The Dr. Hyman Show - The Science of Erectile Dysfunction and Unexpected Ways to Treat It

Episode Date: March 1, 2024

View the Show Notes For This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Get Ad-free Episodes & Dr. Hyman+ Audio Exclusives A decrease in libido or difficulty in achieving or maintaining an erection during sex are tell-tale signs of erectile dysfunction, and they can be uncomfortable to address. Sure, aging and performance anxiety are part of the story, but believe it or not, erectile dysfunction is not just about sexual health. It’s often the first clue of bigger health issues. In this episode of my Health Bites series, I explore the root causes of erectile dysfunction, delving into the limitations of conventional medicine, the little blue pill, and how we can utilize the power of Functional Medicine by making changes to our diet, lifestyle, and even trying things like supplements, peptides, and hormone therapy.  This episode is brought to you by Mitopure and Rupa Health. Support essential mitochondrial health and save 10% on Mitopure. Visit TimelineNutrition.com/Drhyman and use code DRHYMAN10. Streamline your lab orders with Rupa Health. Access more than 3,000 specialty lab tests and register for a FREE live demo at RupaHealth.com. In this episode, I discuss (audio version / Apple Subscriber version): The prevalence of erectile dysfunction (4:34 / 2:04) The root cause of low testosterone (9:38 / 7:08) The conventional medicine approach to treating erectile dysfunction (11:51 / 9:21) How do Viagra and ED drugs work? (16:34 / 14:04) The Functional Medicine approach to treating erectile dysfunction: diagnostic testing (18:58 / 16:28) Root causes of sexual dysfunction (29:42 / 27:12) Diet, lifestyle, and supplements to improve sexual dysfunction (42:22 / 39:52)

Coming up on this episode of The Doctor's Pharmacy. It's all connected, right? It's not just ED. It's heart disease, diabetes, prediabetes, insulin resistance. It's all one problem. And one of the major ways it manifests is by damaging the lining of your blood vessels, leading to less nitric oxide and hardening the arteries, impaired blood flow. This is really a sign that you might have some cardiovascular disease. So you really want to pay attention if you're having erectile dysfunction. So it's not just about sex, it's about your overall health.

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That's right. There are no hidden fees. So don't let lab ordering hold you back anymore. Visit rupahealth.com today and unlock the potential of hassle-free lab testing. That's rupahealth.com. Have you experienced a loss of libido recently? Are you carrying a little excess belly fat? Are you losing or having a hard time putting on lean muscle? What about an uptick in impotence? If you're a guy listening who's answered yes to any of these questions,

then this episode is for you. And if you're a woman who's with a guy who's got these issues, it's also for you. Welcome to another episode of Health Bytes, a special episode of The Doctor's Pharmacy. I'm Dr. Mark Hyman, and today we're diving deep into a topic that's plagued many, but rarely ever openly discussed, and that, my friends, is male sexual dysfunction. And today we're going to be focusing specifically on erectile dysfunction. Now, a decrease in libido or a difficulty in achieving or maintaining an erection during sex are telltale signs of what we call ED or erectile dysfunction. And they can be kind of uncomfortable to talk about. Sure, aging and

performance anxiety are part of the story, but believe it or not, erectile dysfunction is not just about sexual health. It's intricately linked to your cardiovascular and metabolic health as well. And it's often the first clue of much bigger health issues. In this episode, we're going to explore the root causes of erectile dysfunction, and we're going to dive into the limitations of conventional approaches, the little blue pill, and how we can utilize the power of functional medicine by making changes to your diet, your lifestyle, and even trying things like supplements, peptides, and hormone therapy and more. Now, why does this matter? Well, it's a major, major public health concern. An estimated 30

million American men are affected by ED. Now, people don't like to talk about this, and it's uncomfortable to talk about sex. It's kind of a taboo, but you have to talk about it because it's a significant issue that impacts so many aspects of people's life. Now, your physical health and sexual health are totally connected. Obesity, for example, is independently linked to erectile dysfunction. People have what we call a dad bod. You know, it's becoming normalized among young men where you kind of become a little pudgy around the middle. It's not normal. People with a high body mass index or who are overweight

tend to have lower testosterone. I'm going to explain why that is and how you can reverse that. Also, your emotional health and well-being are tied to your sexual function. People who are stressed, you know, have more trouble with sex. Quality relationships and intimacy also plays a big role. And it's so common. We're going to talk about how common this problem is. In the Massachusetts Male Aging Study, ED was the most common sexual health problem. In 1995, it affected about 150 million men worldwide. And that's projected to reach 300 million next year.

The prevalence, in other words, the number of people in the population, men, particularly, obviously, who have this, is about 52% of men between ages of 40 to 70. That's a lot of guys. And what does it mean? Well, erectile dysfunction, or ED, means the inability to have or maintain an

erection. Now, as you get older, it's more common. 40% of men are affected at age 40. 70% of men are affected at age 70. A recent study published in the Journal of Sexual Medicine found that one out of every four men under the age of 40 is affected by ED. Now that's shocking. You're talking about guys under 40, and that's about 25% of men under 40. There's also a strong relationship between testosterone, and particularly testosterone deficiency and erectile dysfunction. And what's shocking, and I see this in my practice, and it kind of blows me away, honestly. Young guys have very low testosterone. I mean, what you'd see sometimes I see in in my practice, and it kind of blows me away, honestly. Young guys have very low testosterone. I mean, what you'd see sometimes I see in a 90-year-old, I see in a

20 or 30-year-old. And about 30% of men age 40 to 79, according to the American Journal of Medicine article, experience low testosterone. Now, researchers show an increased prevalence is associated with aging. That's common. But it's also associated with other diseases that are causing the erectile dysfunction. It's not just the penis that's the problem. It's the rest of your biology and your body that's not operating properly. So obesity, diabetes, high blood pressure are all clues that some things arise with your hormones, your metabolic health, and likely soon with your sexual health. In fact, there's a phenomenon that's called andropause or male menopause, which is sort of a gradual decline in testosterone after the age of 30, about one to

one and a half percent drop in testosterone a year. Now, that doesn't mean it's a norm or it has to be. I mean, I have a guy who's like 62, who's got a testosterone of like 900, which is what you'd see in a healthy young 20-year-old or 18-year-old rearing to go all the time and promise you he's rearing to go all the time. It doesn't mean it's normal, right? It means it's common. It doesn't mean it's normal. Normal just means the average in a population. So it's quote normal, but it's not optimal. And so you have to understand how you want to get to optimal ranges by addressing the root causes of the problem. And there are a lot of ways you can naturally increase testosterone. Now there's a strong relationship between low testosterone and erectile dysfunction. And the reason is that

low testosterone is a clue for other problems. It's a clue that you have poor metabolic health, and it's so common, and I've talked about this so many times on podcasts, but 93% of Americans have poor metabolic health, and that is what leads to erectile dysfunction. I'm going to explain exactly how. We're getting into the science, and by the way, all the references, everything I'm saying is in the show notes. You can go dive deep. You can click through, read the articles yourself. But it's a sort of scary picture in America now with increasing obesity, diabetes, and poor metabolic health. But this leads to what we call endothelial dysfunction. Now, what the heck is that?

