usually not the cause of most men’s ED. 

Myth #8. ED can’t be fixed

Fact: We have very effective treatment options for ED. 

It’s fairly common that men feel like their ED is hopeless and will never get better. The fact is there are many highly effective treatment options available for ED, and almost all cases of ED can be treated. And not just with Viagra!

Myth #9. The only treatment for ED is Viagra or Cialis

Fact: There are many options for treating ED. 

Viagra, Cialis, and the other oral medications completely shifted ED treatment by increasing awareness and providing an easily accessible solution. But there are many other treatment options as well. This includes vacuum device, intracavernosal injections, peptide therapy, GAINSWave, PRP (Platelet-rich plasma, or ‘P-shot’), and Testosterone or hormone replacement therapy for men with low testosterone.

It’s also important to realize that lifestyle changes can dramatically improve your sexual function. Focusing on proper nutrition, good sleep quality and duration, exercising, and effectively managing your stress are part of a systems-based approach to health that has been proven to improve erectile function.

Myth #10. ED is too embarrassing to talk about with my doctor

Fact: ED is a very common issue with men today, even in younger men, and you should feel comfortable discussing it with your doctor.

One of the biggest issues with ED and other sexual health issues is that guys don’t like talking about it.  It can be awkward. But ED doesn’t mean you’re weak. It doesn’t make you less of a man. It just means you need a little help. 

Fact: You can overcome ED

Erectile dysfunction is a real medical condition and it can be serious. If you’re struggling with ED, seek treatment.

But don’t wait for your appointment to make some lifestyle changes that we know help improve erectile function:

  • Quit smoking
  • Eat a balanced, nutrient-rich diet
  • Cut out trans fats, saturated fats, and excessive sugar
  • Exercise regularly
  • Get enough sleep

If you do those things, you’ll set yourself up for success.  If you need help with ED, reach out to me.  

Schedule a consultation to discuss ED treatment.

Take the next steps

Schedule a Call


In Male 2.0™, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death.  Unfortunately, a man who tries to NOT get sick but isn’t really healthy either.  And a man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0!

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com

Want more tips to optimize your health?  Listen to the latest podcasts. Click HERE


Fung, M. M., Bettencourt, R., & Barrett-Connor, E. (2004). Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study. Journal of the American College of Cardiology, 43(8), 1405-1411.

Shamloul, R., & Ghanem, H. (2013). Erectile dysfunction. The Lancet, 381(9861), 153-165.

Yafi, F. A., Jenkins, L., Albersen, M., Corona, G., Isidori, A. M., Goldfarb, S., … & Hellstrom, W. J. (2016). Erectile dysfunction. Nature Reviews Disease Primers, 2(1), 1-20.

Capogrosso, P. M.D., Colicchia, M. M.D., Ventimiglia, E. M.D., Castagna, G. M.D., Clementi, M.C. M.D., Suardi, N. M.D., Castiglione, F. M.D., Briganti, A. M.D., Cantiello, F. M.D., Damiano, R. M.D., Montorsi, F. M.D., Salonia, A. M.D. (2013). One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice. The Journal of Sexual Medicine, 10(7), 1833-1841.

Parazzini, F., Marchini, M., Luchini, L., Tozzi, L., Mezzopane, R., Fedele, L. (1995). Tight underpants and trousers and risk of dyspermia. Internaitonal Journal of Andrology, 18(3), 137-140.

What is Nrf2? Here’s Everything You Need to Know About the Secret to Aging Well

What is Nrf2? Healthy man photo | Gapin Institute


Feel like you’re just not operating at the level you used to?

People tell us that that happens with age—that our bodies start to break down.

But the most recent science is actually calling into question the inevitability of the symptoms of aging. New research in microbiology, chemistry, and genomics is showing us that those uncomfortable symptoms of aging might not be locked in.

This is where “biohacking” comes from: it’s the idea that you can give your body exactly what it needs to properly repair and rejuvenate itself. The result? Optimized health and performance.

Nrf2 is one of the most exciting discoveries in this area and holds some real promise as an anti-aging agent and as a support for your long-term health. In this article, I’ll explain what it is, what it does, and why it matters for your aging. 

What is Nrf2?

Nrf2, short for “nuclear factor erythroid 2-related factor 2”, is a protein that is found in your cells. It is a type of protein called a “transcription factor”, which means that it is involved in gene expression—activating and deactivating parts of a genetic sequence. 

Which genes does Nrf2 affect? It regulates the expression of antioxidant proteins and enzymes, increasing their production to help your body fight off molecules that attack your cells. 

Nrf2 has been found to be an important part of your body’s system of regulating metabolism, inflammation, and immune responses

What’s special about Nrf2?

 Nrf2 is a big deal because it could be the key to aging gracefully and healthily.

When you’re young, your body is good at balancing all the needs of your body at the cellular level. But as you age, these important chemical signallers decline. You begin to produce less of the substances that you need to properly regulate your body.

That means that there are fewer of the peptides, proteins, hormones, and enzymes that help your body repair and rejuvenate. Things start to break down.

The result is that your body gets slower at repairing itself. That’s why you feel tired more often, your body takes longer to recover from exercise, and your skin begins to see signs of aging. You might also notice issues with your sleep or even erectile dysfunction

Oxidative stress contributes to symptoms of aging

At the cellular level, what’s happening is that free radicals are constantly bombarding your cells. The damage caused by these attacks causes your cells to go into a state called oxidative stress, and stop functioning properly. 

When you’re young, your body can easily fight free radicals back. But as you get older, your body can’t do this as effectively. That’s when symptoms of aging start getting worse.

Antioxidants fight free radicals and reduce oxidative stress

You’ve probably heard of the health benefits of antioxidants. Some foods are high in antioxidants and that’s why health professionals sometimes encourage you to include them in your diet. 

Antioxidants  help neutralize free radicals and minimize the damage that they cause. That helps reduce the symptoms of aging. 

But antioxidants aren’t very efficient. One antioxidant molecule neutralizes only one free radical. With more and more free radicals, we need more and more antioxidants. At some point, the antioxidants can’t keep up. 

What does Nrf2 do?

Nrf2 provides a powerful solution to overcome free radicals. It’s known as the “master regulator” of our body’s antioxidant response.

When Nrf2 is activated, it enters the nucleus and turns on several hundred genes, known collectively as “survival genes.” This, in turn, initiates the production of several of your body’s own powerful enzymes that fight free radicals. These enzymes include catalase, glutathione, and superoxide dismutase (SOD)

These enzymes are much more effective than antioxidants at getting rid of free radicals—they can neutralize over 1 million free radicals a second. What that means is that your body can clean itself out quickly and fewer of your cells get into a state of oxidative stress. 

Ultimately, that means you feel fewer symptoms of aging: better energy, better sleep, and even a better sex life

How do I get Nrf2?

Great, Nrf2 can support my health. How do I get it?

You actually don’t need to get Nrf2—it’s already right there in your cells. It comes pre-installed.

The problem is that it’s not activated. It’s a bit like an engine: it just sits in your cells not doing anything until it’s turned on. That’s what Nrf2 activation therapies do: they get into your cells to turn on Nrf2 so that it can enter the nucleus and work its magic. 

Some foods have been shown to activate Nrf2 and the Nrf2 pathway. These have been supported by studies in nutrigenomics—the study of how food influences gene expression and cellular function. 

Some Nrf2-activating foods include:

  • Dark chocolate 

  • Legumes, like lentils, beans, and peas

  • Vegetables, especially dark leafy greens like spinach and cruciferous vegetables like broccoli, cauliflower, and bok choy

  • Spices, especially ginger, turmeric, cinnamon, cloves, and yellow mustard

  • Herbs, like oregano

  • Red wine

  • Tea, especially green and white teas

What about Nrf2 supplements? Do they work?

In addition to activating Nrf2 through the diet, there are now supplements that activate Nrf2 and significantly reduce oxidative stress. 

These have been extremely well-researched by the scientific community and some of the supplements have very strong evidence supporting their use. 

Protandim®, for example, is a supplement designed to activate Nrf2. There have been numerous studies that demonstrate that it improves your body’s antioxidant response capacity. Peer-reviewed, human clinical studies show that it reduces cellular stress in humans by an average of 40 percent in 30 days. Research even suggests that it could be effective in preventing age-related diseases like:

The takeaway for your health: Nrf2 activators could help you feel younger. A men’s health secret.

We often think that there isn’t much we can do about the declines in our bodies that come with age. But science is showing us that that’s not necessarily the case. 

There actually may be ways that we can give our body what it needs to better regulate, repair, and rejuvenate itself.

Nrf2 appears to be one of those ways. Activating the Nrf2 pathway could be a relatively simple—but powerful—way to help you feel younger again. 

It might be as easy as making good diet choices or taking a supplement. 

Schedule a consultation to learn how to personalized health advice so you can live your life to the fullest. 

Ready to take the next steps?

Download the Blueprint

Schedule a Call


In Male 2.0™, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death.  Unfortunately, a man who tries to NOT get sick but isn’t really healthy either.  And a man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0!

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com

Want more tips to optimize your health?  Listen to the latest podcasts. Click HERE


Houghton, C. A., Fassett, R. G., & Coombes, J. S. (2016). Sulforaphane and other nutrigenomic Nrf2 activators: can the clinician’s expectation be matched by the reality?. Oxidative Medicine and Cellular Longevity, 2016. https://doi.org/10.1155/2016/7857186

Hybertson, B. M., Gao, B., Bose, S. K., & McCord, J. M. (2011). Oxidative stress in health and disease: the therapeutic potential of Nrf2 activation. Molecular Aspects of Medicine, 32(4-6), 234-246.

Lim, J. L., der Pol, V., Susanne, M. A., Baron, W., McCord, J. M., De Vries, H. E., & Van Horssen, J. (2016). Protandim protects oligodendrocytes against an oxidative insult. Antioxidants, 5(3), 30. https://doi.org/10.3390/antiox5030030

Men, What is stress doing to your Testosterone?

stress and our testostereone man at desk

Stress is ubiquitous—it affects all of us in one way or another.

Low level stress that you can easily overcome is usually not bad for you. In fact, it can even be good for you. Stress can motivate you, improve your athletic performance, and help you adapt to your environment. 

But long-term or excessive stress can have a profoundly negative effect on your health and even reduce your lifespan. Research shows that stress reduces testosterone levels, which may be one reason why stress is strongly linked with weight gain, poor sleep, and erectile dysfunction (ED)

Getting your stress under control is one of the most important ways to achieve a healthy, satisfying life. In this article, I’ll dive into exactly what stress is and what it is doing to your health, testosterone, and sex life. Then I’ll explain exactly how to beat it. 

What is Stress

We throw the term around all the time, but what exactly is stress?

Stress is a feeling of psychological strain or pressure. It occurs from our own perception of an event or stressor as threatening or challenging to us.

