Impotence

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Try one of these related symptoms.

Premature ejaculation

Impotence

Delayed ejaculation

Low libido

No sex drive

Losing erection with new partner

Sudden loss of erection

Unable to maintain an erection

Difficulty maintaining erection

About the Symptom

Erectile dysfunction or impotence describes consistent and recurrent inability to achieve or maintain an erection firm enough for sex.

When to See a Doctor

Seek professional care if you experience any of the following symptoms

Possible Causes

Generally, Impotence can be related to:

Doctor's Diagnostic Questions

Your doctor may ask these questions to check for this symptom:

Reviewed By:

Kenji Taylor, MD, MSc

Kenji Taylor, MD, MSc (Family Medicine, Primary Care)

Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.

Nao Saito, MD

Nao Saito, MD (Urology)

After graduating from Tokyo Women's Medical University School of Medicine, Dr. Saito worked at Tokyo Women's Medical University Hospital, Toda Chuo General Hospital, Tokyo Women's Medical University Yachiyo Medical Center, and Ako Chuo Hospital before becoming Deputy Director (current position) at Takasaki Tower Clinic Department of Ophthalmology and Urology in April 2020.

From our team of 50+ doctors

Content updated on Feb 6, 2025

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FAQs

Q.

Ashwagandha for ED: Evidence, Stress Pathway, and Limits

A.

Ashwagandha may help mild, stress-related erection problems by lowering cortisol and sympathetic drive through HPA-axis modulation, supporting testosterone, and possibly improving nitric oxide signaling, but direct, high-quality trials on erectile outcomes are still limited. There are several factors to consider, including small short studies, variable product quality, potential side effects and interactions, and the need to pair any 2 to 3 month standardized regimen with lifestyle care and medical evaluation; see details below for evidence, dosing, safety, and when to seek professional help.

References:

Chandrasekhar K, Kapoor J, & Anishetty S. (2012). A prospective, randomized double-blind, placebo-controlled study… Indian J Psychol Med, 23439798.

https://pubmed.ncbi.nlm.nih.gov/23439798/

Ambiye VR, Dongre S, Kulkarni MR, et al. (2013). Clinical evaluation of the spermatogenic activity of the root… Evid Based Complement Alternat Med, 23762118.

https://pubmed.ncbi.nlm.nih.gov/23762118/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… J Hepatol, 16879806.

https://pubmed.ncbi.nlm.nih.gov/16879806/

See more on Doctor's Note

Q.

Low Vitamin D = ED? The Surprising Link

A.

Low vitamin D is linked to worse erectile function, likely via impaired blood vessel health, nitric oxide signaling, hormones, and inflammation, and studies show men with ED often have lower vitamin D while repletion can improve endothelial function. There are several factors to consider, including checking your level, safe ways to optimize it, and when ED may signal cardiovascular or metabolic disease; see below for full details and next-step guidance.

References:

Tarcin O, Yavuz DG, Ozben B, Telli AH, Ogunc AV, Yuksel M, Top C, Akalin S. (2009). Effect of vitamin D deficiency and replacement on endothelial… J Clin Endocrinol Metab, 19917686.

https://pubmed.ncbi.nlm.nih.gov/19917686/

Pawlowski JC, Yuen KY, Heineman J, Motzer RJ, Ishikawa TO. (2015). Low serum 25-hydroxyvitamin D levels are associated with erectile dysfunction… Int J Impot Res, 25760232.

https://pubmed.ncbi.nlm.nih.gov/25760232/

Reverter E, Ginès P, García-Tsao G, Abraldes JG, Planas R, Mas A, Rodés J, Bosch J. (2015). Non-invasive clinical tests predict hepatic venous pressure gradient and are risk factors for decompensation in cirrhosis… J Hepatol, 25146542.

https://pubmed.ncbi.nlm.nih.gov/25146542/

See more on Doctor's Note

Q.

Maca Root for ED: What Human Studies Do (and Don’t) Show

A.

Human studies on maca root for ED show hints of benefit but are inconclusive: one placebo-controlled trial increased libido without measuring erections, and one open-label study in mild ED found self-reported improvements without a control group. Important caveats about effectiveness, safety, dosing, and how it compares to approved treatments could affect your next steps; see below for the complete details.

References:

Gonzales GF, Cordova A, Vega K, Chung A, & Villena A. (2001). Effect of Lepidium meyenii (Maca) on sexual desire and its absent… Journal of Endocrinological Investigation, 11738142.

https://pubmed.ncbi.nlm.nih.gov/11738142/

Meissner HO, Mscisz A, Mrozikiewicz PM, Duda B, & Pisulewski PM. (2006). Therapeutic effects of Lepidium meyenii (Maca) in mild erectile… International Journal of Biomedical Science, 16830898.

https://pubmed.ncbi.nlm.nih.gov/16830898/

Wai CT, Greenson JK, Fontana RJ, et al. (2003). A simple noninvasive index can predict both significant… Hepatology, 12883497.

https://pubmed.ncbi.nlm.nih.gov/12883497/

See more on Doctor's Note

Q.

Magnesium for ED After 65: Heart Rhythm + Kidney Considerations

A.

Magnesium can modestly support erections after 65 by relaxing blood vessels and improving nitric oxide, but heart rhythm and kidney health are crucial; older adults and anyone on diuretics, digoxin, or anti-arrhythmics should confirm electrolytes and eGFR before use. Diet first, then consider 200 to 300 mg elemental magnesium daily from citrate or glycinate under clinician guidance, and seek care for palpitations, dizziness, or signs of kidney trouble. There are several factors to consider. See below for details on interactions, dosing limits up to 400 to 420 mg from all sources, CKD monitoring to avoid hypermagnesemia, symptoms of excess, and non supplement steps that could change your next best move.

References:

Barbagallo M, & Dominguez LJ. (2010). Magnesium and aging: physiologic outcomes and implications for the management of age-related… Curr Pharm Des, 20139332.

https://pubmed.ncbi.nlm.nih.gov/20139332/

Gröber U, Schmidt J, & Kisters K. (2015). Magnesium in prevention and therapy. Nutrients, 26274975.

https://pubmed.ncbi.nlm.nih.gov/26274975/

Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient… Journal of Hepatology, 18357645.

https://pubmed.ncbi.nlm.nih.gov/18357645/

See more on Doctor's Note

Q.

Magnesium for ED: The Mineral Men Keep Googling

A.

Magnesium can support erectile function by improving blood flow, reducing inflammation, and modestly supporting testosterone; in a large U.S. analysis, men with the highest intake had about 41% lower odds of ED. There are several factors to consider, including best food sources, supplement forms and doses, and when to speak with a doctor first. Magnesium is not a cure and works best alongside exercise, weight management, stress reduction, and evaluation for issues like heart disease or diabetes. See the complete details below to understand benefits, safety limits, red flags that require medical care, and practical next steps.

References:

Aune D, & Rask-Andersen M. (2015). Dietary magnesium intake and risk of erectile dysfunction: analyses of the National Health and Nutrition Examination Survey… Eur J Nutr, 25499867.

https://pubmed.ncbi.nlm.nih.gov/25499867/

DiNicolantonio JJ, & O’Keefe JH. (2018). The cardiovascular and endocrine effects of magnesium intake: implications for erectile function… Open Heart, 29401375.

https://pubmed.ncbi.nlm.nih.gov/29401375/

Kamath PS, & Kim WR. (2007). The model for end-stage liver disease (MELD) in liver transplantation: applications for cirrhosis progression… Clin Liver Dis, 17473383.

https://pubmed.ncbi.nlm.nih.gov/17473383/

See more on Doctor's Note

Q.

Over 65 and Thinking Yohimbe for ED? Don’t Without a Doctor

A.

Yohimbe may offer only modest ED benefit and can raise blood pressure and heart rate, worsen heart or liver disease, and interact with common medications, so do not start it after 65 without a doctor’s guidance and appropriate testing. There are several factors to consider. See below to understand more. For safer next steps like cardiac screening, lab checks, medication review, dosing if approved, daily blood pressure monitoring, and urgent warning signs, see the complete guidance below.

References:

Goldstein I, Young JM, Fischer J, Padma-Nathan H, Steers WD. (1987). Yohimbine in the treatment of erectile impotence: a doubl… J Urol, 3577509.

https://pubmed.ncbi.nlm.nih.gov/3577509/

D’Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic rev… Journal of Hepatology, 16221571.

https://pubmed.ncbi.nlm.nih.gov/16221571/

D’Ambrosio R, Lucidi V, Di Marco S, et al. (2008). Liver stiffness measurement predicts clinical complications and mo… Dig Liver Dis, 18061442.

https://pubmed.ncbi.nlm.nih.gov/18061442/

See more on Doctor's Note

Q.