Your endothelium is a lining of your blood vessels. And the health of your blood vessels determines your sexual health and your cardiovascular health and your cognitive health and pretty much everything. In fact, that's one of the problems with COVID and with long COVID, which we've talked about, is this massive damage to the lining of our blood vessels. And that is what happens with COVID that drives so many of the pathologies. Now, men who have low testosterone are 38% more likely to die of a cardiovascular intent. That's like a heart attack or stroke. Now, the question is why? Why do we see low testosterone? Well, it has to do with what we call insulin resistance. Now, I've talked about this

for almost, God, scary now to say 30 years. It is something I've paid a lot of attention to. I've written many books on this. Insulin resistance is the scourge of the modern world. Like TB was everywhere before, and it wasn't even as prevalent as insulin resistance. We're talking about 90% of Americans having some poor metabolic function, and that's some degree of insulin resistance, somewhere on the spectrum from optimal metabolic health, blood sugar regulation, insulin sensitivity to a slow decline in insulin sensitivity, more insulin resistance, prediabetes, type 2 diabetes. It's all a spectrum. And this leads to low libido or low sexual desire, low desire for sex, for masturbation. It's influenced by low testosterone. And basically,

I'll give you the punchline here, but as your belly grows bigger, your testosterone gets lower. Big belly, low testosterone. Why do you have a big belly? Because you deposit fat or VAT, visceral adipose tissue. And this visceral adipose tissue is a, excuse me, my French here, a s*** storm of hormonal and inflammatory chaos. Essentially, it causes an increase in what we call adipocytokines. And we'll talk about why inflammation plays a big role in messing up hormones, particularly testosterone. And it also causes an increase in estrogen for men, lower testosterone, and that leads to sexual dysfunction. So it's a big issue. And so this low sexual desire, low sexual function is influenced by

this low testosterone, but can be influenced by other things like stress, anxiety, and many other chronic diseases. Now, a 2019 study of more than 12,000 45-year-old men found that about one in 20 reported low sexual desire, which is a lot when you think about 45-year-old men found that about 1 in 20 reported low sexual desire, which is a lot when you think about 45-year-old guys. They should be still raring to go. Now, some desire for sex drops naturally with age, but it doesn't go away even in your 60s, 70s, or 80s. I mean, Mick Jagger had a kid at 75. Picasso had a kid.

This was in the pre-Viagra era at 80 years old. So it's not impossible to keep going for a long time. Now, what's the problem with our conventional approach to dealing with erectile dysfunction? It's not just as simple as giving people Viagra or Cialis. It's really about taking a deep dive into the why. What's the cause? Now, often your hormones are not tested. It's amazing how many people go

to the doctor and never get their hormones tested. Don't get testosterone, free testosterone, estrogen, FSH, LH, all the important biomarkers that are critical to understand what's going on with your hormonal health. Also, doctors don't test for insulin resistance. I was recently on a conference call with some of the top scientists and doctors at Quest Laboratories Diagnostics, which is one of the biggest testing laboratories in the country, probably the biggest. And I said, how many doctors are testing for insulin, fasting insulin? And they're like, well, it's pretty low. Maybe 1% of our lab tests are for fasting insulin that are ordered by doctors. Now, this should be a standard test that everybody gets

as part of their annual checkup. It is the most important test to determine your longevity, your risk of heart attacks, cancer, stroke, dementia. It's so critical. The other test that they almost never look at is what we call lipoprotein fractionation. I've talked about this on other podcasts. We'll link to those in terms of how to look at your lipids. But the cholesterol test that doctors do now is really so outdated. It's like, you know, looking at things, you know, with a, you know, like, I mean, listen to your heart with a stethoscope instead of looking at it with an echocardiogram or an MRI. You know, it's just, it's kind of old fashioned and it doesn't, it gives you some indication of what's happening, but it's really not the gold standard. And I asked, again, I asked these experts in cardiovascular diagnostics at

Quest, I said, well, what percent of tests out there are for the lipoprotein fractionation, which means the quality of the cholesterol, the particle number, the particle size, which gives you a much better indication of your insulin resistance and your risk factors. And I said, what percent of your tests are for this 21st century cholesterol panel? And they're like 1% or less than 1%. And so that means 99% of people are not getting the right cholesterol test, which prevents them from really understand what's going on with their metabolic health. Now these tests, hormone tests, insulin, lipoprotein fractionation, A1C, many, many other things, we do test at Function Health. Now, I'm a co-founder of Function Health. I'm the chief medical officer. And I believe that people should have access to their data. And it's very empowering to know what's going on. We found all

sorts of things. We've had over 25,000 members to date at the recording of this podcast. We've had over 3 million biomarkers tested. And you can get over 110 biomarkers for less than $500. And you get testing twice a year and you can track what's going on. You can see changes based on your interventions, lifestyle, diet, supplements, and then actually be empowered with the right information and knowledge and education about what to do about these numbers. Anyway, back to the topic at hand. The other thing is most doctors don't really deal with lifestyle, you know, weight, diet, exercise, sleep. It's considered soft medicine. But the truth is it is the most

important thing in determining your risk factor in your health. And what do they do if you come in complaining of erectile dysfunction? Well, they give you the little blue pill. You know, that was a blockbuster. And that was an accident. That pill was actually designed to treat high blood pressure, but it had a side effect that a lot of the people in the study noticed, and they liked the side effect. And so the drug company got very smart, and they were like, well, this is a lousy blood pressure pill, but it's a great pill for erectile dysfunction and uh you know before that it was it was tough for guys you know they were

vacuum pumps or you know you can have a penile implant there was sometimes revascularization you can do a transurethral kind of thing called muse we used to recommend it's like pretty scary you put a little pellet in the end of your penis. It's painful. There's injections, which you can use, that work, but they're painful. But when Viagra hit the scene in 1998, within six months of approval, there were over 5.3 million prescriptions written. And then the prescriptions have just tripled in the last decade. So there are a lot of other drugs, Cialis, Levitra, Stendra. They work for different reasons and different people, different ways, but