To be clear, stress is not the actual events or stressors in your life.  Your response to those stressors is what triggers your feeling of stress.

Psychologists sometimes classify stressors into four types (1):

  1. Ambient stressors, like noise in a cafe or traffic
  2. Hassles or micro stressors, like not being able to find your keys
  3. Major life events, like getting fired, getting married, or having a child
  4. Crises or catastrophes, like a natural disaster

These have different effects on your overall well-being, but even hassles or micro stressors, when they are constant, can create levels of stress that ultimately affect our health. 

traffic jam - angry stressed businessman driving car

How Stress Affects Health

Stress has a massive physiological effect on our bodies. When we feel stress, our brain sends out a signal to our body and activates a “fight or flight” response. Our pupils dilate, our heart rate increases, and our body releases a number of hormones and chemicals to get us ready to react, such as adrenaline, endorphins, and cortisol.

This response is useful if we’re encountering a situation where we really do need to fight or get away. Athletes, soldiers in combat, or even firefighters benefit from this reaction to stressful situations.

But for most of us, this bodily response is unnecessary. And, when stress is chronic, occurring over a long period of time, these effects can be toxic and dangerous to our health. The amount of stress that you have, and your stress resiliency, can even predict how long you will live.

Risk of disease

One of the most worrying effects of stress on our health is its relationship to disease; research shows that chronic, severe stress vastly increases a person’s risk for several chronic health conditions. 

For example, there’s significant evidence that stress increases the risk of cardiovascular diseases like heart attack, stroke, high blood pressure, and hypertension as well as diabetes and certain types of cancer (2, 3, 4). 

Stress is also clearly associated with mental illness, including depression, schizophrenia, and anxiety (5, 6).

Immune Function

Stress has been found to reduce immune function (7). Research has demonstrated that stress can cause a person to be more susceptible to illnesses like colds (8). Scientists have suggested that stress can affect immune system function at the cellular level, changing the body’s chemical immune response. They’ve found that individuals that report more stress tend to have lower immunity and increased inflammation (7).

Poor lifestyle habits

The way that we cope with stress may also have an impact on our health. When individuals cope with stress by consuming excessive alcohol, smoking, or binge-eating, the result is poorer health. Stress can cause some people to engage in unhealthy habits as a way to cope with the psychological discomfort (9). 

Stress can affect your genes

Epigenetics refers to a process whereby gene expression, or activity, is altered by the environment although the actual genetic sequence is not changed. 

Researchers have found that stress can cause epigenetic changes resulting in negative health outcomes. 

What does all this mean? It means that stress may be able to actually change how your genes are expressed such that you are predisposed to have worse health outcomes. 

How Stress Affects Testosterone and Erectile Dysfunction

Stress has such a powerful effect on us in part because it’s psychological. It affects the hormonal balance in our body, but it also affects our mental health. Both of these things can impact sexual function and performance.

One of the ways that stress impacts sexual function is through testosterone.

What is testosterone?

Testosterone is often called the “male sex hormone”. It plays an important role in several bodily functions for men, including the initial development of the testes and prostate. In adults, testosterone has many surprising effects including being critical to the production of sperm and semen, healthy libido, and even muscular development.

Many men suffer from “low T”. What is low T? It’s a condition where a man’s body does not produce sufficient testosterone for optimal function.

Low testosterone can be caused by various lifestyle factors, including diet, exercise, and poor sleep. Age alone may also be a factor since the production of testosterone tends to decrease with age. Men over the age of 50 tend to experience a 1% decline in testosterone levels every year.

Some of the symptoms of low testosterone include: 

  • Erectile dysfunction
  • Low fertility
  • Loss of muscle mass
  • Anxiety and depression
  • Weight gain
  • Low libido and sex drive
  • Weaker bones
  • Reduced energy
  • Less body hair
  • Foggy brain

Stress has been shown to directly affect testosterone levels. When you’re stressed, your body releases the stress hormone cortisol. And high cortisol levels crush your testosterone. Research has found a clear association between high cortisol levels and low levels of testosterone (13). 

The lower testosterone levels caused by stress, in turn leads to low energy, weight gain, loss of mental focus, and loss of sexual function.

Stress Causes Erectile Dysfunction

Stress is one of the most common causes of ED (14).

Sexual function depends on the complex interaction between physiological and psychological factors. Stress affects both. It causes your body to produce less testosterone, which contributes to difficulty getting an erection. It can also affect the psychological processes associated with sexual arousal. 

Finding ways to effectively cope with stress is an essential part of creating a healthy lifestyle, achieving optimal testosterone levels, and supporting a fulfilling sex life. 

Reduce Stress to Improve your Health, Testosterone, and Sex Life

Great, we need to address stress for better health, more testosterone, and great sex. 

But how?

Develop stress resiliency

This is one of the most important things that you can do to reduce stress: develop ways to cope effectively with stress and create stress resiliency

Stress resiliency refers to your ability to respond to and cope with the stressors that you face in everyday life. Creating resilience to stress can help you experience it less often, for less time, and thus reduce the negative health effects.

To develop stress resiliency, try the following.

  1. Start to think of stress as an opportunity for growth. Ask yourself: What is the stressor? Why am I stressed about it? Where can I feel the stress in my body? What can I do right now to cope and calm myself down? What can I learn to grow from it?
  2. Develop healthy coping habits. These include exercise, meditation, breathing techniques, hobbies you enjoy, and even sex.
  3. Sleep! Sleep is critical for optimal health, but especially when it comes to stress resilience. Good quality sleep allows your body to heal and recover. And good quality sleep lowers cortisol.
  4. Get social support. Engaging with the important people in your life is one of the most effective ways to cope with stress. Even giving social support can improve your stress. 
  5. Focus on eating good quality food. The foods you eat can directly promote or reduce inflammation in your body, and thus affect cortisol production. 


Exercise is one of the most effective ways to beat back stressors (15). Research shows that people who exercise consistently  are better able to develop stress resilience and reduce the health consequence of stress (16). 

man exercising for stress and testosterone levels


Research is increasingly finding the benefits of meditation on everything from cognitive health to physical energy levels. Meditation also turns out to be an effective way to cope with life stressors, even if you do it for just five to ten minutes a day. 

The benefits of meditation include:

  • Stress reduction
  • Better sleep
  • Feeling relaxed
  • Better focus and attention
  • More positive mood
  • Reductions in depression and anxiety. 

Solutions for Erectile Dysfunction and Low T

Do you think your stress is lowering your testosterone? Here are a few ways that you can increase your testosterone naturally

Lose weight

Body fat and testosterone are connected. When guys have higher body fat levels, their bodies create and release less testosterone. And low testosterone causes your body to store more energy as fat. It’s a vicious cycle.

However, you can reverse it and turn it into a positive cycle. When you start to lose weight, you’ll find that your testosterone levels naturally increase. And, as the testosterone in your body increases, you’ll find it easier and easier to lose more weight (17). Losing weight will also help you to stop ED in its tracks

If you are overweight, make this a priority: lose weight to naturally boost your testosterone. improve sexual function, and improve stress. 


It’s not only effective for coping with stress, but also for increasing testosterone. Numerous studies have found that guys that exercise more tend to have more testosterone. 

The best exercise to boost testosterone is strength training and lifting weights. Studies have found that guys of all ages get a boost of T from weight training (18). Moderate cardio exercise is also great. 

And for another added benefit, exercise is an effective way to prevent and help treat ED.

Testosterone replacement therapy (TRT)

Testosterone hormone therapy can be an effective treatment for some guys that suffer from low T. Testosterone therapy can be given topically, by subcutaneous or intramuscular injection, pellets, or more recently oral medication.  Some of the benefits of TRT include (19):

  • Improved energy
  • Better sexual function and sex drive
  • Increased endurance
  • Enhanced ability to gain lean muscle mass
  • Increased mood and energy
  • Improved cognitive function

There can be risks of testosterone replacement therapy, so make sure you consult with a doctor specialized in men’s health and hormone therapy before deciding whether it could be right for you.

Precision Medicine

These recommendations will help the majority of men reduce stress and improve their health. 

But everyone is different. Every man obviously has unique genetics, and thus responds to his environment differently. This is epigenetics.

Why should you care? There may be things that you should be doing to reduce stress and get healthy that wouldn’t work for other men. Whether it be

Precision medicine is a way to get a health plan tailored to your individual genetic makeup. If you’re suffering from stress, low T, or ED, look for solutions designed specifically for you and your genes. 

Optimize your Health with Dr Tracy Gapin. The body is a complex system.

Conclusion: Don’t Let Stress Get You Down

Everyone experiences stress. If stress becomes chronic, and you lose your ability to cope with it, stress can crush your health, leading to weight gain, low testosterone levels, poor energy, and increased risk of erectile dysfunction.

But when you have effective coping mechanisms and view stress as helpful not harmful, you can overcome it and rise to the occasion. Learning to beat stress will help you boost your immune system, lose weight, feel healthier, and enjoy the benefits of higher testosterone.

If you’re concerned about what stress may be doing to your health and testosterone levels, schedule a consultation to learn how to personalized health advice so you can live your life to the fullest. 

In Male 2.0™, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death.  Unfortunately, a man who tries to NOT get sick but isn’t really healthy either.  And a man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0!

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com

Want more tips to optimize your health?  Listen to the latest podcasts. Click HERE


