Whether it is a movie playing with a vacant couch, a mother giving her teenage boy a new pair of noise cancelling headphones, or a businessman starting his day with the happiest shower ever and bouncing his way to work while we hear the familiar lyrics: good morning, good morning… . These are the commercials for the most well known medications for treating erectile dysfunction and are used by millions of men worldwide. In 2014, the total sales for Viagra (sildenafil) was over $1.68 million and Cialis (tadalafil) almost $2.3 million. There is also a huge industry of herbal based alternatives with claims of improving male performance and virility. Although some of the herbal alternatives may also affect testosterone production or secretion, the common effect of all of these products is to increase blood flow and retention in the reproductive organs. What is also consistent with these products is a warning for those with heart disease. This may seem like an obvious warning but it also provides insight into developing an effective strategy for treating erectile dysfunction and male reproductive health in general.
Consider the following list of risk factors and causes of erectile dysfunction in middle aged and older men (non-psychological causes):
Side effects from medications (antihypertensives or antidepressants)
- Active illness/infection
- Smoking and/or excessive drinking
- Being unfit or overweight
- Deterioration of the arteries (atherosclerosis) and/or hypertension
- Use of recreational drugs (cocaine)
This is a very similar set of risk factors for heart disease. The male reproductive organs are comprised of vascular tissue that requires proper circulation of blood both for its function but also for its nourishment. The heart organ is also comprised of vascular tissue and multiple chambers that fill with blood and empty. The demands for their optimal performance should thus be very similar.
The medications, Viagra and Cialis as well as the most common herbal alternatives yohimbe bark, gingko biloba, and horny goat weed all function to increase blood retention within the vessels and reduce vascular resistance. This erectile effect is temporary and may require higher doses overtime. The focus of these substances is on treating the symptom, not the mechanism causing the dysfunction.
Effective treatment of both the symptom and mechanism should focus on vessel health and the contributing factors that damage the vessels. It is also advised to have an assessment by a urologist to determine if there are any blockages in the vessels (varicoceles) and having a semen analysis done to determine if the production and maturation of sperm (spermatogenesis) are taking place properly. Screening for diabetes, hypertension, hyperlipidemia (cholesterol & triglycerides), and having a hormone panel done is the suggested follow up to any semen analysis that has values at the low end or out of range. Stress levels should also be considered. The hypothalamus pituitary connection with the reproductive organs can be interrupted by the adrenal connection which is activated during times of perceived stress. Chronic or repetitive stress response can affect reproductive hormone communication and causes vasoconstriction and elevated blood pressure.
For the reasons outlined above, supplements commonly prescribed for cardiac health should also be considered for erectile dysfunction. Similarly, those men with erectile dysfunction and/or male factor obstructive type infertility should be assessed for cardiac health markers. With cardiac related death being the second highest cause of death for men at almost 20% of all deaths (stats can 2012), the presence of any vascular blockage should be considered a risk factor for a future complication and treatment adopted to improve vessel health.
Holistic treatment for erectile dysfunction and male factor fertility issues (non-genetic) may consider the following :
- Antioxidants: CoQ10, Resveratrol, Vitamin C & E, Zinc
- Omega 3 (with a higher ratio of EPA to DHA)
- Regular exercise that involves an aspect of cardiovascular training.
- Changing habits – quitting smoking, avoiding coffee and minimizing alcohol intake.
- Acupuncture to regulate blood circulation and reduce the effects of stress
- Chinese herbal medicine such as the formula Shen Qi Wan (Kidney Qi Pill) – composed of the following herbs to nourish blood, regulate blood pressure (via the kidneys and bladder), normalize blood sugar levels, antioxidant effect and regulate blood circulation
- Rehmannia Glutinosa (Sheng Di)
- Fructus Corni Officinalis (Shan Zhu Yu)
- Radix Dioscoreae Oppositae (Shan Yao)
- Radix Lateralis Praeparatus Aconiti Carmichaeli (Zhi Fu Zi)
- Ramulus Cinnamomi Cassiae (Gui Zhi/Rou Gui)
- Rhizoma Alismatis (Ze Xie)
- Scierotium Poriae Cocos (Fu Ling)
- Cortex Radicis Moutan (Mu Dan Pi)