they're not bad to use. In fact, they can be helpful. They may be protective against Alzheimer's I read recently. So they increase blood flow, they increase circulation, they increase nitric oxide. We're going to talk about all that. And those are not bad things, but you know, more and more people are actually using this. Even younger people are getting it for off-label use. They secretly take it. They're embarrassed. They have performance anxiety. Maybe they have erectile dysfunction when they're younger. But let's talk about how these drugs work and what is the physiology of actually having an erection. When you have sexual arousal, it causes the release of nitric oxide, which is a good thing, in those cells that we call,

that line your blood vessels, called the endothelial cells. And they're in your penis. And so basically you get increased blood flow because it helps to activate something called guanylate cyclase, an enzyme. You don't have to remember it. I promise no test on this. And that leads to an increase in something called cgmp now that particular thing causes the relaxation of smooth muscle cells or it causes your your muscles to relax and that leads to the dilation of the blood vessels in your penis and that increases blood flow and that leads to an erection and then it gets trapped inside the penis in the corpus cavernosum, which then, you know, maintain the erection and have fun. Now, after you ejaculate, there's an

enzyme called PDE5 or phosphodiesterase type 5, and that degrades the CGMP. So a thing that keeps your erection going. Now, that causes the smooth muscles to contract again, and that reduces blood flow to the penis, and that ends the erection. Now, how Viagra works, sildenafil, encealus, didaphenyl, how they work is they inhibit this PDE5. They inhibit 5-phosphodiesterase, which is this enzyme that degrades CGMP. Now, that prolongs the effect of this particular compound, CGMP, keeps the blood vessels constricted in your penis, and it helps maintain the erection for longer, which is fun

and great, and it's no problem. But side effects are common, about over 1 in 100 people. You get mild headaches, dizziness, flushing, congestion, and sinus, you know, basically having sex, you're congested, running nose, and have a headache. Well, it's not so much fun. It can cause backaches, muscle pain. Sometimes it can cause low blood pressure because it was designed for a blood pressure pill. It can rarely cause a painful erection to last a long time, like over four hours, and that's called pre-opism. And that can damage your penis, and it can cause all the heart issues. Rarely, it can cause vision or hearing loss, but that's very rare. Now, if you're taking drugs like nitrate

drugs, if you have angina, you have heart disease, if you have liver issues, you don't want to take them. So they're not bad, but let's talk about maybe getting to the root cause, which is exactly what functional medicine is about. It's not about treating the symptoms, it's about the cause. So how do we get to the root cause? We have to really understand the full picture. And so we have to look at diagnostics. And I think it's really important to do proper testing so you understand what's happening with your biology. And that's really why we've created Function Health, why I'm the co-founder and chief medical officer, because all the tests that I'm going to mention right now are all available at functionhealth.com and you can sign up. You can just get in there and get your test done and write there's a wait

list, but we can get you off the wait list if you use the code Dr. Hyman. Now, the first thing you want to know is something called sex hormone binding globulin or SHBG. Now, this is important because it regulates the amount of free hormone, free testosterone. It's a protein made by the liver. It binds to testosterone and estrogen, and it basically makes them inactive. So it's sort of like a reservoir of extra hormones when you need them. Also, albumin can bind to estrogen and testosterone, but not as well. And that's something you eat normally in your blood. Now, when you have insulin resistance, high insulin, the liver suppresses the sex hormone binding. And that leads to potentially

more free testosterone. And that can kind of screw up normal hormone balance. And we often see an increase in prostate cancer in the large prostates in guys who have insulin resistance and big bellies. And that's a concern. Inflammation, on the other hand, can also increase sex hormone binding globulin. So why does that matter? If there's inflammation, you get higher binding globulin, it means you get less free testosterone. And that's what matters. That's what does the job. And so when you have less free testosterone from any source of inflammation, you can end up in trouble. So sometimes guys, even with insulin resistance, tend to have the high sex hormone binding globulin because of the belly fat, which is basically a factory of inflammatory molecules. Now, what does testosterone do?

Well, it increases your sex drive or libido. It is involved in the production of red blood cells, which can sometimes be an issue if you're taking testosterone. It is involved in the production of red blood cells, which can sometimes be an issue if you, after you're taking testosterone, uh, it is involved in sperm production, mood. So it makes you happy. Or if you take too much, you can make angry motivation. So it's very important for motivation in men and women. And by the way, women have a lot of testosterone too. Um, it's really critical to build lean muscle mass, which we'll talk about why that's important for sexual function. It helps energy or cognition, recovery from exercise or injury, and it improves insulin

sensitivity. So it's good. Now, free testosterone is the active kind. It's not bound to the sex hormone binding globulin. It's the active form of testosterone, and it's not less than 2% of the total amount. Now, the optimal range, and these are all going to be in the show notes. You have to memorize them now, but you can check it out in the show notes. The optimal range is over 30 picograms per deciliter. Now, you want to look also at the total and the free. So you want to look at both. Now, if you look at the total testosterone, the ranges are kind of screwy because, you know, how we develop reference ranges in America is based on the average or quote normal in a population. So if you're a Martian, you land in America, it's quote normal to be overweight because 75% are overweight. It

doesn't mean it's optimal. So the ranges that we see are not the really optimal levels, but you see ranges of 200 or 300 nanograms per deciliter. But the range should really be over 500. And you have to look at the combination of free and total, but it can be up to a thousand or more. And I think it's important to sort of look at what the symptoms are, what the person's overall health is, and look at the free and total. And you get a sense of how much is going on there. Now, even if your total can be normal, you can still have issues of low testosterone because your sex hormone binding level is high. In other words, there's not enough free testosterone. So I see that very often in my patients. Also, the other hormone that guys have, which you probably may not know, is estrogen or

particularly estradiol. Now, men and women have estrogen and it has a lot of important functions. It does affect the libido. It affects erectile dysfunction and sperm production. It's also important for bone health or brain function and also for nitric oxide production. You don't want it too high or too low. And often guys who have big bellies have basically something called a bromatase in their fat, which turns testosterone

into estrogen. You don't want that. You don't want testosterone turning into estrogen. It's not nice. The other hormone you want to look at is the pituitary hormones and the hypothalamic hormones. Your pituitary hormones are really important. We call LH and FSH, luteinizing hormone and follicle stimulating hormone. Now, it's kind of a weird thing because follicle stimulating hormone sounds like it's for women's follicles that produce eggs, but it's also active in men. So in men, the way this works is your hypothalamus, which is kind of way in the top of your brain, it's kind of the master control center, creates a hormone called gonadotropin releasing hormone. So gonadotropin essentially are the hormones that make gonadal hormones. So it's like stimulates the pituitary to produce the gonadotropic hormones, which are hormones that stimulate the

testicles or the ovaries, which may be the case in women, to produce more hormones. So LH, our luteinizing hormone, which again, it's kind of a weird name because it basically luteal phase of the menstrual cycle, it's named after women's hormones, but it really affects men too. So LH affects cells in the testicles called the lydic cells. Now these cells produce testosterone. So higher LH will increase testosterone. FSH affects different cells in the testicles called the Sertoli cells, and they lead to sperm production. So LH, testosterone, FSH, sperm. Really important. And as important as that's fertility, what's going on with somebody, it's really important.