  1. Wheaton, B., & Montazer, S. (2010). Stressors, stress, and distress. A handbook for the study of mental health: Social contexts, theories, and systems, 171-199.
  2. Dimsdale, J. E. (2008). Psychological stress and cardiovascular disease. Journal of the American College of Cardiology, 51(13), 1237-1246.
  3. Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PloS one, 12(2), e0172126.
  4. Moreno-Smith, M., Lutgendorf, S. K., & Sood, A. K. (2010). Impact of stress on cancer metastasis. Future Oncology, 6(12), 1863-1881.
  5. Bartolomucci, A., & Leopardi, R. (2009). Stress and depression: preclinical research and clinical implications. PloS one, 4(1), e4265.
  6. Corcoran, C., Mujica-Parodi, L., Yale, S., Leitman, D., & Malaspina, D. (2002). Could stress cause psychosis in individuals vulnerable to schizophrenia?. CNS Spectrums, 7(1), 33.
  7. Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130(4), 601.
  8. Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M. (1997). Social ties and susceptibility to the common cold. JAMA, 277(24), 1940-1944.
  9. Steptoe, A., Wardle, J., Pollard, T. M., Canaan, L., & Davies, G. J. (1996). Stress, social support and health-related behavior: a study of smoking, alcohol consumption and physical exercise. Journal of Psychosomatic Research, 41(2), 171-180.
  10. Mulligan, C. J. (2016). Early environments, stress, and the epigenetics of human health. Annual Review of Anthropology, 45, 233-249.
  11. Glad, C. A., Andersson-Assarsson, J. C., Berglund, P., Bergthorsdottir, R., Ragnarsson, O., & Johannsson, G. (2017). Reduced DNA methylation and psychopathology following endogenous hypercortisolism–a genome-wide study. Nature: Scientific Reports, 7, 44445.
  12. Wein, H. (2010). Stress Hormone Causes Epigenetic Changes. NIH Research Matters. https://www.nih.gov/news-events/nih-research-matters/stress-hormone-causes-epigenetic-changes
  13. Rubinow, D. R., Roca, C. A., Schmidt, P. J., Danaceau, M. A., Putnam, K., Cizza, G., … & Nieman, L. (2005). Testosterone suppression of CRH-stimulated cortisol in men. Neuropsychopharmacology, 30(10), 1906-1912.
  14. Rosen, R. C. (2001). Psychogenic erectile dysfunction: classification and management. Urologic Clinics of North America, 28(2), 269-278.
  15. Bond, D. S., Lyle, R. M., Tappe, M. K., Seehafer, R. S., & D’Zurilla, T. J. (2002). Moderate aerobic exercise, T’ai Chi, and social problem-solving ability in relation to psychological stress. International Journal of Stress Management, 9(4), 329-343.
  16. Hsu, Y. C., Tsai, S. F., Yu, L., Chuang, J. I., Wu, F. S., Jen, C. J., & Kuo, Y. M. (2016). Long-term moderate exercise accelerates the recovery of stress-evoked cardiovascular responses. Stress, 19(1), 125-132.
  17. Yassin, A. A., & Doros, G. (2013). Testosterone therapy in hypogonadal men results in sustained and clinically meaningful weight loss. Clinical Obesity, 3(3-4), 73-83.
  18. Craig, B. W., Brown, R., & Everhart, J. (1989). Effects of progressive resistance training on growth hormone and testosterone levels in young and elderly subjects. Mechanisms of Ageing and Development, 49(2), 159-169.
  19. Osterberg, E. C., Bernie, A. M., & Ramasamy, R. (2014). Risks of testosterone replacement therapy in men. Indian journal of urology: IJU: journal of the Urological Society of India, 30(1), 2.


Everything You Need to Know About Viagra and Cialis

Are you struggling with performance issues in the sack? 

If so, you are not alone. Erectile dysfunction (ED) refers to the inability to get or maintain an erection and unfortunately, this issue is on the rise (no pun intended). In 1995, 152 million men worldwide experienced ED, and that number is expected to swell to 322 million by the year 2025.[1]

As shocking as these statistics are, here’s another one: 75 percent of men diagnosed with ED do not seek out treatment.[2] 

Why is this the case? One reason is that men underestimate the prevalence of ED and fear the stigma associated with it. Another is that most assume only older men suffer from ED—that’s just not true. Yes, ED is more common among older men (with 50 percent of men aged 40-70 experiencing ED), but research shows the prevalence of ED in young men might be as high as 30 percent.[3]

The good news is you don’t have to suffer in silence. There are many viable treatments out there to help you “rise to the occasion.” These include ultrasound therapy, priapus p-shots, testosterone replacement hormone therapy, and exercises designed specifically to help erectile dysfunction. Another excellent option is oral medications, like Viagra and Cialis. Because these medications have been around for a long time, a great deal is known regarding their effectiveness and side effects. 

How Do Erectile Dysfunction Medications Work?

To understand how ED drugs work, you first need to know why ED happens in the first place. Although ED has several causes, the most common is vascular dysfunction

Whenever you start to feel hot and heavy, your brain releases certain hormones into your bloodstream. These chemical messengers tell your penis its show time and help it to develop an erection. One of these released chemicals—nitric oxide—is a vasodilator, which is just a fancy way of saying it relaxes your blood vessels and allows them to widen, thereby increasing blood flow. The greater the blood flow, the stronger the erection.

But what happens if your blood vessels don’t fully relax or they are narrow due to plaque buildup? In those cases, you may need a drug to help your vessels relax—essentially a chill pill for your penis. That is where Viagra and Cialis come in.

Both of these medications belong to a class of drugs called PDE5 inhibitors. PDE5 inhibitors work their magic by relaxing tight blood vessels and allowing more blood to flow to certain parts of the body, including the penis. And they have another benefit too. According to Dr. Harry Fisch, urology professor and author of Size Matters, these drugs also reduce the recovery time it takes to achieve a second erection, which is helpful for the 40 percent of men who suffer from premature ejaculation.[4] Lastly, these drugs have a psychological benefit because they help men suffering with performance anxiety gain their confidence back. 

Contrary to popular belief, ED drugs do not enhance the male libido and they rarely result in erections in the absence of sexual stimulation. “The biggest misconception is that these drugs are an on/off switch for erections,” says Dr. Louis Liou, chief urologist at Cambridge Health Alliance in Boston.[5] “You need to be with your partner and have foreplay. Don’t take it, do the taxes or the dishes, and then meet at the bedroom thinking you’ll be ready to go. It’s not like that.” 

ED medications only work in conjunction with sexual stimulation. That’s because they rely on nitric oxide, and as you learned earlier, nitric oxide only gets released during sexual arousal. ED drugs essentially provide a super boost for your naturally occurring nitric oxide, which in turn leads to greater blood vessel relaxation and blood flow. Without sexual stimulation, there is no nitric oxide and ED medications have nothing to work with. So the pump has to be primed, but once it is, ED medications will boost your flow.

How Do Viagra and Cialis Differ?

Although Viagra and Cialis both increase blood flow to the penis, there are important distinctions. 

Viagra, the brand name for sildenafil, was the first oral pill to receive FDA approval for treating ED in 1998. Because it has been on the market the longest, it is often doctors’ first drug of choice when treating patients with ED. The typical dosage recommended is 50mg, although it can be reduced to 25mg or increased to 100mg, if needed. 

Viagra has an effectiveness rate that ranges from 77 percent (50 mg) to 84 percent (100 mg).[6] It requires 30 to 60 minutes to begin working and the effect can linger up to 24-36 hours. Viagra is taken on an as needed basis, which means its use requires a bit of planning. If you want complete spontaneity, this may not be the drug for you.

In 2003, Cialis, the brand name for tadalafil, was also approved by the FDA to treat ED. Cialis can be used like Viagra as needed at a higher dose (typically 20 mg), or can be taken daily at a lower dose (typically 5 mg). When taken daily, Cialis offers more opportunities for spontaneous sexual encounters.

Cialis has an effectiveness rate that is very similar to Viagra, ranging from 71 percent (10 mg) to 84 percent (20 mg).[7] It requires 30-60 minutes to begin working and the effects can last up to 36-48 hours. To be clear, this doesn’t mean you will have an erection for all of that time; remember sexual stimulation is always needed in conjunction with ED drugs. Cialis’ longer duration and allowance for more spontaneity likely explains why men prefer it over other ED drugs.[8]

What Are the Risk Factors? 

The hard truth is that all medications have side effects, and ED drugs are no different.

First, let’s get the scariest side effect out of the way. If you’ve seen a TV commercial for Viagra or Cialis, you’ve likely heard the warning of a prolonged erection. Although it is incredibly rare, some men taking ED drugs do experience erections lasting 4 hours or more. This is not normal, and if it happens to you, consider it a medical emergency. This condition, known as priapism, can cause permanent damage to your penis’ tissue, so you should seek medical attention right away if it occurs. Luckily, priapism is a rare occurrence, but it does have a tendency to occur more frequently in men with sickle cell anemia, leukemia, and some penile deformities.

Now for the more common side effects. These include, in order from most common to least common: headaches, flushing, upset stomach, nasal congestion, vision problems, diarrhea, dizziness, and rash.[9] Cialis can also cause back pains and muscle aches. In most cases, men taking ED medications either don’t experience significant side effects. As Dr. Fisch succinctly put it, “If you have real erectile dysfunction, you’ll put up with nasal congestion.”[10] But here is a piece of useful advice: if you do experience side effects when taking Cialis, consider switching to Viagra since it stays in your system for a shorter duration. 

Beyond side effects, there is also the issue of drug interactions. You can’t take any of the ED medications if you are currently taking nitrate medications (like nitroglycerin) for heart issues. Doing so can cause a sudden and dangerous drop in blood pressure. ED medications can also interact with drugs that lower blood pressure, like alpha blockers or antifungal medications. If you are on such medications, your doctor may recommend you start with a lower dose ED drug, that you use Viagra instead of Cialis since Viagra leaves your system quicker, and that you space your other medications and your ED medication four hours apart. 

Finally, it is worth mentioning that ED can be a sign of a larger health issue. Because ED is often caused by vascular issues, it may be an early detector of cardiovascular disease that should not be dismissed. Yet another reason why any man suffering from ED should seek out the expertise of a doctor.

Do These Drugs Interact with Food or Alcohol?

Let’s face it, no one has sex in a vacuum. We often use food and alcohol as foreplay to relax and get ourselves (and our partner) in the mood. But things get tricky when you are taking ED drugs.

When it comes to food, it depends on the particular drug. Viagra should not be taken with food—doing so slows down the medication’s absorption and reduces its effectiveness. This is not the case with Cialis, which can be taken on a full stomach. However, with both drugs you should avoid consuming grapefruit or grapefruit juice, since this can cause a dangerous drug interaction.

When it comes to alcohol, a glass of wine or a bottle of beer won’t hurt you. But drinking excessively (more than two servings of alcohol a day) while taking ED drugs can put you at risk. Both Viagra and Cialis relax your blood vessels, which in turn lowers blood pressure. The problem is that alcohol does the same thing. That means that if you drink too much while taking ED drugs, your blood pressure could drop to dangerously low levels. You may get light-headed, faint, or even experience heart palpitations. Both ED drugs interact with alcohol in this way, but it’s more likely to occur for men taking Cialis since the drug stays in your system for a much longer duration. 

Plus, here’s something else to keep in mind. Heavy drinking is one of the main causes of erectile dysfunction, especially in younger men. So if you are suffering from ED, you already shouldn’t be drinking more than two servings of alcohol a day. 

Do I Need a Prescription?

In the United States, both Viagra and Cialis (as well as their generic counterparts) require a prescription from a doctor. Interestingly, in 2018 it became legal in the UK to buy Viagra over-the-counter, so in the future this may be an option, but for now, you need a prescription.

Some men try to skip this step and buy ED drugs online. That’s a really bad idea since most versions sold online are not only illegal, they are highly dangerous. In fact, Viagra is one of the most counterfeited drugs on the market and an estimated 80 percent of online sites that claim to sell Viagra are actually selling a counterfeit version.[11] These knock offs have been found to contain chemicals you definitely don’t want to put in your body, like road paint, floor wax, printer ink, amphetamines, and rat poison!

So do yourself a favor. Go to the doctor, get a prescription, and only buy the real deal.

How Much Do These Drugs Cost?

The cost of brand-name Viagra is quite pricey, as high as $77 per 50mg pill. However, in 2017 two companies started producing a generic version of Viagra, which costs around $30 for a 50mg pill. That’s a big improvement, but it’s still a hefty price tag. 