The “Energy Root” for ED—Does It Deliver?

A.

Korean red ginseng, the “energy root,” can deliver modest, clinically meaningful improvements for mild to moderate erectile dysfunction in randomized trials, but results are slower and generally milder than standard medications. There are several factors to consider; see below for dosing ranges, product quality, expected timelines, safety and interaction risks (like blood thinners and diabetes medicines), and guidance on when to involve a clinician or combine with PDE5 inhibitors.

References:

Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. (2008). Randomized, double-blind, placebo-controlled study of Korean red ginseng in p… Int J Impot Res, 18357727.

https://pubmed.ncbi.nlm.nih.gov/18357727/

Yi RJ, Tsai JN, Chien LT, Lai CS, Tsai CC, Wu TL, Chang RC. (2010). Panax ginseng improves erectile function in men with erectile dysfunct… BJU Int, 19791665.

https://pubmed.ncbi.nlm.nih.gov/19791665/

D’Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis. J Hepatol, 16775531.

https://pubmed.ncbi.nlm.nih.gov/16775531/

See more on Doctor's Note

Q.

The ED Supplement That Can Spike Your Heart Rate

A.

Yohimbe (yohimbine) can significantly raise heart rate and blood pressure, triggering palpitations and anxiety, and it is especially risky if you have heart disease, high blood pressure, liver problems, or take interacting medications. There are several factors to consider, including dosing, monitoring, who should avoid it, safer alternatives, and when to seek care; see below for complete details that could shape your next steps.

References:

Gillis JC, & Brogden RN. (1998). Yohimbine: a reappraisal of its pharmacology and therapeutic efficacy in erectile dysfunction… Drugs, 9761458.

https://pubmed.ncbi.nlm.nih.gov/9761458/

D’Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies… J Hepatol, 16446731.

https://pubmed.ncbi.nlm.nih.gov/16446731/

Sandrin L, Fourquet B, Hasquenoph JM, et al. (2003). Transient elastography: a new noninvasive method for assessment of hepatic fibrosis… Ultrasound Med Biol, 12796606.

https://pubmed.ncbi.nlm.nih.gov/12796606/

See more on Doctor's Note

Q.

ACV for ED After 65: Medication Interactions to Know

A.

ACV may modestly support erectile function after 65 by improving insulin sensitivity, weight control, and circulation, but it is not a cure and there are several factors to consider. See below for important limitations and how your overall health and medications could change the risks and benefits. Key interactions to know: higher risk of low blood sugar with metformin, insulin, or sulfonylureas; low potassium and possible digoxin toxicity when combined with diuretics; more stomach irritation with aspirin or clopidogrel; and while ACV does not directly affect sildenafil or tadalafil, the usual nitrate plus PDE5 warning still applies. Start with small diluted doses and talk to your clinician; dosing tips, monitoring advice, and red flags that should prompt urgent care are outlined below.

References:

Johnston CS, Kim CM, & Buller AJ. (2004). Vinegar improves insulin sensitivity to a high-carbohydrate meal… Diabetes Care, 14747359.

https://pubmed.ncbi.nlm.nih.gov/14747359/

Fugh-Berman A. (2000). Herb–drug interactions. Lancet, 10675074.

https://pubmed.ncbi.nlm.nih.gov/10675074/

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok AS. (2003). A simple noninvasive index can predict both significant… Hepatology, 12618032.

https://pubmed.ncbi.nlm.nih.gov/12618032/

See more on Doctor's Note

Q.

Beet Juice for Erectile Dysfunction: Nitric Oxide Pathway Explained

A.

Beet juice may support erections by boosting nitric oxide through the dietary nitrate to nitrite to NO pathway driven by oral bacteria, which relaxes blood vessels and improves penile blood flow. Evidence is promising but limited; common use is 70 to 250 mL taken 2 to 3 hours before activity or daily for several weeks, while considering blood pressure lowering, interactions with nitrates or PDE5 inhibitors, kidney stone risk from oxalates, and avoiding antiseptic mouthwash around dosing. There are several factors to consider, and important dosing, who-benefits, and safety details are explained below.

References:

Lundberg JO, & Weitzberg E. (2008). NO generation from inorganic nitrate and nitrite: role in physiology, nutrition and therapeutics… Arch Biochem Biophys, 18817777.

https://pubmed.ncbi.nlm.nih.gov/18817777/

Jones AM. (2014). Dietary nitrate supplementation and exercise performance… Sports Med, 24571461.

https://pubmed.ncbi.nlm.nih.gov/24571461/

Tsochatzis EA, & Bosch J. (2014). Liver cirrhosis… Lancet, 24704505.

https://pubmed.ncbi.nlm.nih.gov/24704505/

See more on Doctor's Note

Q.

Korean Red Ginseng for ED: What Systematic Reviews Show

A.

Systematic reviews show Korean red ginseng can modestly improve erectile function versus placebo, based on 7 randomized trials with about 370 men, using 600 to 3,000 mg daily for 4 to 12 weeks, with benefits often appearing by weeks 4 to 8. It is generally well tolerated, with mild headache, insomnia, or digestive upset reported, but interactions and product quality matter; there are several factors to consider, so see the complete details below to guide dosing, safety, and next steps with your clinician.

References:

Choi YD, Kim JS, Lee CS. (2002). Randomized, double-blind, placebo-controlled crossover study of Korean red ginseng in the treat… J Urol, 12408813.

https://pubmed.ncbi.nlm.nih.gov/12408813/

Hong B, Lee S, Cho K, et al. (2002). Effects of Korean red ginseng on penile hemodynamic changes in patients with erectile dysfunctio… Int J Impot Res, 12114658.

https://pubmed.ncbi.nlm.nih.gov/12114658/

Park J, Lee H, Ryu HJ, et al. (2018). Efficacy and safety of Korean red ginseng supplementation in erectile dysfunction: a systematic r… J Ginseng Res, 31570857.

https://pubmed.ncbi.nlm.nih.gov/31570857/

See more on Doctor's Note

Q.

L-Citrulline for ED in Older Men: When to Be Cautious

A.

L-citrulline may modestly help mild erectile dysfunction by increasing nitric oxide and blood flow, and most adults tolerate 1.5 to 3 g daily with minor stomach upset. There are several factors to consider; see below to understand more. Older men should be cautious if they have low blood pressure or heart disease, use nitrates, antihypertensives, PDE5 drugs or blood thinners, or have kidney or liver disease, and should monitor for dizziness, chest pain, vision changes or swelling and speak with a clinician before starting.

References:

Schwedhelm E, & Maas R. (2008). Pharmacokinetic and pharmacodynamic properties of oral L-citrulline and… Br J Clin Pharmacol, 18600546.

https://pubmed.ncbi.nlm.nih.gov/18600546/

Liu W, & Zhao X. (2016). Effects of L-citrulline supplementation on blood pressure: a… J Hum Hypertens, 26794187.

https://pubmed.ncbi.nlm.nih.gov/26794187/

European Association for the Study of the Liver; Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL–ALEH clinical practice guidelines: non-invasive tests for… Journal of Hepatology, 25655059.

https://pubmed.ncbi.nlm.nih.gov/25655059/

See more on Doctor's Note

Q.

Maca for ED After 65: What’s Realistic?

A.

There are several factors to consider. Maca may modestly boost libido after 6 to 12 weeks, but evidence that it improves erection firmness in men over 65 is limited, so it is best used with proven treatments and lifestyle changes. Key cautions and next steps, including ruling out cardiovascular or metabolic causes, reviewing thyroid and hormone-sensitive conditions, possible medication interactions, dosing, and when to seek care, are outlined below.

References:

Gonzales GF, Cordova A, Vega K, Chung A, Villena A, Gonez C, Castillo S. (2002). Effect of Lepidium meyenii (Maca) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men. Asian Journal of Andrology, 12480695.

https://pubmed.ncbi.nlm.nih.gov/12480695/

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29424739.

https://pubmed.ncbi.nlm.nih.gov/29424739/

See more on Doctor's Note

Q.

Maca for ED: The “Libido Root” Test

A.

