In many cases, psychological issues develop into performance anxiety which, in and of itself, becomes a self-fulfilling prophecy. Silvestri et al. Marijuana and erectile dysfunction: what is the connection?, [Crossref] [PubMed] Latini DM, Penson DF, Wallace KL, et al. Chou and colleagues reported that statin use was associated with the reduced risk of incident erectile dysfunction (ED) in middle-aged men in Taiwan.

The fact that ACE inhibitors work through other channels than the sympathetic nervous system in lowering blood pressure might in part explain their reduced impact on sexual function.

Instead, the clogged arteries themselves may be the cause. An in vitro study demonstrated statin effects on human testicular testosterone synthesis [67] and in animals effects on the morphology and function of Leydig cells have been seen after statin administration [68]. Learn more about the differences between HDL and LDL cholesterol here. Results of this study showed that in the placebo group, impotence resolved in 2 men only after the study drug was stopped, whereas in the simvastatin group, impotence resolved in 14 men despite continued simvastatin treatment.

The main findings in the literature concern atorvastatin, in particular, because statins and sildenafil, a selective inhibitor of phosphodiesterase type 5 (PDE5i), can activate the nitric oxide (NO) cyclic guanosine monophosphate pathway. Diclofenac can be irritating to the digestive tract. Tadalafil during its metabolism is converted to a metabolite that binds irreversibly to the enzyme active site, permanently inactivating the enzyme. On the other hand, statins have been reported to improve erectile function when the cohorts had no other cardiovascular risk factors accept for untreated ED [70–72]. Given, the concern that statins lower testosterone [11, 12, 14–16], these might perhaps be trials where statins reduced testosterone among men. For example, a study of 3,484 men with erectile dysfunction found that men who were using statins when the study took place were twice as likely as other men to suffer clinical hypogonadism. In men, high cholesterol can damage sexual performance and decreases libido.

5 % in the placebo group. Questions for You to Consider What are statins? When you become aroused, your brain sends chemical messages to the blood vessels in the penis, causing them to dilate or open, allowing blood to flow into the penis. Improvement in ED score with sildenafil was reassessed at 6 and 12 weeks of treatment with atorvastatin (80 mg daily) or placebo. Muscle toxicity is a potential adverse effect not only for statins, but also with 5PD. If you have experienced erectile issues or you have some of the risk factors mentioned above, it may be worth making a trip to your doctor’s office. The association between ED and dyslipidemia have been demonstrated by several studies ( Saltzman et al, 2020 ; Miner and Billups, 2020 ), and other studies have demonstrated that statins can lead to an improvement of erectile function ( Gokkaya et al, 2020 ). Side effects, according to the Mayo Clinic, include:

Primary Navigation

For example, someone with atherosclerosis may experience ED as a symptom of their condition. The ACC also leads the formulation of important cardiovascular health policy, standards and guidelines. A critical review used this study to underpin their doubts about the sexual side effects of β-blockers [20].

Case Reports in Medicine

To yellow card reporting in different countries can be added the prospective cohort study. The symptoms of erectile dysfunction include difficulty achieving an erection, trouble maintaining an erection and a reduced interest in sex. (4) but not for pravastatin and fluvastatin (Do et al, 2020). Although the mechanism remains ill-defined [28], striking results with respect of drug treatment in male hypertensive patients were obtained in the Medical Research Council Trial [29], a single-blind study on the basis of 23,582 patients-years.

The effect was apparent by 6 weeks ( Herrmann et al, 2020 ). We are not aware of any study examining whether lowering testosterone mediates the effect of statins on diabetes, as this possibility has not, to the best of our knowledge, been considered before, and remains speculative. But we know that there has been some association between statins and erectile dysfunction, so a quick literature survey seemed in order, following up on a systematic review from 2020 [1]. Impotence of organic origin (erectile dysfunction) treatment and medications, effect of once-daily tadalafil on confidence and perceived difficulty in performing sexual intercourse in men who were incomplete responders to as-needed PDE5 inhibitor treatment. The IIEF is a validated, 15-item questionnaire to assess five domains of ED over the previous four-week period. Are you at risk for erectile dysfunction?