An even cheaper option is to get a prescription for sildenafil citrate which is used to treat pulmonary arterial hypertension, dropping the price down under $5 for a 100mg pill. Using this drug in an “off label” way to treat erectile dysfunction is a fairly common approach. 

Cialis is not much cheaper than Viagra. A brand-name Cialis pill will cost you as much as $72 for the typical 20mg dose, or $13 for the typical daily dose (5mg). The generic tadalafil can cut the cost down to around $5 for the as needed dose or $3 for the daily dose.

At this point, you may be wondering if Viagra and Cialis (as well as their generic counterparts) are covered by your health insurance. Unfortunately, the answer isn’t clear-cut. Insurance coverage for ED drugs is hit or miss—some cover it, others don’t. You will need to call your specific health insurance company to find out. 

One thing to keep in mind is that insurance companies are often more likely to cover the generic versions of these medications since they cost half the price. Another is that when an insurance company does cover the drug, it is often for a limited supply (for example, four pills per month). Anything above this amount will likely be out-of-pocket. Lastly, know that Cialis is not only used to treat ED, it also treats prostate enlargement. When it’s prescribed for this reason, it usually is covered by health insurance. 

Beyond insurance, there are a number of other strategies you can use to cut down on costs. First, always shop around because prices may vary across pharmacies. Using a price comparison tool like GoodRX is a great option in this regard. Second, ask your doctor about pill splitting, which means getting the prescription at a higher dose and cutting the pill in half. Using this approach is a bit tedious but it will save you a few bucks. Third, explore the drug manufacturer’s websites because they often offer discount programs for new users. Fourth, you can use coupons and discount promotions like those offered at www.goodrx.com or www.drug.com to shave off a little from the final price.

The main point to remember is that having ED doesn’t mean the E-N-D of your sex life. There are lots of options out there, so talk to your doctor and get the treatment you need. And if you are looking for the best natural remedies for erectile dysfunction, check out my article regarding ED lifestyle changes, or my other article regarding vasodilator supplements.


It’s time to get empowered to take control of your health. Unlock the code to peak performance with the Male Method™ to regain your energy, focus and confidence to feel like a man again. 

We take a whole-body, epigenetic approach to health, focusing on all inputs and how they affect the human system. With the Male 2.0 Method, we utilize science-based precision medicine, personalizing your health based on your unique genetic blueprint. No more guessing!

We utilize cutting-edge age management protocols to reverse the aging process and expand longevity. And we track and leverage your biometric data using state-of-the-art wearable technology to truly optimize your health.

Ready to take the next steps? 

Download the Blueprint

Schedule a Call



In Male 2.0™, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death.  Unfortunately, a man who tries to NOT get sick but isn’t really healthy either.  And a man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.GapinInstitute.com

Want more tips to optimize your health?  Listen to the latest podcasts. Click HERE

Ready to take the next steps!?

Download the Blueprint

Schedule a Call


Stop ED in its Tracks

Man on couch disappointed Stop Erectile dysfunction in its tracks

Erectile dysfunction, or ED, occurs when a man has difficulty achieving or maintaining an erection for sexual intercourse. It can be awkward and cause feelings of inadequacy. While ED can be a very distressing health issue, it can also be embarrassing to discuss with your health provider or physician. 

ED is very common, with some research estimating that it affects about one in two American men over 40. (1) It’s up there with hair loss, weight gain, and low testosterone for the most popular men’s health concerns.

The good news is that there are several safe and effective ways to increase male libido and improve symptoms of ED. In this article, I’ll review some of the research on ED and provide some effective options for guys to improve their sexual performance and stop ED in its tracks.

What Causes Erectile Dysfunction?

To begin with, let’s take a bit of a look at what causes ED. 

Erections occur when sexual stimulation causes the body to send out neurochemicals that relax muscles and increase blood flow to the penis. This causes the penis to enlarge and harden. 

Because this process involves a complex combination of psychological input and biological mechanisms, there are a number of ways it can go wrong. Both psychological and physical factors, as well as lifestyle factors, can cause or contribute to ED. (1, 2, 3) Here are some of the most common causes of ED:

Psychological factors:

  • Stress
  • Anxiety
  • Depression

Physical factors:

  • Diabetes
  • High blood pressure
  • Nerve damage
  • Neurological disorders
  • Stroke
  • Blood clots
  • Atherosclerosis
  • Spinal disease

Lifestyle factors:

  • Smoking
  • Alcohol
  • Drug abuse
  • Inactivity
  • Other medications like antidepressants

Each of these may be enough to cause symptoms of ED on their own, but they can also occur together. So what can a guy do to prevent or treat ED?

Diet and Erectile Dysfunction

Several studies have shown that good nutrition can actually help prevent ED. If you put garbage into your body, you’re not going to get your best out of it. You want to make sure you’re fueling yourself with high-quality, nutritious foods so you can maximize your performance in all respects, including in the bedroom.

Healthy breakfast in a bowl fresh fruit and nuts prevent ED

Foods to choose

In general, aim for non-processed, fresh foods and a diet rich in vegetables, healthy fats, and fish (6). The Mediterranean diet seems to be particularly effective for preventing ED. (4) 

Some particular foods may be especially useful for protecting against ED. These include:

  • Pistachios (5)
  • Watermelon
  • Leafy greens
  • Beets
  • Dark chocolate
  • Oysters
  • Shellfish
  • Tomatoes
  • Pink Grapefruit
  • Onions and garlic
  • Cranberries
  • Tea
  • Peanuts

Foods to avoid

Some foods are known to contribute to ED symptoms, so try to avoid them. Common ones include (6):

  • Excessive Alcohol 
  • Red meat
  • Full fat dairy
  • Sugary foods and drinks (7)
  • Foods that are high in saturated and trans fats
  • White bread and processed foods (8)


Can supplements help ED? It appears that some can be effective erectile dysfunction remedies. Here are some of the better-known supplements that can help improve ED:

  • Panax ginseng (9)
  • Rhodiola Rosea (10)
  • Dehydroepiandrosterone (DHEA) (11)
  • L-arginine (12)

Exercises to Help Erectile Dysfunction

Exercise is probably the best natural remedy for erectile dysfunction. Improving cardiovascular fitness together with maintaining a healthy weight have both been shown to be especially effective at helping men achieve satisfying erections.

Cardiovascular fitness

One of the causes of ED is inadequate or impeded blood flow to the penis. Studies have shown that people with ED typically have lower heart-rate variability (HRV), which suggests reduced vascular efficiency and poor overall health. (13) And research has found that moderate and high physical activity are associated with a lower risk of developing ED (6). 

When a guy exercises, and especially when he challenges his cardiovascular system, he is training his body to pump his blood more efficiently. Cardiovascular exercise can also reduce hypertension and prevent cardiovascular disease, both of which are associated with ED. 

More than that, exercise also has beneficial effects on a person’s self-esteem and mental health, each of which can positively impact the psychological factors associated with sexual dysfunction. (6)

Try to get at least 150 minutes of moderate-intensity aerobic exercise a week. (14) Common aerobic exercises are:

  • Running
  • Cycling
  • Swimming
  • Playing tennis

Man running cardio helps to fight Erectile dysfunction

Strength training

Strength training exercises can also help address ED. Strength training and muscle building can build self-esteem and confidence in bed. And, as a nice side-effect, a firmer physique may be more attractive to your partner. 

Try to do strength training exercises for all major muscle groups at least two times a week. (14) You can get this by working out at the gym, or you can try a body-weight training exercise program. 

Weight loss

Being overweight is actually one of the biggest causes of ED (6). Excess fat seems to change body chemistry and lower testosterone which lowers men’s libido. Several studies have found that when overweight guys experience healthy weight loss, their erectile function improves. (15) 

Combining a healthy diet and regular exercise is a good start for guys with a bit extra belly fat to lose some weight. 

Additional lifestyle changes 

Besides exercising and eating well, there are a number of lifestyle changes that can help you improve your health and sexual performance. 

Reduce stress

Stress is known to reduce libido and is an erection killer. It also contributes to other poor health habits like excessive drinking and smoking. If you find ways to cope with your stress, you’ll remove one possible cause of ED.

There are lots of things you can do to combat stress. Consider strategies like starting a meditation routine, connecting regularly with friends, or even seeing a therapist.


Sleep is one of the most important factors in health, especially as we age. Research shows that individuals who do not get adequate sleep—around 7 to 8 hours a night—are more likely to suffer from ED. Sleep apnea, a condition that keeps people from getting enough air as they sleep, which in turn causes them to continually wake up throughout the night, is an especially potent cause of ED. (16)

The solution? Get enough sleep. 

The best way to get enough sleep is to create habits and routines that contribute to sleep hygiene. That includes going to bed at the same time every night, making your sleep environment comfortable, and removing distractions. If you suffer from sleep apnea, discuss treatment options with your doctor.

Communicate with your partner

Open, honest communication with your partner can help build a stronger relationship and enhance emotional closeness. And emotional closeness can lead to better sex. By expressing yourself, and especially expressing your sexual desires, you can increase sexual intimacy and improve your sexual experiences.  

Couple talking and communicating

Therapy for Erectile Dysfunction

Sometimes even with the best care of your body, erectile dysfunction can occur. Luckily, there are lots of erectile dysfunction remedies. 


You’re probably already familiar with sildenafil, or its trade name “Viagra”. Tadalafil, more commonly known as Cialis, is another oral treatment for ED. Both work by helping the blood vessels in the penis relax, allowing them to let more blood in. Both require sexual stimulation to work, and erections go away after sex. They are often effective treatments, but they may not work for everyone.

Medication injections

Medicated injections into the penis immediately before intercourse is an effective ED treatment. (17) There are several possible injections, including papaverine, phentolamine, prostaglandin E1 (PGE1), or alprostadil (Caverject, Edex, MUSE). Each of these work by causing smooth muscle in the penis to relax and blood to enter.   

The Priapus P shot

The priapus p shot, also known simply as p-shots or the “P-shot”, is a different kind of injection. This form of therapy essentially involves taking plasma from a person’s own blood that is rich in platelets. That plasma is then injected into the penis. So rather than medicine, this injection uses material from a person’s own body.

Vacuum therapy

With vacuum therapy, a suction device is placed around the penis. It creates a difference in air pressure that draws blood into the penis. A ring placed at the base of the penis keeps the blood in and helps maintain the erection. The device can create an effective erection for about 30 minutes, after which the ring must be removed. 