Maca root shows modest evidence for boosting libido and may indirectly help erections without raising testosterone, with typical use 1.5 to 3 g daily over 6 to 12 weeks alongside healthy lifestyle habits. There are several factors to consider, including product quality and safety cautions for thyroid issues, anticoagulants, liver disease, and hormone sensitive cancers; see details below to decide next steps and when to talk with a doctor. If ED persists for more than 3 months, medical evaluation is important since it can signal cardiovascular or metabolic conditions; more guidance is provided below.

References:

Gonzales GF, et al. (2002). Effect of Lepidium meyenii (Maca) on sexual desire and its absent relationship with serum testosterone… Eur J Endocrinol, 12824412.

https://pubmed.ncbi.nlm.nih.gov/12824412/

Gonzales GF. (2012). Ethnobiology, phytochemistry and pharmacology of Lepidium meyenii (Maca): a… Fitoterapia, 23238707.

https://pubmed.ncbi.nlm.nih.gov/23238707/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review… J Hepatol, 16309924.

https://pubmed.ncbi.nlm.nih.gov/16309924/

See more on Doctor's Note

Q.

Magnesium and ED: What’s Known (and What’s Not)

A.

Magnesium may support erections by improving blood flow, endothelial nitric oxide, muscle relaxation, and hormone balance, but there are no high quality clinical trials proving it treats ED, the best dose or form is unknown, and it is not a standalone cure. Focus on magnesium rich foods, consider a modest supplement if intake is low, monitor for diarrhea, and talk to a clinician since ED can signal cardiovascular or metabolic disease; there are several factors to consider, and important dosing, safety, and next step details are explained below.

References:

Rosanoff A, & Weaver CM. (2012). Magnesium intake and cardiovascular … J Am Coll Nutr, 22584867.

https://pubmed.ncbi.nlm.nih.gov/22584867/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic … J Hepatology, 16361685.

https://pubmed.ncbi.nlm.nih.gov/16361685/

de Franchis R, & Baveno VI Faculty. (2015). Expanding consensus in portal … J Hepatology, 26174375.

https://pubmed.ncbi.nlm.nih.gov/26174375/

See more on Doctor's Note

Q.

Niacin (Vitamin B3) for ED: Who It Helps and Side Effects

A.

Niacin may modestly improve erections for some men with dyslipidemia or endothelial dysfunction and mild to moderate ED by supporting vascular health and nitric oxide, but evidence is limited and it is not helpful for many cases of severe ED. There are several factors to consider, and individual risks and benefits vary. Side effects can include flushing and itching, stomach upset, higher blood sugar and uric acid, liver injury, arrhythmias, and small increases in bleeding and infections, so consult a clinician first and see below for who might benefit or avoid it, safer dosing and monitoring, and how to combine with other ED treatments.

References:

HPS2-THRIVE Collaborative Group. (2014). Effects of extended-release niacin with laropiprant in high-risk… N Engl J Med, 24988503.

https://pubmed.ncbi.nlm.nih.gov/24988503/

Guyton JR, et al. (2012). Safety and tolerability of extended-release niacin/laropiprant: a meta-analysis… Circulation, 23505130.

https://pubmed.ncbi.nlm.nih.gov/23505130/

Castera L. (2010). Meta-analysis: transient elastography for the staging of liver fibrosis. Aliment Pharmacol Ther, 20616578.

https://pubmed.ncbi.nlm.nih.gov/20616578/

See more on Doctor's Note

Q.

Niacin for ED After 65: Cholesterol, Circulation, and Safety

A.

There are several factors to consider. Niacin can improve cholesterol and endothelial function that supports circulation, which may indirectly help erections, but evidence in ED is limited and it is not a stand-alone cure; see details below. For adults over 65, safety and monitoring are key, as flushing, liver, glucose, and uric acid changes and statin interactions can occur, and dosing plus which tests to check are outlined below to help you decide next steps with your clinician.

References:

Gillard BK, Johnson BL, Schiesser N, et al. (2009). Effect of extended-release niacin on endothelial function in patients… American Heart Journal, 19074488.

https://pubmed.ncbi.nlm.nih.gov/19074488/

Boden WE, Probstfield JL, Anderson T, et al. (2011). Niacin in patients with low HDL cholesterol levels receiving intensive… N Engl J Med, 21502621.

https://pubmed.ncbi.nlm.nih.gov/21502621/

Wiesner R, Edwards E, Freeman R, et al. (2003). Model for end-stage liver disease (MELD) and allocation of donor livers… Gastroenterology, 12512037.

https://pubmed.ncbi.nlm.nih.gov/12512037/

See more on Doctor's Note

Q.

Over 65: Folic Acid for ED—When It’s Worth Trying

A.

Folic acid can be worth trying for some men over 65 with erectile dysfunction, especially when ED is mild to moderate, homocysteine is elevated, or vascular disease is present; evidence suggests modest benefits when used alongside standard treatments. See below to understand more. A common plan is 5 mg daily for 8 to 12 weeks while also optimizing cardiovascular health and checking B12 levels and medication interactions, with guidance from your doctor. There are several factors to consider, and key details that could change your next steps are outlined below.

References:

Huang Y, Zheng Y, Wang Y, Wang R, & Wang X. (2016). Effect of folic acid supplementation on endothelial function… Scientific Reports, 27558770.

https://pubmed.ncbi.nlm.nih.gov/27558770/

Foucher J, Chanteloup E, Vergniol J, et al. (2006). Diagnosis of cirrhosis by transient elastography… Ultrasound in Medicine & Biology, 16862178.

https://pubmed.ncbi.nlm.nih.gov/16862178/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis… Hepatology, 16879839.

https://pubmed.ncbi.nlm.nih.gov/16879839/

See more on Doctor's Note

Q.

Over 65? Ashwagandha for ED—Who Should Avoid It

A.

Over 65 and considering ashwagandha for ED? There are several factors to consider; it may lower stress and modestly support testosterone and blood flow, but evidence in older adults is limited, so benefits vary. Avoid or use only with medical guidance if you have thyroid disease, autoimmune disorders or hormone-sensitive cancers, significant liver disease, low blood pressure, take sedatives or blood pressure, thyroid, diabetes, or immunosuppressive medications, or have surgery planned; see the complete details below, including dosing, interactions, lab monitoring, and red flags that should prompt urgent care.

References:

Singh N, Bhalla M, & de Jager P. (2011). Withania somnifera: a review of its bioactivities, pharmacological properties… J Ayurveda Integr Med, 23230428.

https://pubmed.ncbi.nlm.nih.gov/23230428/

Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastography: a multicenter… Hepatology, 18206700.

https://pubmed.ncbi.nlm.nih.gov/18206700/

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

See more on Doctor's Note

Q.

Over 65? Tongkat Ali Risks (Liver, BP, Prostate)

A.

There are several factors to consider: in men over 65, tongkat ali can help erectile function but may pose risks to the liver, cause blood pressure fluctuations that interact with heart medicines, and has uncertain effects on the prostate. For safer use, work with your doctor, choose a quality standardized extract, start low, and monitor liver enzymes, home blood pressure, and PSA; see the complete guidance below for exact dosing, monitoring timelines, red flags, and who should avoid it.

References:

Chan KL, & Low BS. (2014). Randomized clinical trial on the efficacy of Eurycoma longifolia extract for erectile dysfunction. J Sex Med, 24422468.

https://pubmed.ncbi.nlm.nih.gov/24422468/

Zakaria ZA, & Mohamed IN. (2013). Toxicological evaluation of Eurycoma longifolia root extract: subchronic study in rats. Regul Toxicol Pharmacol, 23249827.

https://pubmed.ncbi.nlm.nih.gov/23249827/

Castera L, Forns X, & Alberti A. (2008). Prospective comparison of transient elastography and liver histology for assessment of fibros… Gut, 18528429.

https://pubmed.ncbi.nlm.nih.gov/18528429/

See more on Doctor's Note

Q.

Red Ginseng for ED After 65: Benefits vs Interactions

A.

Korean red ginseng can modestly improve erection firmness, response time, and confidence in many men over 65, with clinical trials showing benefits after 6 to 8 weeks at about 600 to 1,200 mg taken two to three times daily and mostly mild side effects. There are several factors to consider; see below to understand more. Key risks include interactions that may reduce warfarin’s effect, alter blood pressure, or lower blood sugar when combined with diabetes drugs, plus possible insomnia or hormone related concerns, so review your medications with a clinician and use a standardized, third party tested product; dosing, monitoring tips, lifestyle add ons, and red flag symptoms that should prompt urgent care are outlined below.