You may not know what's going on, and you might have low testosterone, but you could have a pituitary tumor for some reason. So you got to check all these things. Also, we look at prolactin, another hormone we check with Function Health. Again, not usually checked. Prolactin is another pituitary hormone that is involved in many things, including lactation. That's why I call it prolactin. But it can be high in certain benign tumors that grow in the pituitary, which are not that uncommon. And the treatment usually is surgery. Sometimes there's drugs that can treat it. We also need to look at inflammation. And we look at something called HSCRP or high sensitivity C reactive protein. Inflammation is such an important factor in our overall health and aging and

longevity. High inflammation is a root cause of sexual dysfunction, whatever's causing it. Now, many things can cause it, including our diet. That's the number one cause, really sugar, starch, processed foods, all that's driving inflammation, our gut microbiome, environmental chemicals, heavy metals, toxins. There's also endocrine disrupting hormones, which are really concerning to me. And I see a change in the population in the birth rates of men and women. We see changes in fertility. We're going to talk about that on another podcast. And I think a lot of it has to do with with these forever chemicals uh that are petrochemicals that are in the environment that don't go away we used to have dioxin and pcbs and ddt they're still around and now we have other plastics uh and other pesticides and herbicides these are highly dangerous and and they're toxic at very small levels so oh you're

like i'm so out i'm not getting that much of this or that. But you are. Cumulatively, you are over your lifetime. And then they've done fat biopsies of people and they found pretty much every human is a toxic waste tub. And we probably wouldn't be safe to eat if we were food. Other hormones are important as well. Leptin, again, something we check on Function Health that mostly doctors don't check. But leptin is the appetite suppressing hormone. But sometimes when you have insulin resistance, you also but leptin is the appetite suppressing hormone. But sometimes when you have insulin resistance, you also get leptin resistance. So you see high levels of leptin, and that leads to low testosterone and suppressed LH. So that's concerning. In one study in the Journal of Clinical Endocrinology, they looked at three groups of men, and they found that those

with higher leptin levels, mostly due to leptin resistance, had a higher body mass index, and they found that those with higher leptin levels, mostly due to leptin resistance, had a higher body mass index, so they were heavier, and they had lower levels of testosterone. So it's an important thing to check. Adiponectin, another important hormone, it's an anti-diabetic hormone, it's an anti-inflammatory hormone, it prevents heart disease, and it's often low in insulin resistance and inflammation, obesity. So you want to check adiponectin again, and it's often low in insulin resistance and inflammation, obesity. So you want to check adiponectin again, and we check that as part of our panel with function health. Again, it's not usually checked, but it's important because if it's high, it's good. And if it's low, it's bad. We also check your fasting insulin and hemoglobin A1C because

insulin resistance is really, I would say, the majority of the causes of erectile dysfunction as we get older. And it leads to, like I said, low testosterone, higher would say, the majority of the causes of erectile dysfunction as we get older. And it leads to, like I said, low testosterone, higher belly fat, more estrogen, abnormal cholesterol, more inflammation, low sex drive. It's just not a good thing. And your insulin, you really want between two and five. Now, most reference ranges are 15, again, because the average American is unhealthy and overweight. So the reference range is wrong, basically is what I'm saying. So in function health, we talk about what are the current reference ranges and what are the optimum ranges. Also, you want to look at stress hormones like

cortisol and DHEA. And you also look at cardiovascular testing and not just a regular cholesterol panel, as I mentioned, but looking at what we call lipoprotein fractionation. And this really looks at cardiovascular risk, insulin resistance, really important. And I think if you don't look at the right cholesterol panel, you're basically just living in the 20th century and not the 21st century in terms of cardiovascular health. Thyroid also really important. And we have to look at thyroid properly, not just the way doctors do it on their traditional panel or the TSH. You have to look at the TSH, the free T3, free T4, even thyroid antibodies, which we all check on function health. And they're really important because thyroid function, if it's low, will cause a low libido, low sex drive,

a low mood. And it may be as simple as taking thyroid and also will influence sex hormone binding alignment. Now, none of these tests are hard to get or expensive, but unfortunately, your doctor is probably not doing most of them or doing them properly. So that's why, again, I co-founded Function Health and encourage you to check out your own tests so you can see what's going on and be empowered with your own health data and be the CEO of your own health. All right. So what are the root causes of sexual dysfunction? Well, aging. That's a big one. Age basically is the strongest variable associated with every age-related disease, including erectile dysfunction.

As you get older, you lose muscle, you don't exercise as much, you know, you get more insulin resistant, and so you get lower testosterone, you get lower free testosterone, you get higher LH because your body's trying to like make more, but you're just not doing it. So you get lower free testosterone. You get higher LH because your body's trying to make more, but you're just not doing it. So you get lower testicular function. And in a study published in JAMA, about 1,400 men, they looked at men between 18 and 59, and they found that it was an increase in erectile dysfunction with age. Not surprising. It was an older study.

It was published in 99. They also reported a decrease in sexual desire with increasing age. Men in the oldest cohort who were basically 50 to 59, which is young to me because I'm 64, they were three times as likely to experience erection problems and to report low sex desire compared with men who were 18 to 20. So it's common as we get older. And it was likely among men in poor health, poor physical health, and poor emotional health. So it's important. And as you get older, you get more of these what we call comorbidities, which I hate that term. Comorbidities essentially means you've got a bunch of different diseases altogether, like high blood pressure, high

cholesterol, heart disease, diabetes, but they're all connected. They're all the same thing. And we're seeing just massive rates of obesity in this country. 75% of us are overweight. You know, basically 40 plus percent have obesity, not just being overweight. And this all leads to cardiovascular disease. And what is going on in cardiovascular disease is an endothelial problem. It's endothelial dysfunction. It's endothelial dysfunction. And it's basically hardening of the arteries. And guess what? The arteries that are affected first are the small blood vessels. And guess where they live? In your penis. So it's kind of the first telltale sign that something's wrong and it can only be the first sign of heart

disease. And people are not really aware of that. And by the way, smoking is a massive disruptor of endothelial function. And you might remember those ads. Well, you probably don't because most people listening are younger maybe, but I'm old. And there were those Marlboro ads where they showed basically the Marlboro man with a cigarette in his mouth that was kind of limp and falling over. And that's sort of how they basically got people to stop smoking. But it's a big factor if you smoke. Now, what is endothelial dysfunction? Let's talk about it a little bit. Basically, these cells, if they don't work properly, stop producing this important molecule called nitric

oxide. Now, what is nitric oxide? It's not nitrous oxide, which is laughing gas, but it's essentially a gaseous molecule that is made inside your body in your endothelial cells, in your blood vessel cells. It's a signaling molecule. It's a vasodilator. It's an antioxidant. It's an anti-inflammatory. It increases blood flow. It helps lower blood pressure.