Hormone therapy

Hormone therapy, also known as hormone replacement therapy or HRT, is another potential way to beat ED. Testosterone plays a role in normal libido as well as in the erectile process. Men who have lower than normal testosterone may benefit from testosterone replacement therapy. This is especially the case for hypogonadal men with an ED diagnosis. (19) 

Ultrasound therapy

It’s also possible to get ultrasound therapy for erectile dysfunction. This therapy involves sending low-intensity shockwaves, which causes microtraumas. The body then repairs the tissue and generates new blood vessels as it does so. Several studies have found that ultrasound therapy can result in improved blood flow for men with ED. (20)

Penile implant surgery

For stubborn cases of ED that fail other more conservative measures, guys can get a  surgically-implanted penile prosthesis. This can either be semi-rigid or inflatable, and provide an ‘immediate’ erection when desired. 

Using Precision Medicine

In addition to the general advice that’s good for everyone, there may be some specific ways that an individual can address their ED and increase libido.

Precision medicine is effective because it takes into account a person’s own specific genetic make-up. They complete a DNA test, which gives them insight into how their particular body chemistry works. This allows their doctor to tailor a health program directly to how their body is set up. Some providers, myself included, offer VIP lifestyle coaching that can be an effective way to address erectile dysfunction. 

Conclusion: Don’t Let ED Get You Down

Sexual health isn’t just a nice to have—it’s incredibly important to our overall health. Sex can help us stay physically active, lower blood pressure, improve closeness with our partners, and even boost our immune systems. A healthy sex life is essential for our psychological well-being, too. 

Man and woman smiling and jumping on mountain sexual health
ED can be a major impediment to a man’s sexual health, but it doesn’t have to be. Guys can make changes to their lifestyle to help prevent ED, and there are a number of effective medical options to treat it. 

It’s time to get empowered to take control of your health. Unlock the code to peak performance with the Male MethodTM to regain your energy, focus and confidence and feel like a man again. 

We take a whole-body, epigenetic approach to health, focusing on all inputs and how they affect the human system. With the Male 2.0 Method, we utilize science-based precision medicine, personalizing your health based on your unique genetic blueprint. No more guessing!

We utilize cutting-edge age management protocols to reverse the aging process and expand longevity. And we track and leverage your biometric data using state-of-the-art wearable technology to truly optimize your health.

Ready to take the next steps?

Schedule a Call



In Male 2.0™, Dr. Tracy Gapin has turned everything we once thought we knew about men’s health and performance upside down. The old model of how to be “a man” is broken. A man who works himself to death.  Unfortunately, a man who tries to NOT get sick but isn’t really healthy either.  And a man who takes a pill for every ill but is never really cured. That was Male 1.0. Now, imagine being THE MAN ─ owning your performance in the bedroom, the weight room, and the boardroom. Living a fully optimized life. Becoming limitless. This is Male 2.0! Available on Amazon.

Tracy Gapin, MD, FACS  is a board-certified Urologist,  world renowned Men’s Health & Performance Expert, Author, and Professional Speaker. Using state-of-the-art biometric monitoring, nutrition and lifestyle intervention, Dr. Gapin coaches Fortune 500 executives and evolutionary leaders of business, sports medicine, and high performance. He specializes in cutting-edge precision medicine with an emphasis on epigenetics, providing men with a personalized path to optimizing health & performance. www.DrTracyGapin.com

Want more tips to optimize your health?  

Listen to the latest podcasts. Click HERE 


  1. 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.
  2. Çayan, S., Kendirci, M., Yaman, Ö., Aşçı, R., Orhan, İ., Usta, M. F., … & Kadıoğlu, A. (2017). Prevalence of erectile dysfunction in men over 40 years of age in Turkey: Results from the Turkish Society of Andrology Male Sexual Health Study Group. Turkish Journal of Urology, 43(2), 122.
  3. Quilter, M., Hodges, L., von Hurst, P., Borman, B., & Coad, J. (2017). Male sexual function in New Zealand: a population-based cross-sectional survey of the prevalence of erectile dysfunction in men aged 40–70 years. The Journal of Sexual Medicine, 14(7), 928-936.
  4. Giugliano, F., Maiorino, M. I., Bellastella, G., Autorino, R., De Sio, M., Giugliano, D., & Esposito, K. (2010). Erectile dysfunction: adherence to Mediterranean diet and erectile dysfunction in men with type 2 diabetes. The Journal of Sexual Medicine, 7(5), 1911-1917.
  5. Aldemir, M., Okulu, E., Neşelioğlu, S., Erel, O., & Kayıgil, Ö. (2011). Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. International Journal of Impotence Research, 23(1), 32-38.
  6. Maiorino, M. I., Bellastella, G., & Esposito, K. (2015). Lifestyle modifications and erectile dysfunction: what can be expected?. Asian Journal of Andrology, 17(1), 5.
  7. Adamowicz, J., & Drewa, T. (2011). Is there a link between soft drinks and erectile dysfunction?. Central European Journal of Urology, 64(3), 140.
  8. Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192.
  9. Jang, D. J., Lee, M. S., Shin, B. C., Lee, Y. C., & Ernst, E. (2008). Red ginseng for treating erectile dysfunction: A systematic review. British Journal of Clinical Pharmacology, 66(4), 444-450.
  10. Brown, R. P., Gerbarg, P. L., & Ramazanov, Z. (2002). Rhodiola rosea: A phytomedicinal overview. HerbalGram, 56, 40-52.
  11. Reiter, W. J., Pycha, A., Schatzl, G., Pokorny, A., Gruber, D. M., Huber, J. C., & Marberger, M. (1999). Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study. Urology, 53(3), 590-594.
  12. Chen, J., Wollman, Y., Chernichovsky, T., Iaina, A., Sofer, M., & Matzkin, H. (1999). Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized, placebo-controlled study. BJU International, 83(3), 269-273.
  13. Harte, C. B. (2013). The relationship between resting heart rate variability and erectile tumescence among men with normal erectile function. The Journal of Sexual Medicine, 10(8), 1961-1968.
  14. Center for Disease Control and Prevention. (n.d.). How much physical activity do adults need? https://www.cdc.gov/physicalactivity/basics/adults/index.htm
  15. Dallal, R. M., Chernoff, A., O’Leary, M. P., Smith, J. A., Braverman, J. D., & Quebbemann, B. B. (2008). Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. Journal of the American College of Surgeons, 207(6), 859-864.
  16. Zias, N., Bezwada, V., Gilman, S., & Chroneou, A. (2009). Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor?. Sleep and Breathing, 13(1), 3-10.
  17. Duncan, C., Omran, G. J., Teh, J., Davis, N. F., Bolton, D. M., & Lawrentschuk, N. (2019). Erectile dysfunction: A global review of intracavernosal injectables. World Journal of Urology, 37(6), 1007-1014.
  18. Scott, S., Roberts, M., & Chung, E. (2019). Platelet-rich plasma and treatment of erectile dysfunction: Critical review of literature and global trends in platelet-rich plasma clinics. Sexual Medicine Reviews, 7(2), 306-312.
  19. Jacob, B. C. (2011). Testosterone replacement therapy in males with erectile dysfunction. Journal of Pharmacy Practice, 24(3), 298-306.
  20. Gruenwald, I., Appel, B., Kitrey, N. D., & Vardi, Y. (2013). Shockwave treatment of erectile dysfunction. Therapeutic Advances in Urology, 5(2), 95-99.

Erectile Dysfunction and Early Death – What’s The Link?

ED typically stands for erectile dysfunction…

But it could also mean “early death.”

There is a proven and serious link between these two variations of ED—erectile dysfunction and early death.

In fact, erectile dysfunction may be one of the first and most prominent indicators of increased risk for early death. A study at the University of Mississippi—which researched 1,790 men over the course of seven years—found that risk of death was 70% higher in men with erectile dysfunction than without.

Moreover, they found that ED wasn’t just a predictor of increased risk of death in later years with older men. Erectile dysfunction in young men also shows this same increased death rate. And with nearly 25% of men under age 40 suffering from ED, these associated risks of early death at a young age are alarming.

But how could this be? Isn’t erectile dysfunction just a “down there” problem? What does your penis have to do with your lifespan?


The Cause of ED

Let’s first start this discussion by talking about the causes of erectile dysfunction.

ED is the inability to get or maintain an erection.

In order for you to get an erection, your penis has to fill up with blood. When your body starts to feel sexy, it releases hormones like testosterone and nitric oxide (NO). These signal your body and penis that it’s time to start preparing for sex. Nitric oxide relaxes the penile muscles and opens up the blood vessels. This loosens the blood vessels so they can push blood to the penis in order to get an erection.

This means that you need both a healthy hormonal system, neurological system, and vascular or blood system working in tandem to get an erection. (Did you know that much was going on in your body when you’re trying to get it on?)

If one of these systems isn’t functioning properly, you can’t get an erection. For example, if you have unbalanced hormones, your body may be overloaded with cortisol and can’t produce the necessary NO to get an erection. Or if you have anxiety, your brain may not have the capacity to send necessary signals to your endocrine system. Even a porn addiction can cause erectile dysfunction.

ED has a variety of causes, but the primary reason for erectile dysfunction is vascular dysfunction.

“Vascular” refers to your blood vessels. A vascular dysfunction can come from constricted blood vessels, injury to the blood vessels, or plaque buildup in the vessels.

Basically, you need clean and clear blood vessels to push blood flow to the penis in order to get an erection.

If you don’t have clear blood vessels, erectile dysfunction ensues.

Plaque Buildup

“Plaque” is the gunk that clogs the arteries or blood vessels. This is what we refer to as the “hardening” of the arteries, medically referred to as “atherosclerosis.” Basically, cholesterol starts to cling on to the sides of your blood vessels. This clogs up your arteries so blood flow is restricted.

Think of it like a hairball in your shower (I know, it’s your partner’s fault). The hairball latches on to the side of the pipe. A small clump of hair still lets water flow down. But as the hairball grows, it starts letting less and less water flow. Water begins to backup into your shower or bath because the water can’t flow as easily with the growing hairball stuck in the way.

Plaque buildup creates this same sort of narrowing of the blood vessels. It begins to clog up the vascular system so blood can’t flow as easily.

Your body needs blood in order to function properly. Without adequate blood flow, your body can shut down within minutes.

In the brain, clogged arteries cause memory loss, dementia, and stroke.

In the heart, clogged arteries cause angina (chest pain), heart attacks, heart disease, and cardiovascular conditions.

This obstruction of blood flow is what causes heart disease, heart attack, and other fatal diseases.

Erectile Dysfunction and Plaque Buildup

Plaque buildup happens everywhere throughout the body, not just your heart. It’s not restricted to the heart, as we often belief. The heart is often place we care most about, because clogged heart arteries lead to heart disease and heart attacks.

But, in reality, all the blood vessels in your body start to develop the same buildup of cholesterol at the same time.

This means that the vessels in your penis are narrowing at the same rate as the vessels in your heart.

But the vessels in your penis are smaller than those in other places in your body. In fact, the penile arteries are about half the size of coronary ones. This means they can close up twice as fast.

Think of it this way. Is it easier to clog a small sink drain or a large shower drain? What if you used the same sized hairball in both? A large hairball will clog up a narrower sink drain faster than a thicker shower drain.