References:

Kim JH, Yi YJ, & Kim WG. (2008). Efficacy of Korean red ginseng in the treatment of erectile… Phytother Res, 18230800.

https://pubmed.ncbi.nlm.nih.gov/18230800/

Gauthaman K, Adaikan PG, & Prasad RNV. (2010). Efficacy of ginseng (Panax ginseng) in the… Int J Impot Res, 21160711.

https://pubmed.ncbi.nlm.nih.gov/21160711/

Friedrich-Rust M, Ong MF, & Herrmann E. (2008). Performance of transient elastography for the… J Viral Hepatol, 18471242.

https://pubmed.ncbi.nlm.nih.gov/18471242/

See more on Doctor's Note

Q.

Stress-Killing Herb = Better Erections?

A.

Ashwagandha may help erections for some men by reducing stress and cortisol and modestly supporting testosterone and mood, with randomized trials showing significant stress reductions and improvements in male reproductive markers. There are several factors to consider, including proper dosing, safety issues like thyroid or autoimmune disease, possible drug interactions, and the need to rule out cardiovascular or hormonal causes if ED persists. See the complete answer below for specifics that could guide your next steps.

References:

Chandrasekhar K, Kapoor J, & Anishetty S. (2012). A prospective, randomized double-blind, placebo-controlled stud… Indian J Psychol Med, 23439798.

https://pubmed.ncbi.nlm.nih.gov/23439798/

Ahmad MK, Mahdi AA, Shukla KK, Islam N, & Rajender S. (2010). Withania somnifera improves semen quality by regulating… J Assist Reprod Genet, 19661647.

https://pubmed.ncbi.nlm.nih.gov/19661647/

Guha IN, Parkes J, Roderick P, et al. (2007). Non-invasive markers of fibrosis in patients with chronic… Gut, 17470412.

https://pubmed.ncbi.nlm.nih.gov/17470412/

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Q.

The “Blood Flow Vitamin” for ED—Does It Work?

A.

Folic acid, often called the blood flow vitamin, can modestly support erections by lowering homocysteine and boosting nitric oxide, with the clearest benefit in men who are folate deficient or have high homocysteine, but it is not a cure. Doses studied are 1 to 5 mg daily for 4 to 12 weeks and it may work best alongside standard ED treatments; check B12 and talk to your doctor if you have liver or kidney disease, epilepsy, or a cancer history due to possible interactions. There are several factors to consider. See below for the full evidence, who benefits most, safety cautions, and practical next steps.

References:

Widlansky ME, Gokce N, Keaney JF Jr, Vita JA. (2003). Short-term folic acid supplementation enhances endothelial function in subjects with… J Am Coll Cardiol, 12738437.

https://pubmed.ncbi.nlm.nih.gov/12738437/

El-Sakka AI, Tayeb HO. (2007). Hyperhomocysteinemia: an independent predictor of severity of erectile dysfunction in diabetic patients… Int J Impot Res, 17392446.

https://pubmed.ncbi.nlm.nih.gov/17392446/

D’Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review… J Hepatol, 16930543.

https://pubmed.ncbi.nlm.nih.gov/16930543/

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Q.

The “Nitric Oxide” ED Pill That Might Actually Do Something

A.

L-arginine, a nitric oxide precursor, is the ED supplement most likely to help, with modest improvements seen in studies when taken daily at higher doses around 3 to 6 grams, especially in mild to moderate cases. Results vary by person and are generally less robust than prescription PDE-5 medications. There are several factors to consider, including proper dosing, slower onset, side effects like stomach upset or low blood pressure, and important interactions such as with nitrates or blood pressure and diabetes drugs. See below for who might benefit, how to use it safely, and when to speak with a clinician.

References:

Chen KK, et al. (1999). High-dose L-arginine improves sexual function in men with organic erectile… BJU Int, 10448870.

https://pubmed.ncbi.nlm.nih.gov/10448870/

Burnett AL. (2002). Nitric oxide in the physiology and pathophysiology of erectile… Urol Clin North Am, 11873820.

https://pubmed.ncbi.nlm.nih.gov/11873820/

D’Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival… J Hepatol, 16472738.

https://pubmed.ncbi.nlm.nih.gov/16472738/

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Q.

The Nitric Oxide ED Shortcut Everyone’s Trying

A.

Nitric oxide supplements for ED, like L-arginine, L-citrulline, and beetroot, can modestly help mild to moderate symptoms by improving blood flow, with combination formulas sometimes working better than single ingredients, though they are generally less potent than prescription PDE5 inhibitors. There are several factors to consider. See below for dosing and timing tips, evidence on combos like L-arginine with pycnogenol, side effects such as headache or low blood pressure, key interactions with nitrates, PDE5 inhibitors, and alpha blockers, plus heart and liver cautions and when to seek care, since these details can shape your next steps.

References:

Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastography. Hepatology, 18000706.

https://pubmed.ncbi.nlm.nih.gov/18000706/

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24443199.

https://pubmed.ncbi.nlm.nih.gov/24443199/

European Association for the Study of the Liver. (2015). EASL-ALEH clinical practice guidelines: non-invasive tests… Journal of Hepatology, 25630047.

https://pubmed.ncbi.nlm.nih.gov/25630047/

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Q.

The Vitamin That Might Improve Blood Flow… and Erections

A.

Niacin, or vitamin B3, may improve blood flow and erections by boosting nitric oxide, improving endothelial function, and supporting healthier cholesterol; early studies suggest potential benefits, particularly when high cholesterol and ED coexist. There are several factors to consider, including dose and formulation, side effects like flushing and possible liver or glucose changes, and the need to assess cardiovascular causes of ED. See the complete details below for guidance on monitoring, combining with ED medicines, and deciding next steps with your clinician.

References:

Nigam A, Beckman JA, & Creager MA. (2009). Extended-release niacin improves microvascular function in patients… J Am Coll Cardiol, 19533705.

https://pubmed.ncbi.nlm.nih.gov/19533705/

Rader DJ, Hla T, & Yamada N. (2000). Nicotinic acid enhances endothelial function in patients with hypercholesterolemia…. Circulation, 10653597.

https://pubmed.ncbi.nlm.nih.gov/10653597/

Foucher J, Chanteloup E, Vergniol J, et al. (2006). Diagnosis of cirrhosis by transient elastography: a prospective… Hepatology, 16522836.

https://pubmed.ncbi.nlm.nih.gov/16522836/

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Q.

Tongkat Ali: The Testosterone Herb Men Swear By—Does It Help ED?

A.

Tongkat Ali may help some men with erectile dysfunction by raising testosterone and lowering stress hormones, with a placebo-controlled study showing improved erection quality after about 8 to 12 weeks on a standardized extract at 200 to 300 mg daily. See details below. There are several factors to consider, including product quality, dosing, side effects and drug interactions, and the possibility that ED signals cardiovascular or metabolic disease; for complete guidance and next steps to discuss with your clinician, review the information below.

References:

Talbott SM, Talbott JA, George A, & Pugh M. (2013). A randomized double-blind, placebo-controlled study on Tongkat Ali’s effects on testosterone and erectile functi… Aging Male, 23919230.

https://pubmed.ncbi.nlm.nih.gov/23919230/

Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, Bertet J, Bernard PH, Vilgrain V, Couzigou P, & de Ledinghen V. (2006). Diagnosis of cirrhosis by transient elastography: a prospective… Gut, 16569500.

https://pubmed.ncbi.nlm.nih.gov/16569500/

Bernardi M, Caraceni P, Domenicali M, Trevisani F, & Sirianni MC. (2015). Management of ascites and hepatorenal syndrome in cirrhosis: an… J Hepatol, 26142444.

https://pubmed.ncbi.nlm.nih.gov/26142444/

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Q.

Vitamin D and Erectile Dysfunction: What the Research Says

A.

Research shows men with low vitamin D have higher rates of erectile dysfunction, and a randomized trial found that correcting deficiency improved erectile function in some men; there are several factors to consider, including vascular, inflammatory, and hormonal pathways. See more details below. Before starting supplements, check your 25(OH)D level and talk with a clinician about safe dosing and monitoring, since ED can also signal cardiovascular or metabolic disease; the complete guidance on who benefits most, safety, and next step recommendations is below.