And I had a scientist, Dr. Louis Ignaro, on the podcast who won the Nobel Prize in 1998 for his discovery of the role of nitric oxide in the cardiovascular system. And he's amazing. He was 80 years old. He was going strong and he's great. So I would encourage you to listen to that if you want to learn more about this. But these endothelial cells line every inch of your body, including your penis and the corpus cavernosum muscles. And they're very active in that lining. It's the main site of nitric oxide production. It essentially acts on the corpus cavernosum, as we mentioned, to increase the CGMP and that leads to erections. And when that endothelial lining is damaged, it leads to male sexual dysfunction or ED. Now, it's all connected, right? It's not just ED. It's heart disease,

diabetes, prediabetes, insulin resistance. It's all one problem.? It's not just ED. It's heart disease, diabetes, prediabetes, insulin resistance. It's all one problem. And one of the major ways it manifests is by damaging the lining of your blood vessels, leading to less nitric oxide and hardening the arteries, impaired blood flow. And this is really a sign that you might have some cardiovascular disease. So you really want to pay attention if you're having erectile dysfunction. So it's not just about sex. It's about your overall health, particularly your cardiovascular health and metabolic health and your risk of stroke, heart attack, dementia, all of it.

It's not really a local problem. It seems local, but it's not local. It's systemic. And it's a telltale sign of basically endothelial dysfunction if you're having erectile problems. It's like the canary in the coal mine for more life-threatening conditions. You know, the canary, the miners had the coal mine. And when the air was bad, the canary would die. They needed to get out.

Well, if you got this, it's time to get out and change your lifestyle. We're going to talk about what to do to fix endothelial dysfunction. Now, what's the biggest cause? As I've been saying, it's insulin resistance. It's our crappy diet. It's our processed food diet. I mean, I watched the Super Bowl recently and there was 11 commercials for junk food in the first half. I didn't watch the second half. I just got so disgusted. Basically basically insulin resistance is really the big driver. And that leads to bad cholesterol, what we call atherogenic dyslipidemia, which is the

type of cholesterol that causes heart disease. It causes metabolic dysfunction, prediabetes, diabetes, obesity. It's basically what we're all suffering from and dying from. When you have insulin resistance, you have more oxidative stress, more inflammation, that leads to more damage to the blood vessel walls, more endothelial dysfunction, and more heart disease and all of it. So obesity, basically, you've got this big belly fat

and that, even if it's not that big, by the way, doesn't mean a lot, it leads to the development of inflammatory cytokines, which are called adipocytokines or adipokines. Cytokines, you probably remember from COVID. And that leads to vascular inflammation, and that lowers testosterone. So what is driving this? Well, if you know me, you know the answer. It's our diet, right? 65% of our diet is ultra-processed food. We eat about 133 pounds of flour and 152 pounds of sugar per person per year. I mean, the average American consumes about 22 teaspoons of sugar per day. The

average kid, about 34 teaspoons, which is ridiculous. I mean, there's no biological requirement at all for sugar, none. And none for carbohydrates, by the way. What's really scary is that according to the CDC, about one in three Americans have prediabetes. I think it's way more. If you look at the data on the metabolic health stuff I always talk about, the 95% of people are metabolically healthy, that means they're somewhere in the continuum. Might not meet the strict criteria for prediabetes, but they have some metabolic dysfunction. So it's probably more like, you know, two, even maybe 300 million people who at some level have an issue, even if you're not overweight.

You know, there's 75% overweight, but if you have belly fat and you're not overweight, it can still be an issue. If you're under lean or under muscled, it's an issue. So it's really a big problem. And then about almost 40 million Americans have type 2 diabetes. And now people who have ED, I mean, it's really common to have prediabetes. 40% of patients with erectile dysfunction have metabolic syndrome. It's probably more. I think, again, how it's defined.

I think obesity is an independent risk factor for erectile dysfunction. About 80% of men have a higher BMI, meaning they're overweight. If your BMI is 25 to 30, which is sort of mildly overweight, you have a one and a half times risk of having it. If you're over 30 BMI, you have three times higher risk of sexual dysfunction than the general population. That's 300% increased risk of having erectile dysfunction if your body mass index is over 30. And by the way, that accounts for 42% of the population. It's a lot of people. And if you have poor glycemic control, poor blood sugar control, you're about two to five times more likely to have a risk of erectile dysfunction. So what do we see? Often, we see low testosterone and we see high estrogen in these men. And what are the symptoms of low testosterone? You might be listening carefully because you want to know if this is you,

but it's a big deal. And it really affects quality of life significantly. It leads to low libido, or sex drive, erectile dysfunction, as we mentioned. It can lead to the loss of body hair and even facial hair, the loss of muscle and fatigue. It can lead to weight gain, depression, anxiety. And this is commonly what happens when you get higher estrogen and lower testosterone in men. It happens as we get older a little bit, but it doesn't have to. It really has reversible causes like insulin resistance bit, but it doesn't have to, but it really has reversible

causes like insulin resistance, obesity, stress, too much alcohol, pot, or cannabis. It can be a pituitary issue, a hypothalamic issue. It can be leaky gut. It can be a lot of gut. By the way, your microbiome plays a big role in your hormones. We don't have time to get into that today, but it's a big factor. Also, also you can have too much estrogen. And, you know, as men age, testosterone goes down a little bit, estrogen increases, but not at the level we're seeing. And often we see high estrogen in men, and that's concerning. We see, I've seen men with breast cancer. It's a big issue. And so low testosterone and high estrogen increases the risk of erectile dysfunction, even unrelated to age. It can be caused by alcohol, by the way, alcohol, remember beer bellies, that's the same thing. And particularly beer, and particularly because it's very high