Plaque buildup first shows sign in the narrower penile blood vessels than the thicker arteries in other parts of the body.

If you are experiencing erectile dysfunction, it could be because your penis isn’t getting adequate blood flow and there’s likely some sort of vascular clog in the way—like plaque and cholesterol buildup.

If there’s buildup in your penile arteries, there’s buildup in all the arteries in your body, which means that the arteries in your heart are also hardening and clogging.

Erectile dysfunction is the first warning sign of plaque buildup and hardening arteries.

In fact, these two are so linked that ED is often called “penile angina.”

Thus, erectile dysfunction is the first symptom and sign of heart disease, heart attack, dementia, and stroke.

ED = Warning Sign


Let’s reiterate.

Heart disease is the result of plaque buildup in the arteries near the heart.

Stroke is the result of plaque buildup in the arteries in the brain.

Erectile dysfunction is often the result of plaque buildup in the arteries in the penis.

Plaque buildup throughout the body happens all at the same time.

So if you’re showing signs of plaque buildup in one area (like the penis), it means your entire body’s blood vessels have that same buildup.

So erectile dysfunction does not cause heart disease or stroke.

But it may be your first clue that something serious is going on in your body.

So stop ignoring your erectile dysfunction!

In fact, one study found that nearly 70% of patients rushed to the ER for chest pain—whether angina or heart attack—had erectile dysfunction symptoms leading up to hospitalization.

You read that right.

7 in 10 men with heart concerns first showed erectile dysfunction.

Erectile dysfunction is your body’s red flag.

Another study found that doctors can predict the hardening of the coronary arteries and related cardiac stress with an accuracy of 80% after measuring blood flow in the penis.

Yup, doctors use a PCDU (penile color Doppler ultrasound) to measure the blood in a flaccid penis, and they can tell how severe your heart disease is with 80% accuracy.

So why aren’t more men getting their penile blood vessels checked out?

Because they don’t know that erectile dysfunction is the first sign of serious diseases.

They don’t know that ED is linked to overall mortality and cardiovascular mortality rates.

They don’t know that having erectile dysfunction makes you 70% more likely to die an early death.

But now you know.

So what can you do about it?

Reducing Your ED2 Risk

  1. Don’t just think about your penis.

When most men get erectile dysfunction, they think first and foremost about the consequences in the bedroom.

Of course you want to solve your ED so you can have a healthy sex life again.

But, as we’ve come to find, ED is more than just a “down there” problem. ED can be a symptom of a serious underlying disease.

That’s why taking pills like Viagra can be so dangerous. You’re masking the symptoms and pretending everything is okay, rather than seeing ED as the serious symptom it is.

So focus on addressing the root cause of your erectile dysfunction: the blood vessels.

If you can clear out your blood vessels, you’ll likely stop having erectile dysfunction and you’ll have a healthier heart and brain.

The Rancho Bernardo Study found that risk factors for heart disease are also the risk factors for erectile dysfunction. Improving these risk factors in mid-life can decrease the risk of cardiovascular disease and erectile dysfunction.

So focusing on heart health will ensure erectile health and vice versa.

Keep in mind that not all men will suffer erectile dysfunction due to a vascular dysfunction like plaque buildup. ED can also be a hormonal or psychological concern.

Nevertheless, ED doesn’t happen “just because.” It often signals some other underlying concern, like diabetes or chronic stress.

Both diabetes and chronic stress can increase your risk of early death. (Chronic stress has even been shown to cause atherosclerosis.)

See how ED can be your best friend in alerting you to other problems in your body?

Talk to a doctor to discover the cause of your ED—and how to attack the problem at its core.

  1. Reduce your body’s inflammation.

Atherosclerosis is a systemic inflammatory condition. This means that those with chronic inflammation are at a greater risk of plaque buildup.

Chronic inflammation may be linked to almost all deadly diseases, including cancer, stroke, Alzheimer’s, and heart disease. It’s also been linked to—you guessed it— erectile dysfunction.

Click here to learn more about this silent killer and how to overcome chronic inflammation fast.

  1. Eat a Mediterranean diet.

The Mediterranean diet has been shown to have positive results on both your heart and penis. This diet cleans out your arteries, reducing gunk from clogging up your vessels. 

The Mediterranean diet consists of fresh fruit and vegetables, whole grains, nuts, olive oil, and legumes. Olive oil especially has been linked to a decrease in cardiovascular disease and early mortality rates. This article by EatingWell makes the Mediterranean diet easy to understand. 


Want to get exact recipes and foods you should be eating for heart and sexual health? 

The Mediterranean diet also improves metabolic syndrome, endothelial function, and inflammatory markers. Metabolic syndrome increases your risk of early death due to its conditions of pre-diabetes, high blood pressure, high cholesterol, and obesity. Learn more about overcoming metabolic syndrome for optimal health here.

Moreover, you should avoid any inflammatory or vessel-clogging foods. This includes packaged and processed foods, animal meats (in high quantities), soy, flaxseed, dairy, fried foods, salt, and alcohol. Learn more about the 7 foods causing your erectile dysfunction and clogging your arteries.

You should also focus on keeping your vitamin D levels high. Vitamin D deficiency is linked to erectile dysfunction and other health concerns, including cancer, diabetes, bone loss, and heart disease.

Also check out: 13 Natural Vasodilators To Treat Your ED

  1. Workout.

When you get the blood pumping with physical activity, you’re forcing blood to flow through the veins. This can actually help unclog your veins and get rid of plaque buildup.

Cardio gets the blood moving and the heart pumping, which helps clear out any gunk and keep your vessels clear.

Let’s go back to that shower clog. You may pour a heavy-duty clog solution like Plumr or Power Plumber down the drain (rather than snaking the drain, which we all hate to do). These solutions work in a similar way as a surge of blood from working out. It helps push out the clogs because the pressure is so powerful.

Working out is one of the healthiest ways to keep your blood free of serious buildup.

Check out these 9 exercises to beat ED and keep your heart healthy.

  1. Stop thinking you’re immune.

If you’re under 40 and you have erectile dysfunction, you’re at the same risks of early death as men over 40.

You’re also not alone. Nearly 25% of men under 40 suffer from erectile dysfunction at some point.

If you have erectile dysfunction under 40, you should be even more aware of your vascular and heart health. It’s critical that you talk to your doctor about lifestyle and eating habits to reduce cholesterol, blood pressure, and risk factors.

No matter who you are or what age you are, if you have erectile dysfunction, it’s time to visit the doc.

Erectile dysfunction is not something to be ashamed of.

Think of ED as your body’s way of saying, “Hey, guy! Wake up!”

I know you want to have vibrant, passionate sex once again.

I know you want to have a healthy heart, brain, and blood flow.

And I know you want to live a long and energetic life.

So stop waiting to take your health into your hands.

Are Low Vitamin D Levels Linked To ED?

Studies have concluded that vitamin D deficiency and erectile dysfunction are strongly correlated. In fact, a study published in Dermato-endocrinology found that men with a vitamin D deficiency have a 30% greater prevalence of ED and an 80% greater prevalence of severe ED compared to men with optimal levels of vitamin D.

But why is this? What’s the link between vitamin D and the ability to have an erection?

More importantly, what can you do to ensure that a vitamin D deficiency isn’t killing your sex life?

What Is ED?

Erectile dysfunction, also called “impotence,” is when a man has difficulty achieving or maintaining an erection long enough to have satisfactory sexual intercourse. This could mean that the erection quickly fades or that he can’t have an erection at all.

Erectile dysfunction has a lot of moving parts. The causes of ED can be varied, which can make it difficult to treat in the long-term. ED can be neurological (brain), vascular (blood vessels), muscular, hormonal, and even psychological. Oftentimes, ED is a vascular problem caused by endothelial damage or inhibition of vasodilation. Basically, this means that the blood vessels are damaged and can’t properly transport blood to the penis (which is what gets the penis hard).  

ED is often a symptom of another underlying disease or concern, like cardiovascular disease or diabetes. In fact, erectile dysfunction is often one of the first and primary indicators of heart disease.

What Is A Vitamin D Deficiency (VDD)?

A “deficiency” of a vitamin means that your body doesn’t have the amount of that nutrient in the body for proper function. A vitamin D deficiency is usually classified as anything below 20 or 30 ng/mL. The Vitamin D Council recommends optimal vitamin D levels between 40 and 80 ng/mL.

Nearly three-quarters of all U.S. teens and adults are deficient in vitamin D. Often called the “sunshine vitamin,” scientists are realizing more and more just how important vitamin D is to overall health. In fact, research has shown that a deficit in vitamin D can be linked to a number of health concerns, from cancer to diabetes to bone loss to heart disease… to erectile dysfunction.

Vitamin D plays a role in the health of:

  • Bone
  • Immune system
  • Muscle function
  • Cardiovascular system
  • Respiratory system
  • Brain development

Did you know: Vitamin D is the only vitamin that your body produces. Your body can’t make other vitamins; it receives those vitamins from foods. But your body can make vitamin D when your skin is exposed to sunlight.

Because of this unique aspect of vitamin D, it’s not always the easiest vitamin to give to our bodies. Eating more of a food won’t necessarily increase our vitamin D levels that much. The process of making vitamin D is a little more complex than other nutrients.

And that’s one reason why so many Americans are deficient in vitamin D.

Most people don’t show signs of vitamin D deficiency… though most people have it. Interestingly, a 2015 study found that 67% of 160 physicians studied had vitamin D deficiencies. Even doctors—who should be the best at watching their health—are deficient in vitamin D.

Vitamin D deficiency (VDD) has become an epidemic.

How Are ED And VDD Linked?

A number of recent studies have proven that vitamin D deficiency and erectile dysfunction have some sort of correlation, independent of other risk factors. Researchers have concluded that “a significant proportion of ED patients have a vitamin D deficiency.” Ultimately, as researchers Sorenson and Grant wrote in their 2012 study: “We conclude that VDD contributes to ED.”

This study also found that low levels of vitamin D promoted endothelial dysfunction. Vitamin D has been shown to help improve endothelial function, while a deficiency in vitamin D contributes to endothelial dysfunction.

But what is endothelial dysfunction?

The endothelium is the inner lining of the blood vessels. This basically keeps your blood flowing smoothly and healthily. If there is endothelial dysfunction, there is an imbalance in the vessels, which restricts blood flow. This dysfunction can come from high blood pressure, diabetes, high cholesterol, plaque build-up, smoking, or other environmental factors.

In order for you to have an erection, your penis needs to fill up with blood to get “hard.” If your blood vessels aren’t working properly, blood can’t get down to your penis to fill it up. This can cause a vascular-related erectile dysfunction.

Vitamin D has been shown to promote endothelial function. In the opposite way, vitamin D deficiency can actually damage our endothelial system and injure our blood vessels. If your blood vessels are injured, they can’t do their job and get blood flowing to your penis to have an erection.