References:

Li YF, Wang TY, Guo JJ, Zhang M, & Xia QR. (2019). Serum 25-hydroxyvitamin D levels and risk of erectile dysfunction: a cross-sectional… Int J Impot Res, 29806009.

https://pubmed.ncbi.nlm.nih.gov/29806009/

Aykac O, Erturhan S, Sezgin O, Yaman O, & Yaman KM. (2018). Impact of vitamin D supplementation on erectile function in men with hypovitaminosis D: a randomized… Andrologia, 30214480.

https://pubmed.ncbi.nlm.nih.gov/30214480/

Annweiler C, Schott AM, Allali G, Bridenbaugh SA, Kressig RW, Herrmann FR, & Beauchet O. (2019). Vitamin D-related treatments for erectile dysfunction in aging men: a systematic review… J Endocrinol Invest, 31541997.

https://pubmed.ncbi.nlm.nih.gov/31541997/

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Q.

Vitamin D for ED Over 65: When Supplementing Makes Sense

A.

Vitamin D can support erectile function in men over 65 by improving endothelial nitric oxide and blood flow; consider supplementing if a 25-hydroxyvitamin D blood test is low, using 50,000 IU D3 weekly for 8–12 weeks when deficient or 1,000–2,000 IU daily if insufficient, with a target of 40–60 ng/mL. There are several factors to consider, including cardiovascular risks, medications, and toxicity limits, so recheck levels after 3–4 months, avoid more than 10,000 IU daily without medical supervision, and pair vitamin D with lifestyle and hormone evaluation; see below for important details that could shape your next steps.

References:

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. (2011). Evaluation, treatment, and prevention of vitamin D defici… J Clin Endocrinol Metab, 21188120.

https://pubmed.ncbi.nlm.nih.gov/21188120/

Tarcin O, Yavuz DG, Ozben B, et al. (2009). Effect of vitamin D deficiency and replacement on endothe… J Clin Endocrinol Metab, 18678623.

https://pubmed.ncbi.nlm.nih.gov/18678623/

European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of pa… Journal of Hepatology, 29459475.

https://pubmed.ncbi.nlm.nih.gov/29459475/

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Q.

Women: Ashwagandha for ED—Could This Help If Anxiety’s the Issue?

A.

Ashwagandha may help when anxiety is the main driver of low arousal by lowering stress and cortisol, which can indirectly support genital blood flow and sensitivity, but direct evidence in women is limited. There are several factors to consider; see below to understand more. If you try it, use a quality standardized extract and pair it with stress management and communication, and review dosing, timing, safety, interactions, and red flags that warrant medical care in the detailed guidance below.

References:

Chandrasekhar K, Kapoor J, & Anishetty S. (2012). A prospective, randomized double-blind, placebo-controlled study of safety… Indian J Psychol Med, 23439798.

https://pubmed.ncbi.nlm.nih.gov/23439798/

Parasuraman S, Thing GS, & Dhanarajan V. (2014). A 30 days open labeled study on the tolerability and efficacy… J Ayurveda Integr Med, 24818090.

https://pubmed.ncbi.nlm.nih.gov/24818090/

Foucher J, Chanteloup E, Vergniol J, et al. (2006). Diagnosis of cirrhosis by transient elastography: a prospective… Hepatology, 16780921.

https://pubmed.ncbi.nlm.nih.gov/16780921/

See more on Doctor's Note

Q.

Women: Folic Acid for ED—Is This Actually About Heart Health?

A.

Folic acid may support erectile function by lowering homocysteine and improving blood-vessel health, but ED is often really about heart health and can precede cardiovascular disease by 2 to 3 years. Large trials show folic acid reduces stroke risk and slightly lowers heart events, yet ED-specific evidence is limited and the best next step is a medical evaluation and broader cardiovascular care; there are several factors to consider, so see below for important details that can guide your next steps.

References:

Aversa A, Bruzziches R, Francomano D, Natali M, Spera G. (2007). Erectile dysfunction as a marker of cardiovascular disease… Journal of Sexual Medicine, 17850509.

https://pubmed.ncbi.nlm.nih.gov/17850509/

He FJ, Li J. (2008). Meta-analysis of folic acid supplementation, homocysteine, and risk of stroke and coronary… BMJ, 18765756.

https://pubmed.ncbi.nlm.nih.gov/18765756/

Schuppan D, Afdhal NH. (2011). Liver cirrhosis… Lancet, 20082713.

https://pubmed.ncbi.nlm.nih.gov/20082713/

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Q.

Women: Magnesium for ED—Is This a Deficiency Problem?

A.

Magnesium deficiency can contribute to erectile dysfunction by reducing healthy blood flow, nerve function, and insulin sensitivity, so correcting a true deficiency may help but it is not a standalone cure. There are several factors to consider. See below for who is at risk, how to test levels, food first strategies, safe supplement forms and dosing up to 350 mg elemental magnesium daily, possible drug interactions, and other causes of ED like cardiovascular, hormonal, psychological, and lifestyle factors that may change your next steps with a clinician.

References:

Shechter M, Sharir M, et al. (2000). Oral magnesium therapy improves endothelial funct… Circulation, 10677435.

https://pubmed.ncbi.nlm.nih.gov/10677435/

Zhang X, Li Y, Del Gobbo LC, et al. (2016). Effects of magnesium supplementation on insulin resist… Sci Rep, 27230776.

https://pubmed.ncbi.nlm.nih.gov/27230776/

Kamath PS, Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

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Q.

Women: Niacin for ED—Could It Cause Flushing or Medication Issues?

A.

Yes, niacin can cause flushing and medication issues; flushing is very common, and evidence for using niacin to improve sexual arousal in women is minimal. There are several factors to consider. See below to understand more. Niacin can raise liver enzymes and blood sugar and may interact with statins and blood pressure medicines, so talk with a clinician before using it. See the complete guidance below for ways to reduce flushing, who should avoid niacin, and warning signs that mean you should stop and seek care.

References:

Knopp RH, & Klemp KF. (1996). Influence of sustained-release nicotinic acid on lipid and… J Clin Pharmacol, 8867263.

https://pubmed.ncbi.nlm.nih.gov/8867263/

Tunaru S, Lattig J, Kero J, et al. (2003). Nicotinic acid activates GPR109A to mediate… Nat Med, 12724768.

https://pubmed.ncbi.nlm.nih.gov/12724768/

Malinchoc M, Kamath PS, Gordon FD, et al. (2000). A model to predict poor outcome in pa… Hepatology, 10878766.

https://pubmed.ncbi.nlm.nih.gov/10878766/

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Q.

Women: Red Ginseng for ED—What to Expect (and Watch Out For)

A.

Korean red ginseng may modestly improve mild to moderate erectile function over 8 to 12 weeks, but results vary and depend on the dose used, standardized product quality, and the person's overall health. There are several factors to consider, including possible insomnia or stomach upset, blood sugar and blood pressure changes, interactions with blood thinners and diabetes or hypertension medicines, and red flags that warrant medical care. Review the complete guidance below to understand what to expect, what to watch for, and how partners can help.

References:

Kim DK, Park YH, Jung YJ, & Kim M. (2002). Panax ginseng in the treatment of erectile dysfunction: a randomized, double-blind, placebo-controlled… International Journal of Impotence Research, 12442947.

https://pubmed.ncbi.nlm.nih.gov/12442947/

Shergis JL, Zhang AL, Zhou W, & Xue CC. (2013). Panax ginseng for erectile dysfunction: a systematic review and… PLoS One, 24349073.

https://pubmed.ncbi.nlm.nih.gov/24349073/

Attele AS, Wu JA, & Yuan CS. (1999). Ginseng pharmacology: multiple constituents and multiple… Biochemical Pharmacology, 10385502.

https://pubmed.ncbi.nlm.nih.gov/10385502/

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Q.

Women: Tongkat Ali for ED—Could It Affect His Heart, Sleep, or Mood?

A.

Tongkat ali may modestly support erections and libido, with early evidence suggesting it is generally heart neutral at 200 to 400 mg daily and may ease stress to improve sleep and mood; high doses can rarely cause insomnia or irritability. There are several factors to consider, especially if he has heart or liver disease or takes medications. See below for important details on evidence limits, interactions, dosing and product quality, monitoring, and red flags to guide your next steps.