Still, the researchers argued that statins may well be the culprit and that further research is justified. The IIEF‐5 score was significantly higher after sildenafil treatment than in the atorvastatin treatment group, and the IIEF‐5 score after combined treatment was significantly higher than in the sildenafil or atorvastatin treatment groups ( Gokkaya et al, 2020 ). 4% reduction here among men mainly using simvastatin 20 mg/day, suggesting a possible dose response of statins on testosterone. Ask a doctor about trying Viagra today. Left untreated, ED can contribute to worsened stress and anxiety as well as low self-esteem, relationship problems, and impotence. The researchers state that the increase seen was equivalent to about one-third of the improvement seen with drugs specifically designed to treat erectile dysfunction, such as the class of drugs known as phosphodiesterase 5 (the most famous of which is Viagra aka sildenafil. )

“We hoped to see some small improvement but it was much larger than expected.

Useful Links

We continue to identify technical compliance solutions that will provide all readers with our award-winning journalism. Around eight million Brits take statins for heart health. In 2020/4, the WHO Uppsala Monitoring Centre had 144 reports of decreased libido, and 498 reports of impotence. Statins are commonly prescribed for people with ailments such as diabetes or heart disease, which can cause erectile dysfunction. 8 million people to 29. ED patients with high cholesterol levels are likely to be taking a statin anyway, he added.

In many cases, ED is rooted in psychological issues — especially in men under 40 years of age. Research in 2020 suggested that statins might actually cause erection problems by lowering testosterone levels. Also known as ED, erectile dysfunction is defined as the inability to achieve or maintain an erection firm enough for sex. If you ask your physician whether your statin drug might have caused your erectile dysfunction, compare his/her answer with the findings above. I want to know if there is anything I can take for arthritis pain that will not give me stomach ulcers, raise my blood pressure or lead to a heart attack.

The side effects of high cholesterol in men can lead to erectile dysfunction. Treating atherosclerosis with statins may, therefore, lead to a decrease in ED symptoms. Impotence and smoking, at a molecular and cellular level in the animal model, cigarette smoking (CS) is linked to significantly higher markers of oxidative stress and cavernosal tissue apoptosis (31). ” Kostis also adds that the erectile function benefits associated with statin use was larger than the reported effect of lifestyle modification. What ED Treatment Options Are Available? Eat healthy and regularly.


“The increase in erectile function scores with statins was approximately one-third to one-half of what has been reported with drugs like Viagra, Cialis or Levitra. It is estimated that 18 million men in the United States experience erectile dysfunction. But definitive evidence about such a relationship would require a carefully controlled study, Goldstein said. It can stick to the inside of arteries, leading to a buildup of atheroma, a fatty substance that narrows the arteries and makes it difficult for blood to pass through. Thanks for registering! (7%) responded to a questionnaire about sexual function at a mean posttransplant time of 5.

Antipsychotics also are often prescribed “off-label” to treat agitation and depression, among other conditions.

About This Article

However, in this study there was no placebo group, which may limit the interpretation of the results. They showed that α-adrenergic antagonists used as treatment for hypertension do not seem to adversely affect sexual desire. In high dose statins and in rare occasions, people are at risk for increased blood sugar (or Type 2 Diabetes), muscle cell damage, liver damage and cognitive problems. Similarly, it is not known if such an intervention will improve symptoms in patients with established ED. Angiotensin-converting enzyme (ACE) inhibitors, particularly captopril, have been associated with improved sexual function [47–49].


How do erections work? ” Talk with your doctor or other health care provider. Taking certain medications is also associated with causing or exacerbating ED.

In the treatment of hypertension, when compared with spironolactone, the selective mineral corticoid receptor antagonist eplerenone provides a reduced incidence of gynaecomastia [37]. And patients do not have to take specific drugs for erectile dysfunction. Additionally, in an experimental model of diabetes characterized by RhoA/ROCK overactivity, ED, and hypogonadism, it has been demonstrated that both testosterone and statin therapy restored electrically stimulated penile erection by down‐regulation of the RhoA/ROCK pathway; moreover, the effect of statin was obtained independently from the concomitant hypogonadal state ( Morelli et al, 2020 ). 6 % of the bendroflumethiazide group. Among the patients studied, 244 (7%) patients were being treated with statins. The beneficial effects on sexual function were confirmed in a study among 2202 hypertensive patients, reporting an increase of sexual intercourse per week when treated with valsartan. Be sure to verify your new user account in the next 24 hours, by checking your email and clicking the "verify" link. 9% of cases, recovery occurred after withdrawal of statin, and rechallenge was positive in 5 cases.