Moreover, damaged blood vessels can also lead to an increased risk for cardiovascular disease, which we’ll discuss below.

Vitamin D also plays a role in nitric oxide synthesis. Nitric oxide is needed to relax the smooth muscles of the penis and open up the blood vessels to allow blood to flow into the penis. NO functions as a natural vasodilator that’s essential to gaining an erection.

Some studies suggest that vitamin D may regulate the synthase or production of nitric oxide. This means that vitamin D could play an integral role in boosting blood flow to the penis. In reverse, a deficiency in vitamin D could mean an inhibition of nitric oxide synthesis. Without NO, there’s no erection. If VDD prevents NO, then an erection is impossible.

How Are VDD And CVD Linked?

Moreover, as discussed, erectile dysfunction is often a symptom of cardiovascular disease (CVD). Risk factors that are associated with CVD are also associated with a high ED risk, like smoking and being overweight. If vitamin D deficiency contributes to erectile dysfunction, scientists have concluded that VDD may also be linked to cardiovascular disease.

Ultimately, vitamin D deficiency is closely associated to both erectile dysfunction and cardiovascular disease.

And you don’t want either of those health issues.

So it’s time to get rid of your vitamin D deficiency (because, like most people, you’re probably not getting the vitamin D you need).

How Do You Get The Vitamin D You Need?

As discussed earlier, vitamin D is a unique nutrient. Your body chemically creates vitamin D when it receives sunlight. (Yes, you’re like a plant going through photosynthesis!) In this way, obtaining a healthy amount of vitamin D means committing to lifestyle changes for the long haul.

But these changes are fun, if you ask me!

  1. Sunlight

The best way to increase your vitamin D is to get more sunlight. Exposing your skin to the sun is the fastest and most efficient method of vitamin D consumption.

This doesn’t mean you need to tan or burn in order to be healthy. In fact, you shouldn’t be tanning or burning, which can end up chemically altering your cells and causing long-term problems (like wrinkles and cancer). Rather, you only need a few minutes of unprotected sunlight in order to get your full daily dose of vitamin D. You should then apply sunscreen liberally to ensure you don’t do any long-term damage with the UV rays.

Yes, the doctor is telling you to get out and go surfing, go for a bike ride, or take a walk around the park in the middle of the workday!

A few variables will affect the amount of vitamin D you get from the sunlight:

  • Time of day: your skin can produce more vitamin D if you get sunlight exposure during the middle of the day
  • Location: the closer you are to the equator, the more UV rays you’ll receive, and the easier it will be for your body to produce vitamin D
  • Altitude: the closer you are to the sun, the more vitamin D you’ll make (sun is more intense on a mountain than on a beach, even if the temperature disagrees)
  • Exposure: the amount of skin you expose to the sun affects the amount of vitamin D you’ll produce
  • Skin color: pale skin can make vitamin D quicker than darker skin tones
  • Age: your body’s production of vitamin D naturally slows down as you age
  • Sunscreen: wearing sunscreen can block the UV rays that are transformed into vitamin D
  • Pollution: polluted or cloudy air will soak up more UV rays than non-polluted air, stealing some of your vitamin D potential
  • Glass: glass blocks UVB rays, which are the rays needed for vitamin D production

Generally, I don’t recommend tanning beds to get the vitamin D you need. Often, you need only a few minutes of exposure to get your daily dose of vitamin D. Most indoor tanning bed sessions can cause severe burns and tans with long-lasting consequences.

  1. Supplements

The second best way to get vitamin D is through supplementation. If you don’t live in a sunny area or you don’t want to expose yourself to UV rays, vitamin D supplements are usually a good option.

Different organizations and doctors have different ideas about the correct dosage of vitamin D supplements. The Vitamin D Council recommends about 5,000 International Units (IU) of vitamin D daily; the Endocrine Society recommends about 1,500-2,000 IU per day; and the Food and Nutrition Board recommends 600 IU per day and 800 for seniors. The Food and Nutrition Board is the official recommendation by the U.S. government.

Ultimately, there isn’t a “right” answer just yet on how much you should be taking. But you should definitely not be taking more than 10,000 IU per day. The Food and Nutrition Board even says the maximum dosage should be 4,000 IU per day.

Generally, you should take vitamin D3 as opposed to vitamin D2. Vitamin D3 is not vegetarian, so talk to your doctor if you do not want to take an animal-based product.

You can also take cod liver oil, which contains vitamin D. However, cod liver oil has higher amounts of vitamin A than D. Taking too much vitamin A can be dangerous, so it’s important to maintain a healthy balance when supplementing with cod liver oil.

Vitamin D is fat-soluble. If you take too much, your body can’t easily get rid of it. You don’t want to be swimming in vitamin D, as high doses may cause diseases like MS or prostate cancer. Learn more about the link between vitamin D and prostate cancer here.

Talk to your doctor before adding any supplements to your regimen.

  1. Diet

Although our bodies produce most of our vitamin D, you can still get small amounts of vitamin D with your diet. However, most scientists believe that eating vitamin D won’t provide enough of the vitamin to stay healthy.

Nevertheless, adding vitamin D foods to your diet can help supplement your anti-VDD efforts.

  • Salmon
  • Mackerel
  • Tuna
  • Sardines
  • Herring
  • Raw milk
  • Caviar
  • Oysters
  • Shrimp
  • Eggs
  • Mushrooms
  • Fortified cereal and oatmeal
  • Nutrient-Additive milk (cow and soy)
  • Fortified orange juice

  1. Workout

Working out won’t necessarily give you more vitamin D, but it can help you absorb more of the vitamin D you do get. Vitamin D is extracted from the blood by fat cells. This means that the more fat you have on your body, the more vitamin D will be pulled out of use. Thus, people with a high body mass index (over 30) often have lower blood levels of vitamin D.

If you are carrying some extra pounds, you could be sabotaging any vitamin D regimen you try to implement. Moreover, being overweight is also strongly linked to erectile dysfunction and cardiovascular disease.

If you want to lower your vitamin D deficiency and minimize your risk of ED and other serious diseases, it’s time to lose some of the weight.

Struggling to lose weight and feeling overwhelmed by health concerns? Learn about metabolic syndrome here.

The Bottom Line

Vitamin D deficiency is a common concern throughout the U.S. This deficiency can cause a number of serious health concerns, including erectile dysfunction and cardiovascular disease.

But thankfully, a deficiency is easily solvable—by adding more of that vitamin into your body! By getting more sunlight, adding vitamin D supplements, and changing your diet and exercise, you can lower your risk of vascular problems and ED in no time.

Are you ready to finally balance your health?

Are you ready to get back to that energetic vigor of your youth?

Of course, you are!

Sign up for the Male 90X program right now!

This genetic-based report and private consultation will get you started on the steps of total body transformation to realign every aspect of your health and wellness.

What are you waiting for? Get Male 90X now to start living the life you deserve!

9 Exercises To Beat ED And Have Better Sex

It’s time to get physical! If you want better “physical fun” in the bedroom, you need to improve your daily physical activity outside the bedroom as well.

Are you one of the 30 million men suffering from ED? If so, you may be feeling trapped or suffocated in your sex life. You can’t get or maintain an erection like you used to, which can hurt your confidence, your intimacy, and even your relationships. You might be feeling unfulfilled or unsatisfied. There may be a loss of intimacy between you and your partner. You may be falling into anxiety or depression, or you may have trouble getting your partner pregnant.

Many men think popping a blue pill will do the trick. In reality, these only mask the symptoms without getting to the root causes of your ED or related complications. Plus, they often have more side effects than benefits!

But thankfully, you can overcome ED in a natural and effective way… with exercise!

Why exercise for ED?

Exercise can help treat almost all causes of ED. This makes it the ideal addition to any ED treatment. I like to call this solution: “sexercise.”

ED has 8 main causes. Physical activity actually addresses each cause in some way or another.

1. Stress and anxiety

Stress and psychological problems is one of the most common causes of ED. Working out has been shown to lower stress, reduce cortisol levels, improve mood, and increase endorphins (the “happy” chemical in your brain). According to the American Psychological Association, exercise betters our body’s communication system between all of our organ processes and functions. The more sedentary we are, the less efficient our bodies are at communicating and responding to stress. In this way, exercise is crucial to both the body’s physical and mental reaction to stress.

2. Obesity

Obesity is a significant risk factor for erectile dysfunction. The only treatment that works to overcome obesity-related ED is weight loss. Exercise is crucial to any diet and weight loss plan. You need to stay active to burn calories, shed fat, build muscle, and maintain a normal body weight.

3. Cardiovascular disease, high blood pressure, and high cholesterol

Exercise improves heart health and improves oxygenated blood flow throughout the body. Benefits of regular exercise on cardiovascular risk factors include: increase in insulin sensitivity, increase in good cholesterol, reduction in bad cholesterol, reduction in blood pressure, and reduction in body weight. Exercising regularly is the best way to take care of your heart and blood.

4. Relationship concerns

Communication problems in your relationship can cause erectile dysfunction. But research suggests that working out together can actually improve your overall relationship by increasing your happiness, boosting romantic attraction, enhancing support, and increasing emotional bond. Exercise also helps better overall health, which makes for a healthy relationship in tandem.

5. Confidence concerns

Men suffering from ED due to “performance anxiety” often have low self-confidence or a negative view of their body. Studies have shown that exercise can enhance attractiveness and increase energy levels, where participants rate themselves as higher on positive perception of self. Those men who were working out consistently considered themselves more desirable and were thus able to perform better sexually.

6.  Sleep deprivation

A lack of sleep—with regards to both quantity and quality— has been linked to erectile dysfunction. In fact, a 2016 survey found that 65% of men who came in with sleep apnea (a sleep disorder) also had symptoms of erectile dysfunction. Working out regularly can improve your quality of sleep and help you fall asleep faster. In fact, exercise is the most effective natural cure for insomnia.

7. Hormonal imbalance

There is a link between low testosterone and erectile dysfunction, though it still calls for further exploration. Nevertheless, we know that a severe imbalance of hormones—like too much cortisol and estrogen with low testosterone—can negatively impact sexual performance. Exercise has been shown to help balance out hormone production, raise testosterone, and lower cortisol and estrogen. Basically, exercise can help put your hormones in a sex-friendly state.


8. Nitric oxide

It’s also important to note the link between nitric oxide and exercise. Nitric oxide (NO) is the chemical that opens up the blood vessels (vasodilation) in the penis and relaxes the muscles in the pelvis. After an erection, your nitric oxide levels will naturally decrease to signal to your body that it’s time to stop having an erection. NO basically controls your erections; you need an appropriate amount of nitric oxide in order to have and maintain an erection for any period of time.

Almost every type of exercise is proven to increase the production of nitric oxide. This is because exercise forces the blood to pump harder, so the blood vessels must dilate to handle the pumping blood; this exercised-induced vasodilation then helps produce more nitric oxide. The reverse is true as well; nitric oxide can help improve physical endurance and performance. This helps create a positive cycle to quell erectile dysfunction symptoms.