References:

Talbott NA, Talbott JA, Pugh M, & Zhong Q. (2013). The effect of Eurycoma longifolia (Tongkat Ali) supplementation on stress hormones and mood state in moderately stressed subjects. Journal of the International Society of Sports Nutrition, 23639885.

https://pubmed.ncbi.nlm.nih.gov/23639885/

D’Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review. Journal of Hepatology, 16762319.

https://pubmed.ncbi.nlm.nih.gov/16762319/

Singal AK, & Kamath PS. (2009). Model for end‐stage liver disease: uses, advantages, and limitations. Hepatology, 19432880.

https://pubmed.ncbi.nlm.nih.gov/19432880/

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Q.

Women: Zinc for ED—Is He Just Deficient or Chasing a Trend?

A.

There are several factors to consider. Zinc supports testosterone and nitric oxide, but research suggests supplements help mainly when a true deficiency exists and are not a proven fix for most cases of ED. Before trying it, assess deficiency risks and other causes of ED, focus on zinc-rich foods first, and avoid high doses that can cause harm; key details on safe amounts, product quality, and when to see a doctor are outlined below.

References:

Prasad AS, Mantzoros CS, Beck FW, Hess JW, Brewer GJ. (1996). Zinc status and serum testosterone levels of healthy adul… Nutrition, 8733112.

https://pubmed.ncbi.nlm.nih.gov/8733112/

Castera L, Forns X, Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elas… Journal of Hepatology, 18343258.

https://pubmed.ncbi.nlm.nih.gov/18343258/

Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK. (2014). Elastography for the diagnosis of severity of fibrosis in chronic li… Journal of Hepatology, 24694275.

https://pubmed.ncbi.nlm.nih.gov/24694275/

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Q.

Yohimbe/Yohimbine for ED: Why Experts Warn About Blood Pressure Risks

A.

Yohimbe and yohimbine may offer modest help for psychogenic erectile dysfunction, but experts warn they can raise blood pressure and heart rate, trigger palpitations, and pose serious risks for people with hypertension, heart disease, anxiety disorders, or interacting medications. There are several factors to consider, including dosing, product variability, side effects, and safer alternatives like PDE5 inhibitors, lifestyle changes, and therapy. See below for complete details that could change your next steps.

References:

Ionescu E, & Bengel R. (1997). Sympathoneural and hemodynamic effects of the α2-adrenergic antagonist yohimbine in humans. Clinical pharmacology & therapeutics, 9274581.

https://pubmed.ncbi.nlm.nih.gov/9274581/

Craft GH, & Ford JH. (2010). Efficacy of yohimbine hydrochloride in the management of psychogenic erectile dysfunction: a systematic review. The journal of sexual medicine, 20557060.

https://pubmed.ncbi.nlm.nih.gov/20557060/

Garcia-Tsao G, Abraldes JG, Berzigotti A, & Bosch J. (2017). Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology, 27874946.

https://pubmed.ncbi.nlm.nih.gov/27874946/

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Q.

Zinc for ED After 65: Helpful If Low—Risky If You Overdo It

A.

Zinc can support erections after 65 if you are truly deficient by aiding testosterone and nitric oxide, but taking extra when levels are normal is not proven to fix ED and can be harmful. Discuss testing before supplementing, aim near 11 mg daily and avoid more than the 40 mg upper limit, since excess zinc can trigger copper deficiency, drug interactions, and other issues; there are several factors to consider, and key dosing details, food sources, cautions, and next steps are outlined below.

References:

Scaglione F, & Filippi AR. (2008). Role of zinc in andrology and reproductive endocrinology. J Endocrinol Invest, 18576148.

https://pubmed.ncbi.nlm.nih.gov/18576148/

Prasad AS, Mantzoros CS, Beck FW, Hess JW, & Brewer GJ. (1996). Zinc status and serum testosterone levels of healthy adults. Nutrition, 8864492.

https://pubmed.ncbi.nlm.nih.gov/8864492/

Jain M, & Kar P. (2011). Diagnosis and assessment of severity of liver cirrhosis: focus on clinical… World J Gastroenterol, 21556110.

https://pubmed.ncbi.nlm.nih.gov/21556110/

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Q.

Zinc for ED: The “Simple Fix” Men Miss

A.

Zinc is an often overlooked factor in erectile function because it supports testosterone production, nitric oxide, and vascular health; deficiency can lower libido and weaken erections, so correcting low zinc through diet or modest supplementation may help. There are several factors to consider. See below for who is at risk, safe dosing and food sources, potential side effects, how zinc fits with lifestyle changes, and when ED could signal a condition that needs medical evaluation.

References:

Prasad AS. (2013). Discovery of human zinc deficiency: 50 years later… J Trace Elem Med Biol, 23642869.

https://pubmed.ncbi.nlm.nih.gov/23642869/

Sandrin L, Fourquet B, Hasquenoph J-M, Yon S, Fournier C, Mal F, et al. (2003). Transient elastography: a new noninvasive method for assessment of hepatic fibrosis… Ultrasound Med Biol, 12737898.

https://pubmed.ncbi.nlm.nih.gov/12737898/

Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

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Q.

Apple Cider Vinegar for ED—Should I Let Him Try This?

A.

There are several factors to consider: there is no clinical proof that apple cider vinegar treats ED, though it may modestly help via better blood sugar control, weight management, and cardiovascular health; if he tries it, dilute it and watch for tooth enamel erosion, reflux, and interactions with diabetes medications or diuretics. See below for details. Because ED can signal heart disease, diabetes, or hormonal issues, sudden or persistent symptoms should be evaluated by a clinician. See below for safe dosing tips, red flags, and evidence based options that could change the next steps.

References:

Ostman EM, Granfeldt Y, Persson L, & Björck IM. (2005). Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread… Eur J Clin Nutr, 15674302.

https://pubmed.ncbi.nlm.nih.gov/15674302/

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok AS. (2003). A simple non-invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C virus… Hepatology, 12883497.

https://pubmed.ncbi.nlm.nih.gov/12883497/

Friedrich-Rust M, Rosenberg W, Parkes J, Herrmann E, Zeuzem S, & Bojunga J. (2009). Acoustic radiation force impulse imaging for non-invasive assessment of liver fibrosis in patients with chronic liver… J Hepatol, 18206734.

https://pubmed.ncbi.nlm.nih.gov/18206734/

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Q.

Apple Cider Vinegar for Erectile Dysfunction: Evidence, Risks, Alternatives

A.

There is no direct clinical evidence that apple cider vinegar treats erectile dysfunction; at best it may modestly improve related metabolic factors like insulin sensitivity, weight, and blood pressure, but benefits for erections remain unproven. Because ACV can erode teeth, irritate the gut, and interact with medicines, use only diluted 1 to 2 tablespoons daily and prioritize proven options like lifestyle changes and FDA-approved ED treatments, and seek medical care since ED can signal cardiovascular disease; key risks, safer alternatives, and next steps are explained below.

References:

Johnston CS, Kim CM, & Buller AJ. (2004). Vinegar improves insulin sensitivity to a mixed meal in subjects wi… Diabetes Care, 14747239.

https://pubmed.ncbi.nlm.nih.gov/14747239/

Kondo T, Kishi M, Fushimi T, Ugajin S, & Kaga T. (2009). Vinegar intake reduces body weight, body fat mass, and serum tr… Biosci Biotechnol Biochem, 19230293.

https://pubmed.ncbi.nlm.nih.gov/19230293/

Gines P, Cardenas A, Arroyo V, & Rodes J. (2004). Management of cirrhosis and ascites. N Engl J Med, 15356308.

https://pubmed.ncbi.nlm.nih.gov/15356308/

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Q.

Beet Juice = “Vegetable Viagra”? Here’s the Truth

A.

There are several factors to consider. Beet juice raises nitric oxide and can lower blood pressure and improve circulation, so it may modestly support erections in some men, but direct studies in erectile dysfunction are limited and it is not a substitute for proven treatments. Safety cautions with blood pressure or blood thinner medicines, kidney stone risk, how to use it, and when to see a clinician for persistent symptoms are detailed below and could influence your next steps.

References:

Webb AJ, Patel N, Loukogeorgakis S, et al. (2008). Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to… Hypertension, 18071067.

https://pubmed.ncbi.nlm.nih.gov/18071067/

European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognos… Journal of Hepatology, 30208439.

https://pubmed.ncbi.nlm.nih.gov/30208439/

D’Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studie… Hepatology, 16908796.

https://pubmed.ncbi.nlm.nih.gov/16908796/

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Q.

Beet Juice for ED After 65: Blood Pressure + Kidney Stone Cautions

A.