in carbohydrates and sugar. A diet high in starch and sugar will cause this. And so you know if you have it, you just look down, look down and look at your belly. If you're, you know, I always say use the mirror test, it's very cheap. You just look in the mirror, jump up and down. If your belly jiggles, you probably have it, right? You can use a waist to hip ratio. You can measure your waist. If you're a man, your waist divided by your hips, basically around your belly button, biggest point around your hips, biggest point with the tape measure. And if it's less than 0.9, you're good. If it's over 0.9, you're in trouble. If for a woman, if it's over 0.9, you're good. If it's over 0.9, you're in trouble. For a woman, if it's over 0.8, you're in trouble. If it's less than 0.8, you're probably okay. But it depends on where that cat

is too. So it's not always just about the tape measure. And the clues are there. I mean, we've talked about it. It's all this insulin resistance, diabetes. And what happens when you have high insulin, which is an epidemic in this country, is it stimulates this enzyme that I mentioned earlier called aromatase, and that increases the conversion of testosterone to estrogen. So you're basically making estrogen in your body, even if you don't have ovaries, right? You're making it in your fat tissue. And that's concerning. A few other things to mention before we get into the treatment. Sleep issues. Sleep apnea is a big factor, very underdiagnosed, very common. And that will lead you to produce less nitric oxide, low testosterone, and erectile dysfunction.

People basically don't breathe at night. They stop breathing. They get CO2. It screws up their sleep. It increases cortisol. That decreases testosterone. It's a mess. If insomnia is an issue for you, it also might be a factor in sexual function.

So you got to get that sorted. And I have a sleep master class. We'll link to it in the show notes. Psychological factors also play a big role, even independent of the insulin resistance, depression, anxiety, chronic stress. I mean, you know, you don't want to be making babies when life's stressful, right? Basically disrupts your whole hypothalamic, pituitary, gonadal axis. Lifestyle factors play a big role. Being sedentary, not exercising, big factor. Substance abuse, alcohol, particularly opiates. I think Andrew Huberman's talked a lot

about this on his podcast. Alcohol abuse is a big factor. Alcohol increases aromatase, makes you have more estrogen. It increases desire, but it decreases the ability, particularly when you're drunk and you get a beer belly, you get hair loss. So tobacco, we mentioned smoking, just forget about it. It's not even worth talking about. Everybody knows it's bad. Certain medications, by the way, can mess up your libido, like a lot of the antidepressants. That'll make you more depressed, right? The SSRIs like Prozac, Zoloft, they lead to lower sex drive. They can kind of make you numb to life and sex. Long-term use of steroids may do it, opioids. Also a drug that's used commonly for male baldness called finasteride, Propecia, and inhibits an enzyme called 5-alpha reductase, which reduces a form of testosterone called DHT. And that's a

problem. So it's a lot, and you might be depressed, and I get it. But the good news is this is super treatable and super fixable. And if you're systematic about it, you can actually get your sex drive back and your sexual function back. And with functional medicine, it's really about dealing with the root causes. And you start with lifestyle, diet, lifestyle, and basic supplements. So what should we do? Well, basically we should be focusing on our lifestyle, what we're eating, our sleep, stress, exercise, getting our weight under control, and taking the right supplements. Now, if you do all that stuff, and we're going to get into the specifics of those, if you do all that stuff and it doesn't get better, then you would digitally

consider some alternative therapies that are being used out there. And there's a lot of good therapies that are around. Peptides are actually being used and can be very helpful. You probably may not know what peptides are, but you've heard of Ozempic, I'm sure. You've heard of insulin, I'm sure. Those are peptides. Those are little tiny mini proteins the body uses to regulate everything, including hormones. So you can actually take them. There's shockwave therapy, which is using ultrasound and shockwaves to damage the penis a little bit and increase blood flow, circulation, repair, recruit stem cells. That can be helpful. The testosterone replacement therapy can be helpful or hormone optimization therapy in select patients. Stem cells have been used and

they're expensive, but they can really work. Also pelvic floor dysfunction. We haven't talked much about that, but a lot of guys and women have dysfunctional muscles in their pelvic floor that can lead to erectile dysfunction. And physical therapy can be very helpful. And that can be exercises. It can be internal massage that can help relieve some of that. So it can be something to explore if you're having trouble. So what should you be eating to optimize your sexual health? Well, guess what? It's what you eat for everything else, right? Whole foods and anti-inflammatory diet should be high in antioxidants high in phytochemicals polyphenols lots of fiber like one study in young men aged 18 to 40 found that men

with ed consumed a lot uh less of vegetables from flat and flavonoids basically phytochemicals compared to the control group that didn't have ed uh even after adjusting for age and body mass index it was found that consuming flavonoids uh which are basically from these phytochemicals compared to the control group that didn't have ED. Even after adjusting for age and body mass index, it was found that consuming flavonoids, which are basically from these phytochemicals from colorful plant foods, about 50 milligrams a day, reduced the risk of ED by 32%. Pretty good, just from eating vegetables.

So eat your vegetables. Flavones or your class of flavonoids, they're especially linked to healthy erectile dysfunction. So where do you get them? Parsley, celery, onions, oranges, thyme, oregano, basil. You basically eat your way to better health and sexual health, actually. Men without ED tended to eat more of these things, and they eat more fruits and vegetables. They ate less dairy. They drank less. They smoked less compared to men who have erectile dysfunction. No surprise. The study that was then suggested

that increasing the consumption of fruits and vegetables and flavonoids can lower the risk of ED in young men. So basically eating fruits and vegetables can lower your risk. In 2020, a study in JAMA of 21,500 men from the Health Professionals Follow-Up Study, they found a significantly important link between adherence to a healthy diet as measured by basically a higher Mediterranean diet score and a risk of ED. So the healthier diet overall, you know, good olive oil, nuts and seeds, lots of fruits and vegetables, whole grains, all can be helpful. And that's whole grains, not whole grain bread, but whole grains. And men who were younger than 60 with the highest

Mediterranean diet score had a 22% relative risk reduction, meaning they were 22% less likely to have erectile dysfunction. And those between 60 and 70 actually saw an 80% reduction. So even as you're older, you eat more fruits and vegetables. It works. Also, you want to eat fat because guess what? How do you make testosterone? You make it from fat, particularly cholesterol. Ooh, cholesterol, that's bad. No, not necessarily. You need cholesterol for everything in your body,

particularly your cell membranes, your brain function, and your sex hormones and many other hormones. Also, monounsaturated fats are great. Olive oil, avocados, olives, all great. Lots of omega-3s are anti-inflammatory. The smash fish, I call them, sardines, mackerel, anchovies, herring, salmon, eating lots of even plant-based omega-3s like walnuts, chia seeds, hemp seeds are fine. Saturated fat. Now, saturated fat is not for everybody, but particularly for people with insulin resistance, it can be very good, particularly for regeneratively raised meats from grass-fed butter, ghee, eggs, coconut oil.