Overall, exercise increases energy, tones muscle, and burns fat. This improvement in overall health can help combat the typical causes of erectile dysfunction. Study after study has proved that physical activity is linked to sexual vigor. Not only does it improve your erectile dysfunction, but it can also improve your flexibility, endurance, and performance in the bedroom…

So what are you waiting for?

Below you’ll find the 9 easiest exercises that will improve your ED symptoms and sexual health—and you can do them today! No equipment and no experience needed.

1. Kegels

Kegels aren’t just for women. These exercises are actually one of the best ways to regain your overall sexual health since they target the pelvic muscles. The pelvic muscles contract around the testes and base of the penis during sex, contributing to the “hardness” of the erection. Kegel exercises can strengthen two key muscles: the pubococcygeus (PC), which is the muscle that stops the flow of urine, and the perineal muscles, which is the muscle that supports erectile rigidity and ejaculation. Overall, the strength of these muscles impacts erections, sexual experience, ejaculation, and bladder.

Like all of our muscles—these pelvic muscles tend to get weaker with age. This weakness means the muscles can’t contract enough to help the penis “stand up” and have an erection, thus contributing to erectile dysfunction.

But all muscles strengthen when you use them. Think of lifting: the more often you curl a dumbbell, the more your bicep grows. The same is true of the pelvic muscles. The more you use them, the stronger they’ll bebe. Kegel exercises are like lifting but for your penis. The stronger your sex muscles, the better you can control your erections and sexual endurance.

Note: This also means that the more you have sex, the stronger your pelvic muscles; the stronger your pelvic muscles, the better your erections and sexual health. So, if you have just mild ED and can still have sex, this doctor says to do it… and do it often.

So how do you use Kegels to strengthen the pelvic muscles and get back in the game?

  1. You shouldn’t stop the flow of urine while peeing. This can cause infection and bladder problems. But stopping mid-flow onvr can help you get used to the feel of these muscles.
  2. You want to try to squeeze and tighten these pelvic muscles.
  3. Try not to tighten the surrounding muscles. Focus on the PC muscles. Be aware not to tighten your abs, butt, or thigh.
  4. Start with 5-second squeezes. Squeeze for five seconds, then relax.
  5. Do 10 to 20 reps of 5-second squeezes.
  6. As you get more comfortable, increase the length of the squeezing and number of reps.
  7. Be sure to breathe as normal. Don’t hold your breath.
  8. Do a set of reps two to three times per day.

The best part about Kegels is that you can do them anywhere at any time. You can do them while on the floor, in bed, during a commercial break, or even sitting at your desk at work.

Try it right now as you read the rest of this article!

2. Aerobic Exercise

A number of studies and reviews have concluded that aerobic exercise can help improve ED by boosting blood flow. When working out, your heart is pumping faster. This “clears out” your veins from buildup and blockages caused by obesity, diabetes, high cholesterol, and heart disease (which all contribute to by ED).

Furthermore, research presented in the Journal of Applied Physiology found that aerobic exercise of moderate intensity for 5 to 7 sessions per week for 12 weeks increased nitric oxide levels by 32%. Remember that nitric oxide is what pushes blood flow into the penis for an erection and relaxes the penile muscles to allow for stiffness.

A 1990 study reported that aerobic exercise overall:

  • Increases levels of sexual intimacy
  • Improves sexual function
  • Creates more satisfying orgasms
  • Boosts energy levels
  • Lowers blood pressure
  • Improves muscle tone
  • Reduces body fat
  • Improves self-image
  • Betters sleep

What kind of aerobic exercise should you be doing? Anything that gets your heart rate up! This could be running, using the elliptical, rowing, swimming, or dancing. Even good, old-fashioned walking has significant health benefits. In fact, a Harvard study found that brisk walking 30 minutes per day had a 41% reduction in the risk for erectile dysfunction. I usually recommend avoiding biking, as that can bring with it other concerns for male sexual health.

Whatever aerobic exercise you choose—get sweaty and get your heart rate up!

3. Lifting & Squats

Aerobic exercise can help burn fat and improve ED symptoms, but you shouldn’t neglect your weight training as well. If you are also suffering from symptoms of low testosterone levels, I always recommend men with low T stick to high-intensity interval training. This is because HIIT weight lifting can drastically spike your testosterone levels in the short- and long-term. This, in turn, improves workout performance, burns fat, builds muscle, and heightens the libido.

Although low testosterone and erectile dysfunction are not the same, data suggests they are linked in some way. If you have low testosterone, you won’t have interest in sex; and not having sex means your penis goes unused, which can eventually weaken the pelvic muscles and cause ED. Furthermore, low libido can often cause psychological or relationship concerns that can exacerbate erectile dysfunction. ED is just one part of the equation of men’s sexual health.

Thus, it’s time to get lifting! Not only will it boost your testosterone, but HIIT weight training will also get your heart pumping (like aerobic exercise). Lifting can regulate your hormones, boost your metabolism, and improve weight loss efforts—all of which are vital to erectile function.

My favorite move is the squat. Squats are one of the best exercises because they work a number of large muscle groups at once. The more you’re working, the more benefits you’re getting. Squats are resistance exercises, performed in intervals, with high intensity—the perfect combo for boosting testosterone levels. Plus, squats improve blood flow to the pelvic region. The more blood flow near the penis, the easier it is to gain an erection.


4. Yoga

Yoga is one of my favorite cures for ED and sexual health. A study of a 12-week yoga program found “significant improvement” in sexual scores for men with an average age of 40. They had improvement in: erections, desire, intercourse satisfaction, performance, confidence, ejaculatory control, partner synchronization, and orgasm.

Countless studies prove yoga has benefits relating back to a number underlying causes of ED. Overall, yoga can increase quality of life by enhancing muscular strength, improving cardiovascular function, improving sleep patterns, reducing stress, anxiety, and depression, and more. Relaxation is the key here; the intense relaxation that comes from yoga actually helps improve blood flow and oxygen circulation in the blood, which in turn improves organ function (like the sex organs and muscles).

Moreover, certain yoga poses boost blood flow to the penis and work those pelvic muscles. I like to think of these yoga poses as a “wake up call” to your penis, by stimulating the vessels and muscles around it.

Below you’ll find my favorite yoga poses for improved sexual health.

5. Paschimottanasana (Seated Forward Bend)

The “seated forward bend” is easy and comfortable, relaxing the pelvic muscles and promoting blood flow to the hips and penis. It’s also great for reducing stress in a pinch.

How to do:

  • Sit on a yoga mat or blanket with your legs in front of you.
  • Keep your upper body long and straight.
  • Lean forward from the hips, moving your chest towards your knees.
  • Lengthen your tailbone as you reach down towards your feet.
  • Reach as far as you can. Extend and grab your feet if possible. If not, go as far as you can for a comfortable stretch. You can also use a yoga strap around your feet for a deeper stretch.
  • Hold the post for 1 to 3 minutes and then release.

6. Uttanasana (Standing Forward Bend)

The “standing forward bend” or “intense forward-bending pose” helps with anxiety and stress, while also stimulating organs in the abdomen (including the sex organs). Tradition even says that this pose is so beneficial for sexual health that it can actually help with male and female infertility.

How to do:

  • Stand with your hands on your hips.
  • As you exhale, bend forward from the hips.
  • Keep your back straight as you bend forward. Lengthen the torso as you bend.
  • Keep your knees straight. A soft bend is okay for newbies.
  • Bring your fingers down towards the floor.
  • If you can’t reach your feet with your hands, cross your forearms and hold your elbows. You can swing gently.
  • Relax into the pose for 1 to 3 minutes.
  • As you inhale, focus on lengthening and straightening your spine. As you exhale, relax deeper and fuller into the stretch, letting gravity pull you down.
  • Avoid straining your neck or back. You should be able to nod your head yes and no while in the pose.

7. Baddha Konasana (Butterfly Pose)

The “butterfly pose” or “bound angle pose” stretches the inner thighs and groin. It opens up the hips and pelvis in a way that stimulates the prostate gland, bladder, kidneys, and abdomen.

How to do:

  • Sit upright with your legs extended in front of you.
  • Bend one knee at a time while you exhale, pulling your heel inward towards your pelvis.
  • Drop both knees to either side. Press the bottoms of your feet together.
  • Use your first and second fingers to grab your big toes. You can also grab your ankles with your hands.
  • As you breathe, focus on straightening your torso. Imagine someone is pulling up a string that’s attached to your spine.
  • Stay in the pose for 1 to 5 minutes.

8. Janu Sirsana (Head-To-Knee Pose)

The head-to-knee pose helps with flexibility in the lower body while also relieving stress and improving blood flow in the groin.

How to do:

  • Sit on your mat or blanket with legs extended in front of you.
  • Bend in one knee, bringing the heel towards your pelvis.
  • Rest the sole of that foot against your other thigh.
  • Release your knee towards the floor. Support with a blanket if you need to.
  • As you inhale, raise both of your hands towards the sky.
  • As you exhale, hinge from the hips and bend towards your extended foot.
  • Try to bring your chin to your knee. If you can, clasp your hand around your foot. If you can’t, bend as far as you can and hold on to your shins.
  • Stay in this position for 1 to 3 minutes.
  • Inhale and raise your arms overhead to return to sitting.
  • Repeat with the other leg folded in for balance.

9. Dhanurasana (Bow Pose)

The “bow pose” stretches your muscles in the groin and thighs while energizing the reproductive areas. Plus, it’ll boost your flexibility—and may make an interesting sex position in the bedroom.

How to do:

  • Lay face down on your mat on your stomach. Your feet should be hip-width apart and your arms at your sides.
  • Bend your knees in towards your back, grabbing the front of your feet with your hands.
  • Raise your upper body and pull up on your legs at the same time. Your chest and knees should both be lifted off the floor, while your pelvis stays grounded.
  • Stay in the pose for 20 to 30 seconds. While posing, take a few deep breaths. The deeper the breath, the more it will stimulate your pelvis.
  • Exhale as you release from the pose.
  • Repeat two or three more times.

Bonus: Work out with your partner.

Getting your heart rate up together can help bring you closer to one another. Partners that work out together find that they have an improved sex life in the bedroom as well. This is likely due to improved self-confidence, regulated hormones, endorphin release, and all those great benefits from working out. But, more than that, couples that work out together connect on a physical level outside of the bedroom. This connection translates back into the bedroom nicely. This is especially true for yoga. One study found that “partner yoga may help couples who are struggling with sexual dysfunction.”

Bottom line

You can naturally overcome your erectile dysfunction and improve your sexual health… and it costs you nothing but your time and willingness! The above 9 exercises and poses will put you on a track of sexual health that will make you looking, feeling, and being the most vigorous you in years. Say goodbye to ED (and hello to exercise).