It was found that after liver transplantation, the proportion of sexually inactive men decreased significantly from 29% to 15%,but the proportion of men with ED remained unchanged. Furthermore, Mayo Clinic states that clogged arteries can cause ED. In vitro contractility studies were conducted in the rabbit model, and in the rat model, the sildenafil effect on electrical stimulation—induced erection was investigated.

The number of cases is small compared to the very widespread prescribing of lipid lowering drugs, especially statins.

Article Info

In a double-blind comparative study in 451 patients of both sexes, patients were allocated either to treatment with the calcium channel blocker amlodipine or with the ACE inhibitor enalapril for 50 weeks after a 4-week placebo run-in. The report is published in the April issue of the journal. There is evidence that these cholesterol-lowering drugs lower testosterone levels (BMC Medicine, Feb. )

Antipsychotics are used to treat schizophrenia, bipolar disorder and other serious psychiatric conditions. The results of this study showed that in both diabetic models, atorvastatin did not affect glycemia, lipid plasma levels, and the hypogonadal state. This was a systematic review and meta-analysis of studies assessing the effects of statin therapy on erectile dysfunction. Since α-adrenergic antagonists are first-line therapy for benign prostate hyperplasia (BPH) but only second-line agents for the treatment of hypertension (doxazosin and terazosin), most knowledge regarding sexual adverse effects of α-adrenergic antagonists comes from BPH studies.

Millions of Americans are prescribed statins to prevent heart disease, but some stop taking the medication or take less than the prescribed dose, Kostis said.

Easy Aisle

Finally, there was no statistically significant difference in penile erection after intake of simvastatin or placebo (Mastalir et al, 2020). 5 (range, 0–25), and 22% of these patients experienced new onset of ED. Statins inhibit the enzyme 3‐hydroxy‐methyl glutaril‐CoA (HMG‐CoA) reductase, which catalyzes the rate‐limiting step in de novo synthesis of cholesterol—that is, the conversion of HMG‐CoA to mevalonate. Erectile dysfunction and hypertension: impact on cardiovascular risk and treatment. Although not statistically different, the frequency of men able to achieve intercourse by vaginal penetration without PDE5i was 40% in group 2 compared with 17.

Several scattered studies have found a relationship between statin use and lower levels of male hormones. 8%, meaning that nearly three of every one hundred users of rosuvastatin could expect erectile dysfunction or worsening of their existing ED. 36 nmol/L, p < 0. In contrast, among those who were not told the drug's name or its side effects, only 3% said they experienced ED. One prescription option that often is overlooked is the drug salsalate. There are also studies showing that reducing cardiovascular risk factors, like losing weight, can improve erectile function.

International Journal of Impotence Research

Major risk factors for erectile dysfunction include diabetes, smoking, drug and alcohol abuse, overweight, depression, stress, heart disease and certain medical treatments. Moreover, the Rho‐kinase inhibitor H‐1152 dose‐dependently increased erectile response and shifted voltage sensitivity with statin treatment. Testosterone is the primary male sex hormone, and it’s necessary for an erection to be achieved. Also, a systematic review revealed that statins may cause ED []. This is suggested by three randomized clinical trials using atorvastatin (from 40 to 80 mg daily), that showed a significant improvement in ED compared with the placebo19, 21, 26 after less than 6 months using the medication. Call your physicians at Boston Medical Group for appointment. These groups were homogeneous for age, body mass index, and systolic and diastolic blood pressure, and the group of patients treated with hypolipidemic drugs showed a lower level of triglyceride and higher levels of HDL cholesterol compared with the group not receiving hypolipidemic medication.

This column, "What Matters," regularly appears in Internal Medicine News, a publication of Frontline Medical Communications. I am now on diclofenac and take Nexium (40 mg) for GERD. 3 at baseline to 18.

Forgot Your Password?

There was no significant increase in IIEF domain scores for subjects treated with placebo. But, in a comparing study between the ACE inhibitor lisinopril and the β-blocker atenolol, lisinopril only caused a temporary decline in sexual activity. We are engaged on the issue and committed to looking at options that support our full range of digital offerings to the EU market. Because male sexual arousal is a fairly complex process, it can sometimes be difficult to identify a specific cause.

