I think what makes us sick also causes erectile dysfunction, hypertension, diabetes, cardiovascular disease.
Mark Hyman, M.D.
Erectile dysfunction is a common condition impacting more than 12 million men in the U.S. alone.  In fact, it is the most common sexual issue men report to their doctors. Despite its prevalence, however, it continues to be a topic many men resist addressing with their physicians.
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Discussions surrounding sexual health can be uncomfortable, but they’re worth having. Left untreated, erectile dysfunction can impact relationships and mental health, causing compounding stress across multiple areas of your life. With that said, there’s another – and even more important – reason to report the condition to your doctor.
Like many other physical anomalies, erectile dysfunction can be an early warning sign of a more serious illness. In fact, physical factors are suspected to underlie up to 90% of cases in men older than 50. 
Atherosclerosis – a condition in which the arteries become blocked or hardened – is one example, while the condition can also point to heart disease, as well as high blood pressure caused by type II diabetes.
Sexual health is therefore often more closely related to heart health than many patients realize, and investigating the underlying cause for erectile dysfunction could even hold life-saving possibilities in some men.
Thus, patients who are experiencing this frustrating symptom should address it sooner rather than later and with an experienced physician who specializes in age management and conditions experienced by older adults. Because the vast majority of its sufferers fall within the ages of 50 to 69 years old, age management specialists are best equipped with the right resources, knowledge, and experience to address erectile dysfunction.
In traditional medicine, erectile dysfunction is treated with:
As the world’s leader in age management medicine, Cenegenics is here to help men experiencing erectile dysfunction and its related symptoms. Our physicians take an all-encompassing approach to optimizing wellness and decreasing disease risk as well as enhancing lives in the areas of nutrition, exercise, and hormone regulation.
With a broad range of customizable solutions, we not only restore quality of life by addressing conditions such as erectile dysfunction, but also improve vitality to help you feel even better than before. Here, we take a closer look into this important men’s health topic with a brief guide on what erectile dysfunction entails and how our program can help.
Erectile dysfunction, also referred to as impotence, is clinically defined as the inability to get and keep an erection firm enough for sex.  Like decreased libido, it is a common sexual complaint associated with testosterone deficiency.
Yet, it is more complex than libido. Erectile dysfunction can be a multifactorial diagnosis for causes spanning not only sexual and emotional domains, but also involving a subset of vascular and neurological physical domain considerations. We’ll explore possible causes of erectile dysfunction in greater depth in an upcoming section.
Erectile dysfunction is typically self-diagnosable, but demands clinical input in order to determine the underlying cause and establish an effective treatment plan. Although it can be identified exclusively by the inability to get and keep a firm erection, it can also produce additional symptoms.
The most obvious symptom of erectile dysfunction is the persistent inability to keep a firm erection. Difficulty getting an erection and reduced sexual desire may also accompany the condition. To develop a better understanding of the possible physical barriers to healthy erections, let’s take a moment and revisit some basic principles in how erections work.
When a man is sexually aroused, nerves release chemicals which in turn stimulate blood flow to the penis. The blood then enters two erection chambers located in the penis, which are made up of spongy tissue. This tissue, called the corpus cavernosum, relaxes and traps blood to produce an erection. After orgasm, the tissue then contracts to release blood back into circulation, causing the erection to come down. 
While factors like stress and temperature can influence erections, a persistent inability to keep a firm erection to engage in intercourse should be addressed. With that said, the impact of erectile dysfunction can extend beyond the physical realm, too. Its implications can also transcend into relationships as well as mental and emotional wellness.
Unfortunately, while impaired sexual performance can lead to guilt, low self-esteem, fear of sexual failure, and stress, these factors can also exacerbate erectile dysfunction. Thus, the symptoms of the condition often take on a cyclical effect, in which the connection between physical and emotional factors intensifies and the condition overall worsens. It is for this reason – and the potential indicator of an underlying disease – that the root cause of erectile dysfunction must be identified, which brings us to our next section.
With so many potential factors contributing to erectile dysfunction, only a trained physician can diagnose and treat the root cause. In many cases, treating health-related factors and behaviors is enough to address the condition.
At Cenegenics, each patient undergoes extensive lab work so that clinicians have a robust range of biomarkers to assess which can shed light on undiagnosed or underlying medical conditions. These can also reveal risk factors for chronic diseases such as diabetes, a common culprit behind erectile dysfunction.
