A review of published studies shows that the world-wide incidence of inability to achieve an erection varies widely from three percent to 76.5 percent, and the geographical incidence of impotence is associated with all the same risk factors as those for heart attacks, dementia and having an enlarged prostate (BJU International, July 3, 2019). About 20 percent of North American men over age 20 suffer from erectile dysfunction (ED), which is defined as the inability to achieve or maintain an erection for satisfactory sexual intercourse.

Being impotent more than doubles a man’s chances for suffering a heart attack or stroke and dying from heart disease (Circulation, June 18, 2018). The same factors that block the arteries leading to your heart also block the arteries leading to the penis. Three out of four cases of impotence are caused by arteriosclerosis (Journal of Urology, Jan 1994;151(1):54-61). Doctors often do not ask their male patients about impotence because of concern about embarrassing them, but doctors should screen all their male patients for impotence and those who are impotent should have a work up for all the known risk factors for heart attacks, and then be instructed on the same lifestyle changes recommended for people at risk for heart attacks and dementia.

Common Risk Factors
ED has the same risk factors as heart attacks, including obesity, hypertension, smoking, and diabetes. The most common risk factors of ED are blood vessel disease (arteriosclerosis), high blood sugar after meals (diabetes or pre-diabetes), and lack of the male hormone, testosterone.

When a man lacks testosterone, he usually has little or no sexual desire. If he still has desire, his testosterone is usually normal but his blood vessels are usually damaged and the same damage that occurs in the arteries leading to his heart has also occurred in his penis. Lack of male hormones is strongly associated with increased blood levels of triglycerides and LDL cholesterol that increase risk for diabetes, high blood pressure, arteriosclerosis, and obesity. Men who are impotent and have big bellies and small buttocks are usually already diabetic.

All men with ED should get blood tests for diabetes, testosterone, prolactin (a hormone that can cause impotence), cholesterol and triglycerides, and have their blood pressure checked. Perhaps the most important blood test is to check sugar levels one hour after a person eats a regular meal. If his blood sugar is greater than 145 mg/dl, he is usually diabetic, even if his fasting blood sugar is normal.

Treatment of ED
Most impotent men will have blood vessel damage from arteriosclerosis or diabetes and should follow a program that includes:
• losing weight if overweight
• starting a supervised exercise program
• following a healthful, plant-based diet with plenty of vegetables, fruits, beans, nuts and other seeds
• restricting refined carbohydrates (sugared drinks and foods made from flour), fried foods, and meat from mammals and processed meats
• avoiding smoking and second hand smoke
• avoiding or restricting alcohol

Men who need testosterone replacement should not take testosterone pills because they go from the intestines to the liver to lower the good HDL cholesterol and increase risk for heart attacks. They should use a route that bypasses the liver such as testosterone injections or testosterone gel that is rubbed on the skin.

My Recommendations
Any man who becomes impotent needs an immediate evaluation for the cause. ED is a major risk factor for heart attacks, strokes, dementia, and premature death. Often the lifestyle changes listed above can cure ED, prevent heart attacks, and possibly reduce the likelihood of becoming demented.