Beet juice after 65 can support erections by boosting nitric oxide and blood flow, but it can also lower blood pressure and may increase oxalate load that contributes to kidney stones in susceptible people. There are several factors to consider, see below to understand more. If you have low blood pressure or use antihypertensive medicines, monitor your readings and start with small amounts; if you have a history of stones, hydrate, pair with dietary calcium, and limit portions, with more practical dosing, timing, and safety details provided below.

References:

Kapil V, Milsom AB, Okorie M, Maleki-Toyserkani S, Dilworth LD, Haddock R, Qureshi S, Benjamin N, Lundberg JO, & Ahluwalia A. (2015). Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized… Hypertension, 25385766.

https://pubmed.ncbi.nlm.nih.gov/25385766/

Knight J, Goldfarb DS, Assimos DG, Pak CY, Pearle MS, & Curhan GC. (2003). Demographic, dietary, and urinary factors in kidney stone formation… Kidney Int, 12582205.

https://pubmed.ncbi.nlm.nih.gov/12582205/

Castera L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, Couzigou P, & de Ledinghen V. (2008). Non-invasive evaluation of liver fibrosis using transient elastography… Journal of Hepatology, 18313237.

https://pubmed.ncbi.nlm.nih.gov/18313237/

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Q.

Horny Goat Weed for ED: Evidence, Side Effects, Product Quality Issues

A.

Evidence is limited: small, short trials and preclinical data suggest only modest benefit for mild ED, often requiring weeks of daily use and generally weaker than prescription PDE5 medicines. Side effects can include dizziness, low blood pressure, palpitations, and interactions with blood pressure medicines, anticoagulants, and nitrates, and product quality is a major concern due to undeclared PDE5 adulterants and variable icariin content. There are several factors to consider for safety, product choice, and when to seek care; see important details and next steps below. Talk with your clinician before trying it.

References:

Yuan J, Ma X, & Wu L. (2014). Efficacy and safety of Chinese herbal medicine for erectile dysfunction: a systematic review and meta-analysis. PLoS One, 24984130.

https://pubmed.ncbi.nlm.nih.gov/24984130/

Braunstein Z, Bamgboye O, & Zylstra C. (2012). Detection of novel phosphodiesterase-5 inhibitors in herbal supplements marketed for sexual enhancement. J Pharm Biomed Anal, 21995560.

https://pubmed.ncbi.nlm.nih.gov/21995560/

Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using FibroScan (transient elastography). J Hepatol, 18372061.

https://pubmed.ncbi.nlm.nih.gov/18372061/

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Q.

Horny Goat Weed: Real ED Booster or Just Marketing?

A.

There are several factors to consider; early research suggests horny goat weed’s icariin may offer only mild, inconsistent ED benefits, and results are less reliable than prescription PDE5 inhibitors. See below to understand more, including safety risks and interactions, who should avoid it, how to choose and dose a product, signs that warrant a medical evaluation, and evidence-based alternatives that could be better next steps.

References:

Wang CJ, Lu JH, & Chen XM. (2017). Efficacy and safety of herbal medicines for the management of erectile dysfunction: a systematic review and meta-analy… Phytother Res, 27919738.

https://pubmed.ncbi.nlm.nih.gov/27919738/

Qian ZM, Lei P, Lai LH, Pang XP, Ko KM, & Lau CW. (2007). Effects of icariin on erectile function and antioxidant sta… Life Sci, 17912230.

https://pubmed.ncbi.nlm.nih.gov/17912230/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrh… J Hepatol, 16588363.

https://pubmed.ncbi.nlm.nih.gov/16588363/

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Q.

Is Watermelon Nature’s Viagra?

A.

Watermelon can modestly support erections by providing L-citrulline that converts to nitric oxide, but research directly testing watermelon is limited and typical servings are unlikely to match the effectiveness of prescription ED medicines. There are several factors to consider, such as realistic dosing, blood sugar or kidney issues, and warning signs that ED may reflect cardiovascular disease; see below for the complete answer and guidance on next steps in your healthcare journey.

References:

Figueroa A, & Sanchez-Gonzalez M. (2011). Watermelon consumption increases plasma arginine concentrat… Nutrition, 21779049.

https://pubmed.ncbi.nlm.nih.gov/21779049/

Stanislavov R, & Nikolov S. (2003). A pilot study to evaluate the efficacy of L-arginine in men… International Journal of Impotence Research, 12844330.

https://pubmed.ncbi.nlm.nih.gov/12844330/

D’Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirr… Journal of Hepatology, 16473092.

https://pubmed.ncbi.nlm.nih.gov/16473092/

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Q.

L-Arginine for Erectile Dysfunction: Evidence and Safety Considerations

A.

L-arginine can modestly improve erections in some men with mild to moderate ED by boosting nitric oxide, with small studies including 5 g daily for 6 weeks reporting benefits. Safety matters, since it can cause gastrointestinal upset and lower blood pressure and may interact with nitrates, PDE5 inhibitors, and conditions like herpes, asthma, or kidney and liver disease. There are several factors to consider; see below for dosing, who might benefit most, potential interactions, and when to seek care.

References:

Chen J, Webber LL. (1999). Oral L-arginine improves sexual function in men with organic erectile… Int J Impot Res, 10537385.

https://pubmed.ncbi.nlm.nih.gov/10537385/

Moncada S, Palmer RMJ, Higgs EA. (1991). Nitric oxide: physiology, pathophysiology, and pharmacology. Pharmacol Rev, 18254114.

https://pubmed.ncbi.nlm.nih.gov/18254114/

Gines P, Quintero E, Arroyo V, et al. (1987). Compensated cirrhosis: natural history and prognostic factors. Hepatology, 3292702.

https://pubmed.ncbi.nlm.nih.gov/3292702/

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Q.

L-Citrulline for Erectile Dysfunction: Evidence, Dosing Concepts, Safety

A.

L-citrulline can modestly help erectile dysfunction by boosting nitric oxide; small trials show benefit in mild to moderate cases with 1.5 to 3 g daily for 2 to 4 weeks, and some use 2 to 3 g about an hour before sex, though larger trials are still needed. It is generally well tolerated, but higher doses can cause stomach upset and it may lower blood pressure, so use caution with kidney or liver disease and if you take PDE5 inhibitors or nitrates. See below for evidence details, dosing titration and combination strategies, quality and safety tips, and when to seek medical evaluation that could guide your next steps.

References:

Schwedhelm E, Maas R, Freese R, Jung D, Lukacs Z, Jacob R, & Böger RH. (2008). Pharmacokinetic and pharmacodynamic properties of oral L-citrulline and L-arginine… Br J Clin Pharmacol, 18093027.

https://pubmed.ncbi.nlm.nih.gov/18093027/

Curis E, Nicolis I, Moinard C, Osowska S, Zerrouk N, Bénazeth S, & Cynober L. (2005). Almost forty years of research on citrulline: focus on the physiology and… Amino Acids, 15625075.

https://pubmed.ncbi.nlm.nih.gov/15625075/

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24461768.

https://pubmed.ncbi.nlm.nih.gov/24461768/

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Q.

Men 65+: Watermelon for ED Over 65: Helpful Habit or Just a Myth?

A.

Watermelon contains L-citrulline that can modestly support nitric oxide and blood flow, but typical servings provide far less than studied doses, so it is a healthy habit rather than a standalone fix for ED in men over 65. There are several factors to consider, including cardiovascular risks, medications, lifestyle changes, and evidence-based options like citrulline supplements or PDE-5 inhibitors; for key details and when to seek care that could change your next steps, see below.

References:

Collins JK, Wu G, Perkins-Veazie P, et al. (2007). Acute ingestion of watermelon juice increases plasma arginine concentrations in adults: a pilot study… J Nutr, 18550805.

https://pubmed.ncbi.nlm.nih.gov/18550805/

Schwedhelm E, Maas R, Freese R, et al. (2011). Pharmacokinetics of oral l-citrulline and l-arginine: impact on nitric oxide metabolism… Br J Clin Pharmacol, 21397215.

https://pubmed.ncbi.nlm.nih.gov/21397215/

D’Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in compensated and decompensated cirrhosis… J Hepatol, 16481155.

https://pubmed.ncbi.nlm.nih.gov/16481155/

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Q.

Nitric Oxide Supplements for ED After 65: Blood Pressure Risks

A.