And actually, you can increase your testosterone levels by eating saturated fat. Now, you have to keep an eye on your lipids. Everybody's different. Some people can tolerate them, some people can't. So keep an eye on it, and you can use function to track it and see what happens. But it could be an experiment, like change your diet, add more saturated fat, see what happens in your testosterone. I noticed when I started eating more saturated fat, my testosterone levels went way up. So you can change it by your diet. Getting quality protein, really important. Regeneratively raised grass-fed meats, wild-caught seafood, pasture-raised chicken. I mean, I've written a lot about this. My peak diet book, you can check out, Food, What the Heck Should I Eat? Also, don't eat so much sugar and

starch, right? Eat low-glycemic carbs, right? Vegetables, things that help blood flow, circulation, vascular health, berries, nice starchy veggies, leafy greens, beets, dark chocolate, that's good. Macarons, salmon, sardines, walnuts, chia seeds, watermelon, pomegranate, garlic, citrus foods, tomatoes, lycopene, great for the prostate, ginger, turmeric. All these are really awesome foods that help to improve your overall phytochemical content and that help blood flow and circulation. So the ones I mentioned are particularly around blood flow and circulation. So you can eat your way to better sex is basically what I'm saying. Also, of course,

avoid all the bad stuff, right? Ultra processed foods, sugar, sugar, sweetened beverages, the worst high fructose corn syrup, all the conventional dairy products, conventional meats have lots of hormones, antibiotics. Don't eat a low fat diet. It's bad news. For most people. It significantly decreases the total and free testosterone. Avoid toxins like big fish, mercury-containing big fish like tuna, swordfish, halibut, and so forth. Chilean sea bass are bad. And also alcohol, not great. I think we're coming more and more to understand that alcohol, even a little bit is harmful. And so you can have it occasionally. I do, but I probably wouldn't have it more than once or twice a week. Uh, definitely there's no health benefits. So just,

um, get that out of your mind. It's basically a poison and you're, you know, as Paris Seltzer said, the dose makes the poison. So while I have a glass of wine occasionally when I go out for sure, but, uh, it's definitely not a habit. Also, recreational drugs do contribute to erectile dysfunction, things like opioids, cigarettes, marijuana concern. And of course, we mentioned the toxins. You want to try to reduce your exposures. All the endocrine-disrupting chemicals, the plastics, deodorants, aluminum, fragrances, basically everything. There's a

great website. I'm on the board of the Environmental Working Group. It's EWG. You can go to EWG.com, and they have great ways to reduce your exposure through skincare products, household cleaning products, through foods, really, really well-researched databases. So you can choose products that aren't going to kill you and pollute you, basically. Obviously, lifestyle, really important. Exercise is key. Exercise helps with insulin resistance. It helps with improving muscle mass, reducing body fat, helping inflammation. It's just all around the best thing. So about 150 minutes a week, three or four times a week, you can do aerobic exercise, walking, biking, running, rucking, swimming, whatever you love, tennis. Just do something, right?

Also HIIT training. That's when you do high intensity exercise. Do that at least once a week. That's like sprinting. Weightlifting, really important. At least three times a week, 20 minutes, 30 minutes. You can use bands. You can use weights.

It's critical. Why? Because when you do strength training, you're actually building muscle and that will improve insulin sensitivity. It will increase testosterone, particularly loading large muscles like your glutes and your thighs, your hamstrings. It increases testosterone and also growth hormone. If you have sleep issues, fix those. Sleep apnea is important to fix, very common. When you lose weight, it'll help. But using the dietary things we talked about and the lifestyle things that should help.

But basically you want to fix sleep apnea and you might need to see pap, you might need testing, you might need to see a doctor, but get that checked out. Mouth taping can be helpful. People are really into it. You can use 3M micropore tape for sleep taping, mouth taping at night, or there's mouth tape. Also, pay attention that you're a biological creature, right? You're not a machine. And you should follow a circadian rhythm. Wake and sleep

at the same time, at least seven hours of sleep a night. Rhythm matters. And particularly, testosterone peaks in the morning and it goes down during the day. And when you screw up your wake-sleep cycle, it can affect testosterone. It can affect your endothelial production. So just get in a rhythm. Get sunlight early in the morning, which helps program your circadian rhythm and your pineal gland. Don't be in bright lights at night.

You know, dim the lights. Sleep with blackout curtains. Amazing. It's an amazing invention. I love them. Try to reduce blue light an hour before bed. Do stress relief techniques. Again, stress plays a big role in erectile dysfunction.

Meditation, breath work, active relaxation, higher cortisol and stress, lower testosterone. Now, what about supplements? Well, there's a lot of things you can try, but a multivitamin is important and mineral. Fish oil, omega-3s really help with that. Inflammation, they help with mood, they help with libido. Vitamin D, very important. Low levels are associated with low testosterone in men. It's important. Low testosterone is something that can be sometimes supported with herbs. And there's a long history of use and a lot of research on this, like long jack, fenugreek, maca, sometimes using DHA, which is a hormone, can help. If you

have a lot of stress, you can use some of the adaptogens like ashwagandha, ginseng, Siberian ginseng, rhodiola, magnesium. There's some that really help for libido. A lot of people are selling this online, but you want to find good quality products. But Tonkat Ali is something that's been talked about a lot recently. A study found that supplementing with Tonkat Ali really reduced tension, stress, and anger, and confusion, and cortisol, but it increased testosterone by about 37%. It's an ancient remedy, but it could help improve your stress hormone profile and help your sex drive. So it might be worth a try. There's another one called shalajit. I don't know if I'm pronouncing it right, but it's an Ayurvedic compound from black, brown exudate that oozes from sedimentary

rocks around the world, largely in the Himalayas. It increases libido. It's a great antioxidant. It helps blood flow, helps sexual performance, prevents premature ejaculation, maintains erection. So, and there's been randomized placebo-controlled trials, believe it or not. One was done of 75 healthy volunteers, aged about 45 to 55, and taking about 250 milligrams twice a day really improved DHA and testosterone levels. So that's good. Now, there's a lot of other treatments that you might consider after you do all the lifestyle and supplement things that might be helpful. And these really have to be decided on a case-by-case basis. Pelvic floor therapy, I would consider checking that out. If you're a bike rider, if you've had any injuries, surgeries,