“But the important thing is that by improving cholesterol levels, patients were also benefiting from better erections.

Erectile Dysfunction Treatment and Prevention

The benefits of statins prevailed over the side effects in 10 of 11 studies reviewed, he said. The median age of patients was 56 years, the median induction period was 16 days, and the median recovery period was 27 days. Moreover muscle toxicity is a potential adverse effect not only for statins, but also with 5PDi so their concomitant use should be carefully monitored. Cognitive-behavioral therapy (CBT) is a popular method because it helps address negative patterns of thought that can contribute to performance anxiety. Finally, 15 patients were also receiving other drugs, and 3 had diabetes (Carvajal et al, 2020). Potential subjects were excluded if they were currently using antilipidemics.

Clinical Care/Education/Nutrition/Psychosocial Research

Further limitations would be that the most significant benefits for ED with simvastatin may be reached at higher doses, such as 40 mg, or higher, and that the difference between groups may be <40%, which determines the need for a greater number of patients for evaluation. It could be something as simple as a run away script or learning how to better use E-utilities, http: Recent epidemiological studies have underlined the close association between ED and comorbid conditions such as hypertension, diabetes mellitus, and dyslipidemia. The study’s authors note that oxidized LDL inhibits vascular smooth-muscle relaxation. Inflatable devices or malleable rods can be surgically implanted on either side of the penis to help achieve an erection. In the few studies concerning sexual function in female patients with antihypertensive treatment, metoprolol seems to negatively affect female sexual function index scores (FSFI) [16], especially in comparison with ARBs which seem to ameliorate FSFI scores [17, 18]. Reply via e-mail at [email protected] Over half of men had a fall in 5 or more points on IIEF with statins, and 22% experienced new onset erectile dysfunction.

Concurrently, group S received simvastatin (20 mg/kg daily). And for all the conditions listed above, there are alternative drug and nondrug treatments. The same cardiology congress that brought us statins for erectile dysfunction had Professor Giovanni de Gaetano’s study showing that a diet of fish, vegetables, nuts and oils can reduce early death from heart disease by 37%. Furthermore, group I showed improvement of only the eNOS‐related pathway, whereas group S effectively controlled both the eNOS‐related and RhoA/Rho‐kinase pathways ( Park et al, 2020 ). Then, penile tissues were processed for molecular assessment. However, when these were combined with the RCTs, statins were still associated with a significant 3. Moreover, observational studies suggest serum testosterone has sex-specific physiological effects on diabetes, negative among men [41], but positive among women [41], when statins increase diabetes in both sexes [4, 5, 42].

  • The JUPITER study showed the safety and efficacy of the use of statins in primary prevention, selecting patients according to the usCRP levels.
  • Statins are used to control LDL Cholesterol in our bodies.
  • Among men the evidence was homogeneous and largely related to typical doses for the target group using statins for the prevention of cardiovascular disease, where statins potentially lowering testosterone has always been a concern [11, 12, 14–16].
  • Concerning female sexual function, valsartan has been shown to improve sexual desire and sexual fantasies, while atenolol significantly worsened these items [18].


The authors of the paper, which appears in Clinical Endocrinology , noted that none of the trials were particularly large or particularly long and then made their conclusion. 10 healthy ways to manage erectile dysfunction, eD often has an impact on the emotional well-being of both men and their partners. In diabetic rats, atorvastatin ameliorated the erectile response to electrical stimulation of the cavernous nerve and normalized the sildenafil effect on erectile function, strongly decreased by diabetes. “Doctors need to be informed about and responsive to patient concerns,” Dr. Total cholesterol (CHOL), low (LDL) and high (HDL) density lipoproteins and triglycerides (TRG) were assessed in all participants. In this study, 131 men were randomized to 40 mg of atorvastatin or matching placebo. The researchers identified 11 randomised controlled trials (RCTs) and three observational studies.

Among men who had high cholesterol and erectile dysfunction – and who were taking statins – there was a statistically significant increase in erectile function, amounting to a 24. Although the methods used by the researchers were sound, the 11 randomised controlled trials included in the analysis only included a total 713 men. In younger women, some RCTs indicate that low doses of testosterone may improve glucose metabolism [44, 45]; female to male transsexuals given high doses of testosterone have improved glucose metabolism [46].