Here are a few of the most common physical and psychological factors that can cause erectile dysfunction. Keep in mind that, because there are many possible influences on sexual health and performance, this list may not be entirely exhaustive:
It’s worth noting that the degree to which these conditions can influence a man’s ability to get and maintain an erection can vary significantly. For instance, men with diabetes are two to three times more likely to experience erectile dysfunction than those without.  On the other hand, just 10% of cases are attributed to psychological factors, while the vast majority are found to be caused by physical influences.
At this point, you may be wondering why testosterone deficiency wasn’t listed above. After all, aren’t hormones and sexual health closely related? Indeed, erectile dysfunction and hypogonadism – the reduction or absence of hormone secretion by the gonads – are often linked; find out more about this relationship below.
In addition to the possible causes cited in the previous section, testosterone deficiency can also be a direct cause of erectile dysfunction. In fact, investigation into testosterone deficiency and testosterone therapy is generally a good starting point for any patient experiencing the symptom, as testosterone deficiency has been associated with a decline in erectile function, and testosterone is inversely correlated with increasing severity of erectile dysfunction. 
If a patient is found to have low testosterone, hormone therapy can improve both libido and erectile dysfunction symptomology. In fact, testosterone therapy has been shown to cause improvements in the areas of morning erections, erectile function, sexual motivation and satisfaction, sexual thoughts, and total erections.
Patients with erectile dysfunction of vascular etiology could see more robust responses than those with physical contributions to the condition, but again, because the majority of cases are physical, a patient’s candidacy for hormone replacement therapy should be explored where appropriate.Nonetheless, the efficacy of testosterone therapy, in the absence of sound nutrition and exercise, is likely to be limited. Thus, addressing erectile dysfunction to achieve the best possible results requires more than just a “simple fix;” in many cases, research-based and clinically-proven lifestyle optimization tactics are needed. The problem lies in the fact that many patients are unsure of where to start. This is precisely where the Cenegenics age management program excels.
The fact that erectile dysfunction can be caused by a complex interplay of factors, including nutrition and exercise, is further complicated by the fact that each person may be affected by these influencers differently. Thus, what may work for some may not work for others. It is for this reason that a comprehensive approach must be taken to pinpoint possible underlying causes and effectively address the breadth of factors that could be contributing to erectile dysfunction.
Cenegenics uses a non-invasive approach to treat erectile dysfunction through use of the following:
Cenegenics empowers its patients to achieve optimal wellness across five key areas: enhanced libido, weight management, improved cognition, better sleep, and boosted energy. These pillars comprise the foundation of the program but provide only a glimpse into how far-reaching it truly is.Because our clinical team specializes in age management, our physicians are well-versed in the barriers to sexual health with which men, through their middle ages and beyond, are faced. This means that you’ll receive targeted treatment plans to address both the symptom itself as well as any other conditions that could be contributing to it. Discover below how to treat erectile dysfunction with a few of the precise ways our programs help you restore your sexual health.
When we think of the role nutrition plays on our wellness, oftentimes factors like weight and heart health come to mind. Yet, nutrition can influence virtually every function the body performs – including your ability to get and maintain an erection. While there are known dietary agents that can impede sexual function (including alcohol), there are also nutrients that can play a part in improving erections.
According to research, men who consumed primarily nutrient-rich foods like fruit, vegetables, fish, and whole grains while limiting consumption of red and processed meats and refined carbohydrates were less likely to experience erectile dysfunction. Thus, what you put on your plate could play a role in your sexual health. 
Moreover, excess fat impacts many of the hormones that can contribute to erectile dysfunction. For instance, a man with a 42-inch waist is 50% more likely to experience erectile dysfunction than someone with a 32-inch waist. Likewise, obesity increases the risk of both vascular disease and diabetes, two important causes of the condition. Thus, in men with poor diets, addressing nutrition could be one of the best tools available in pursuit of alleviating erectile dysfunction.
Unfortunately, nutrition simply isn’t the first priority for many men with busy lifestyles. The modern American diet focuses largely on convenient, palatable options instead of providing the body with the fuel it needs to perform well. The nutrition team at Cenegenics is made up of age-management professionals who will work closely with you to develop nutritionally sound yet realistic eating patterns to help you improve wellness across a number of key areas.
Not only could this lead to beneficial changes in the area of sexual health, but with long-term compliance, it will also lead to better weight management and decreased risk of chronic illness.
Like nutrition, physical activity (or lack thereof) is also tied to sexual health. Exercise is often considered to be the most largely under-prescribed yet most powerful form of all-natural, free medicine we have available to help us reduce our risk of disease. It can also help us feel better, too. Consider this: men who exercise at least three hours each week have a 30% lower risk for erectile dysfunction compared to those who get very little to no exercise. 