some of those pelvic floor muscles get wonky and they can be helped by massage and treatment with a pelvic floor therapist. That's something we talk about a lot in medicine, but it's important. There's also peptides. Now, peptides, we mentioned, are these little small mini proteins like insulin, nozempic, but there's a lot of them, thousands of them. And some improve testosterone, some improve growth hormone, and they can help with lean muscle mass, recovery, increased energy, bone density. Just to mention a few, kissapeptin is one that helps with testosterone. Testamoralin, samoralin, CJ-1295, all can be potentially helpful. And you'd want to work with a doctor to, you know, do that, obviously. Testosterone placement therapy. You know, you have to be a good candidate. You have to do the right tests, all the things we mentioned that you can get on

function health. Really really depends on the individual, your age, overall factors. And it's something you decide with an expert. And it's not just like everybody gets it. There's these low T clinics out there that give everybody disaster. And I'm not a big fan of that. I think there's a risk to it. I think it really has to be personalized and individualized. But it can really, you know, if you are not responding to the other interventions, it might be helpful. And then some of this can be really effective. So there's certain reasons you wouldn't do it. Like if you have potentially, you know, risk benefit issues, we'll talk about what those

are. But like, you know, certain blood conditions and certain prostate issues that might be concerning. But, you know, there was a big concern about heart disease. And, you know, it does raise cholesterol. And so there was this belief that it increased the risk of heart attacks. So there's a big trial. It's called the Traverse Trial, published in the New England Journal of Medicine.

It was a placebo-controlled study with men aged 45 to 80 who had low testosterone. And they were at increased risk of cardiovascular disease and heart attacks, right? And the goal of the study was to look at the efficacy and the safety of testosterone replacement therapy. Now, what they found was no significant difference, no significant difference in major adverse cardiovascular events between testosterone and the placebo groups. And that suggests that testosterone replacement therapy is not more harmful than a placebo in that population. So now there were some limitations in the study. It was a small increase in total testosterone because they use a topical gel. Maybe it was the method

of menstruation. Maybe injections would have a different result. But it's really a bit of a reassuring study. Now, it can improve when you take testosterone replacement therapy. It can improve your symptoms of low testosterone. It can improve your quality of life. But it's really, I think a little more research is still needed, but I'm not concerned about it in select patients that are followed carefully and followed up with lab work and their risk factors and their heart disease risks. So not so worried about it. Now, there's really no data on, again, a big worry, which is using testosterone replacement therapy and having an increased risk of prostate cancer. Now, in fact, low testosterone is associated with prostate cancer. So I think, you know,

the fears around testosterone and prostate cancer and heart disease have been mostly put to bed. But we're still learning and doing more research. Now, if you want to have a baby, it's a problem. So it's not great if you're trying to conceive because it shuts down the stimulation of the Sertoli cells, which make sperm. And that's not good. So you don't really want that. And I think that you can treat that with things like Clomid and other things to stimulate your testicles if you're on testosterone, but it's something you'd have worked with a doctor on. Also,

you want to be careful if you have a history of prostate cancer, if you have heart failure, you have a high PSA or enlarged prostate, if you have sleep apnea, if you have a high red blood cell count, it can be an issue because it can increase your red blood cells. So you can get like thick blood and strokes and clotting. So you have to really track that and check your blood count. So basically you need to see a doctor if you're going to do this. You need a real thorough evaluation. You need the right blood test, like we talked about from Function Health. You need a detailed medical history, a physical exam, and all that is really important if you're going to use testosterone. Now, what else is available?

Well, shockwave therapy can be really something you can do, and it's pretty non-invasive. It's pretty safe. Low-intensity shockwaves, basically sound waves, basically one or two times a week for 15 minutes for about six weeks, and that basically causes little microtrauma to the penis. And that leads to something called angiogenesis. So basically when you have a trauma, it increases blood flow, new blood vessels to grow and it recruits stem cells. So it can be really helpful. And then some men find that very helpful. There are other therapies tend to be a

little more experimental, a little more expensive exosomes, which are basically like the small vesicles that are released from your stem cells that carry RNA, proteins, lipids. They don't really have the ability like stem cells to kind of have any genetic identity, but they can really help inflammation and modulate the environment and may help in repairing and regenerating penile tissue. And they basically are given by injection directly into the penis. So we need more trials on that. But, you know, they're really safe and you can get them from synthetic ones or donor derived or even from your own. Stem cells are another thing to think about. They're found in your bone marrow, fat tissue. You can use umbilical stem cells from donors. They actually can become something that can, I think is going to be a very effective treatment. But again, it's expensive. It's not FDA approved and so forth.

Other treatments, well, hyperbaric oxygen. We talked about that on the podcast, but it actually increases blood flow again. It's a study by urologist in Turkey, involved a hundred men and they compared the effects of oxygen therapy, Cialis, or no treatment. And they basically found that the hyperbaric oxygen treatment for 90 minutes a day was compared to taking Tadafanil or Cialis five milligrams a day or placebo for a month. And what they found was basically the oxygen and the Cialis groups both had a 50% improvement in erectile dysfunction. So that's pretty cool. It's non-invasive. It's a really safe treatment. And the effect lasts about two months. And basically, it's kind of cool. So I think the oxygen therapy has less side effects.

It also helps your body heal in other ways. It's been linked to increased nitric oxide and stem cells and all kinds of things. Other things for erectile dysfunction, well, there's injections. I think I'll try mix, which you can use when you want to have sex. You inject a little bit of this medicine in the base of your penis and it makes your penis hard and you can have sex. It can be a problem if you take too much. It can lead to your long erections and you need to make sure you have the antidote. There's penile implants, there's vacuum pumps and all that you need to see a urologist with. So this is a lot. We covered a lot of stuff around sexual health, men's health, testosterone, lifestyle changes. It's not something you have to suffer with. If you have this or

if your partner has this, it's something to think about getting on top of and not just letting go because it's embarrassing. It's not really just a bedroom problem, as we discussed. It's sort of a window into your overall health, especially your heart and your metabolic health. And with functional medicine, there's silver lining that in understanding these lifestyle and diet changes, you know, we can really make a big difference, not just for your sexual health, but your overall health. So think about getting on a healthy diet, getting off the starch or sugar, exercising, getting on the right supplements, trying some of these experimental things like peptides, even hormone therapy, lots to explore that can lead not just to a better sex life, but a more

vibrant, healthy life. Thanks for listening today. If you love this podcast, please share it with your friends and family. We'd love to hear your comments and your questions, and please leave us a rating and review. And of course, subscribe wherever you get your podcasts. You can find me on all social media channels at Dr. Mark Hyman, and you can also subscribe to my YouTube channel at Dr. Mark Hyman. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free MarksPix newsletter at drhyman.com forward slash MarksPix. I promise I'll only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my

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