WASHINGTON (March 29, 2020) — Statins are associated with a significant improvement in erectile function, a fact researchers hope will encourage men who need statins to reduce their risk of heart attack to take them, according to research to be presented at the American College of Cardiology’s 63rd Annual Scientific Session.

All rights reserved. They prescribe the best course of treatment for erectile dysfunction after thorough assessment. 3 (the highest score is 30). First, given when they were conducted, not all the trials had high quality scores. Heart disease, atherosclerosis, high cholesterol and high blood pressure can all impact the amount of blood flowing to the penis. In a subsequent study, the validated Sexual Health Inventory for Men (SHIM) 5‐item questionnaire, based on the IIEF questionnaire, was administered to 76 men with chronic stable coronary artery disease during routine outpatient cardiology. One was a small, but randomised and double blind comparison of atorvastatin and placebo in 12 men with erectile dysfunction and who were taking sildenafil [6]. 2020 icd-10-cm diagnosis code f52.21: male erectile disorder, moreover, they stated that given this and the fact that deviation may worsen with ESWT, this treatment cannot be recommended. Today in addition to the classical proerectile-effect, several studies have demonstrated that PDE5 can also influence vascular endothelium; given that the combinated therapy statins plus PDE5 could be very useful in patient with high cardiovascular risk [4, 5].

These words are enough to make any man nervous.

Ask the Pharmacist

Some research even suggests the effect of blood pressure drugs may be more psychological than physical. 3 on a 25-point scale. The 5p-a-day cholesterol-buster clears arteries, easing blood flow and helping maintain stiffies, say experts. 16, 18, 19, 21, 22, 23, 26 The explanations of how statins could improve ED are based mainly on the pleiotropic effects of this class of medication, that is, effects that go beyond simply lowering cholesterol levels.

Cholesterol lowering drugs ‘reduce erectile dysfunction’,” reports the Daily Mail.

Diffuse Thinning

In many cases, diagnosing erectile dysfunction requires little more than a physical exam and a review of your symptoms. Do these remedies for erectile dysfunction work? In particular, it helps the men get an erection easier and faster. The five-item IIEF is a widely used, multi-dimensional self-report instrument for the evaluation of male sexual function. Among women less concern has existed [34]. LDL cholesterol is the type that causes problems.

Ages That Bring Rages

Another study evaluated the frequency of ED after liver transplantation and discussed the potential risk factors. 9 points in men who took statins - from 11. However, considering the strong correlation and pathophysiological link between endothelial and erectile function, beta-blockers with beneficial effects on nitric oxide synthase and oxidative stress can improve erectile function [27]. Incidence of withdrawal from randomised treatment because of impotence (rates per 1000 patient-years) was 0. The atorvastatin effect on hyperglycemia‐induced RhoA/ROCK signaling was evaluated with the ROCK inhibitor Y‐27632 in both animal models and by analyzing functional effects downstream to RhoA activation in hfPSMCs. Rather than preventing the possibility of a heart attack in the future, the more immediate benefit of improving erectile function might improve adherence to statin therapy, he added. In some cases, Boston Medical Group can help patients resume their sexual performance in just one visit.

Study Selection

Statins are unlikely to be prescribed for erectile dysfunction in men without cardiovascular risk factors. Atorvastatin was associated with a statistically significant improvement in the mean IIEF-5 score (P =. Causes of erectile dysfunction, it has been shown that levels of the hormone prolactin are abnormally low in men with erectile dysfunction and premature ejaculation. )Since statins are the most commonly prescribed drug in the UK, will erectile dysfunction (whatever doctors call the condition, it still sounds pejorative) be consigned to history? Furthermore, ACE inhibitors have been reported to reverse endothelial dysfunction by preventing the effects of angiotensin II, prolonging the half-life of nitric oxide and decreasing degradation of bradykinin. Cholesterol is a waxy, fat-like substance. The higher your LDL levels the more likely to develop erection problems and severe cases lead to impotence. Researchers in Poland searched hospital records for a representative sample of statin-using men and then compared their testosterone levels with those of statin-free men who were otherwise similar. Men were 18-70 years of age and had an inadequate response to sildenafil 100 mg, LDL cholesterol less than 160 mg/dL, and ED for more than 6 months.