However, exercise is also similar to nutrition in the fact that it is only effective with the patient’s compliance. Thus, the more likely you are to stick with an exercise program, the more likely you are to witness its widespread results.
While some research suggests that certain targeted exercises, including pelvic floor exercises, could improve erectile function, in many cases, a broader attempt at improving physical fitness should be made to sustain noticeable results. 
Regular exercise is good for the circulatory system which, as described above, plays a major role in enabling healthy erections. Moreover, both improved nutrition and increased physical activity can help to address many of the possible causative agents behind erectile dysfunction including keeping weight under control, increasing testosterone, and driving self-confidence.Finding the right exercise program to fit your unique lifestyle and preferences can be daunting. Plus, a common complaint among many adult males is lack of time for a robust physical fitness regimen. Cenegenics recognizes these obstacles and helps you overcome them with the development of individualized plans that can improve cardiovascular health with as little time investment as possible. Our expert-led, prescribed routines are also based largely on patient preferences to facilitate sustained compliance.
In addition to helping you address any gaps in nutrition and embark on a physical fitness journey, Cenegenics clinicians may also recommend hormone replacement therapy (HRT), if it’s deemed necessary based on lab results. Keep in mind, however, that we do not use a “one size fits all” modality to improve testosterone levels.
In fact, our approach to patient care comes from multiple sources including age management physicians, nutrition and exercise physiologists, phlebotomists, and nutraceutical experts. We assess the entire picture of patient health by taking into consideration key factors such as carbohydrate metabolism to observe the ways in which bioidentical hormones are impacting critical bodily functions.
Moreover, each patient’s biomarkers are closely and continuously monitored. Our physicians are proactive in measuring the impact of hormones on prostate, kidney, and liver health, as well as other biomarkers, and they are well-versed in their understanding of how hormones directly affect carbohydrate and lipid metabolism.
This means that treatment is always fit to the precise needs of the individual, and improvement of sexual health or symptoms like erectile dysfunction will never be pursued at the expense of your overall health. Additionally, all aspects of HRT, including diagnostics, clinical support, and pharmacy items, are provided in-house and managed internally – both for your convenience and to ensure accuracy and effectiveness of treatment.
It’s also important to note that Cenegenics is unique in its approach to HRT in that we help patients overcome all of the challenges that could be contributing to erectile dysfunction. In addition to improved libido and erectile function, our program also facilitates weight loss, mental acuity, better sleep, improved energy, and decreased disease risk.
These factors are what continue to drive patients to Cenegenics as the premier choice not only for effectively addressing age-related conditions like erectile dysfunction, but for better health and vitality overall.
Erectile dysfunction affects over 12 million men in the United States. ED is a multifactorial diagnoses, as the cause of erectile dysfunction can span over various factors including lack of exercise (sedentary lifestyle), anxiety, depression, smoking, excessive alcohol consumption, certain medications and chronic diseases.
Cenegenics physicians empower patients to achieve optimal wellness, including increasing sexual libido and desire, through nutrition, exercise, and hormone replacement therapy when clinically indicated. Excessive fat can decrease levels of testosterone, which may cause erectile dysfunction and low sex drive. Individualized nutrition and exercise plans help patients lose weight, increase libido, and increase self-confidence.
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About the Contributor
Global Director of Nutrition & Exercise
Rudy Inaba is Cenegenics’ Global Director of Nutrition & Exercise. He is a recognized fitness and sports nutrition consultant with nearly 15 years of experience in clinical exercise physiology and lifestyle management. After pursuing his Master of Science in Clinical Exercise Physiology at the University of Nevada Las Vegas, Rudy joined Cenegenics where he leads 20 clinical locations nationwide in their advancements in kinesiology, nutritional biochemistry, and their analyses of industry research & market trending.
This guide was produced with contributions from the following key resources:
The Cenegenics Education and Research Foundation
The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy
Jeffrey Park Leake, M.D., CPT
Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.
Todd David Greenberg, M.D., CSCS
Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.
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 Urology Care Foundation, see above.
 “Symptoms & Causes of Erectile Dysfunction.” National Institute of Diabetes and Digestive and Kidney Diseases. July 2017. Retrieved from URL: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
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 H.A. Feldman et al. “Impotence and its medical and psychological correlates: results of the Massachusetts Male Aging Study.” Journal of Urology. Jan. 1994. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pubmed/8254833
 Constance G. Bacon, ScD et al, see above.
 Mark Grace Dorey et al. “Pelvic floor exercises for erectile dysfunction.” Sexual Medicine. 05 Apr. 2005. Retrieved from URL: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2005.05690.x