Nitric oxide supplements like L-arginine, L-citrulline, and beetroot may modestly improve erections after 65, but they can lower blood pressure and dangerously compound the effects of antihypertensives or nitrates, leading to dizziness or fainting. There are several factors to consider, including PDE5 drug interactions, starting with low doses, and home blood pressure monitoring; talk with your clinician before starting and see the details below to guide safer next steps.

References:

Traish AM, Park K, & Min S. (2006). Phosphodiesterase type 5 inhibitors and L-arginine for the man… J Sex Med, 16954095.

https://pubmed.ncbi.nlm.nih.gov/16954095/

Dong JY, & Qin LQ. (2011). Effect of oral L-arginine on blood pressure: a meta-analysi… Am Heart J, 22105247.

https://pubmed.ncbi.nlm.nih.gov/22105247/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of surv… J Hepatol, 16647872.

https://pubmed.ncbi.nlm.nih.gov/16647872/

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Q.

Nitric Oxide Supplements for ED: Who They Help, Who Should Avoid

A.

Nitric oxide supplements can help some men with mild to moderate erectile dysfunction, with evidence for L-citrulline, L-arginine, and L-arginine plus Pycnogenol improving erection quality and generally causing only mild side effects. There are several factors to consider; see below to understand more. Avoid these if you take nitrates or nitric oxide donors, have unstable heart disease, very low blood pressure, kidney or liver problems, or if ED is severe or sudden, and talk with a clinician about dosing, interactions, and safer alternatives because important details that can guide your next steps are outlined below.

References:

Fukui T, Yamaguchi S. (2010). Oral l-citrulline improves erection hardness in men with mild erectile dysfunction: a randomized, double-blind, placebo-controlled trial… Urology, 20403717.

https://pubmed.ncbi.nlm.nih.gov/20403717/

Stanislavov R, Nikolova V. (2006). Efficacy and safety of combined L-arginine and Pycnogenol supplementation in the treatment of erectile dysfunction: a double-blind, placebo-controlled study… International Journal of Impotence Research, 16612345.

https://pubmed.ncbi.nlm.nih.gov/16612345/

Scaglione F. (2008). Role of L-arginine in the treatment of erectile dysfunction: systematic review of the literature… International Journal of Impotence Research, 18609217.

https://pubmed.ncbi.nlm.nih.gov/18609217/

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Q.

Over 65 and Considering L-Arginine for ED? Read This First

A.

For men over 65, L-arginine may modestly improve mild to moderate ED by boosting nitric oxide and blood flow, typically at 2 to 5 g per day, but it is usually less reliable than prescription ED medicines. There are several factors to consider. See below to understand more, including how kidney and liver function, heart disease and current medications affect safety, common side effects like GI upset and low blood pressure, key drug interactions with nitrates, antihypertensives and possibly PDE-5 inhibitors, and how to start low and monitor, which could change your next steps.

References:

Chen J, Cui Y, & Su SB. (2009). Efficacy and safety of oral L-arginine in the treatment of erectile dysfunction: a meta-analysis… J Sex Med, 19516305.

https://pubmed.ncbi.nlm.nih.gov/19516305/

Sandrin L, Fourquet B, & Hasquenoph JM. (2003). Transient elastography: a new noninvasive method for assessment of hepatic fibrosis… Ultrasound Med Biol, 12787907.

https://pubmed.ncbi.nlm.nih.gov/12787907/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Journal of Hepatology, 16398717.

https://pubmed.ncbi.nlm.nih.gov/16398717/

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Q.

Over 65? Horny Goat Weed Risks You Shouldn’t Ignore

A.

If you are over 65, horny goat weed may pose real risks, including dangerous drops in blood pressure with heart or BP medicines, more bleeding on blood thinners, possible liver strain and kidney issues, side effects like dizziness and palpitations, and variable supplement quality, with limited proof of benefit. There are several factors to consider; see below for who should avoid it, safer use and monitoring tips, red flag symptoms that need urgent care, and evidence based alternatives to discuss with your doctor.

References:

Zheng S, Zhang J, Shi X, et al. (2015). Subchronic toxicity evaluation of total flavonoids from Epimedium in rats… Regul Toxicol Pharmacol, 25698512.

https://pubmed.ncbi.nlm.nih.gov/25698512/

Wai CT, Greenson JK, Fontana RJ, et al. (2003). A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C… Hepatology, 12489282.

https://pubmed.ncbi.nlm.nih.gov/12489282/

Castera L, Foucher J, Bernard PH, et al. (2005). Prospective comparison of transient elastography, FibroTest, APRI, and liver biopsy for the assessment of liver fibrosis in chronic liver diseases… Gastroenterology, 16219714.

https://pubmed.ncbi.nlm.nih.gov/16219714/

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Q.

Pomegranate Juice for ED After 65: Heart Benefits vs Hype

A.

Pomegranate juice may modestly support erections after 65 by improving heart and blood vessel health, but evidence for direct ED improvement is limited and not definitive. There are several factors to consider, including dosage, sugar content, medication interactions, and when to seek care. See below for practical tips, risks, and how to combine it with a broader ED and heart health plan.

References:

Pourmasoumi M, & Morvaridzadeh M. (2020). Effects of pomegranate juice consumption on blood pressure… Complementary Therapies in Medicine, 31363441.

https://pubmed.ncbi.nlm.nih.gov/31363441/

Samarghandian S, & Farkhondeh T. (2017). Pomegranate and its beneficial effects on human health: a review of… International Journal of Clinical Medicine, 28951766.

https://pubmed.ncbi.nlm.nih.gov/28951766/

Vergniol J, & Foucher J. (2011). Prospective evaluation of liver stiffness measurement for monitoring… Journal of Hepatology, 21676171.

https://pubmed.ncbi.nlm.nih.gov/21676171/

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Q.

Pomegranate Juice for ED: What Studies Suggest and Limits

A.

Studies suggest pomegranate juice may modestly help erectile function, with one small placebo-controlled trial finding improvement in 24% of men vs 10% on placebo, likely via antioxidant and vascular effects; evidence remains limited and not definitive. Results are usually modest, and important limits include sugar content and possible interactions with blood pressure medicines, blood thinners, and liver disease; see below for who might benefit, how to use it, what to watch for, and when to talk to a doctor.

References:

Shukla M, Gupta K, & Kumar V. (2007). Pomegranate juice supplementation improves erectile function in men with mild-to-moderate erectile dysfunction: a double-blind, placebo-controlled pilot study… Int J Impotence Res, 17446460.

https://pubmed.ncbi.nlm.nih.gov/17446460/

Aviram M, & Rosenblat M. (2004). Pomegranate phenolics and cardiovascular health: effects on biomarkers of oxidative stress and endothelial function… J Nutr Biochem, 15284381.

https://pubmed.ncbi.nlm.nih.gov/15284381/

Angulo P, & Batts KP. (2010). Clinical predictors of cirrhosis progression and decompensation in patients with chronic liver disease… Hepatology, 20109617.

https://pubmed.ncbi.nlm.nih.gov/20109617/

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Q.

The “Honey Packet” ED Trend: What’s REALLY Inside?

A.

There are several factors to consider. Many "honey packet" ED products contain undisclosed prescription PDE5 drugs like sildenafil or tadalafil at unpredictable doses, while pure honey itself does not treat erectile dysfunction. These packets can cause serious side effects and interactions, especially with nitrates or liver disease, so review the safety risks, proven alternatives, and clear next steps with a clinician in the full explanation below.

References:

Nakamura Y, Fujita K, & Yamaguchi T. (2011). Determination of five phosphodiesterase type 5 inhibitors… Journal of Chromatography A, 21886378.

https://pubmed.ncbi.nlm.nih.gov/21886378/

Meleigy MA, El-Gendy NS, & Abbas IM. (2015). Traditional uses, chemical composition, and biological… Journal of Ethnopharmacology, 25510715.

https://pubmed.ncbi.nlm.nih.gov/25510715/

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver… Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

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Q.

The “Red Juice” ED Fix You’ve Heard About—Does It Work?

A.

There are several factors to consider: pomegranate “red juice” may support erections by improving blood vessel and nitric oxide function, and small trials report modest benefits, but evidence is limited and it is not a standalone fix. If you try it, choose 100 percent juice in moderate portions due to sugar, check for medication interactions, and use it alongside lifestyle changes or prescribed ED therapies; see details below for dosing tips, safety precautions, and when to seek care.

References:

Aviram M, Dornfeld L, Rosenblat M, Volkova N, Kaplan M, Hayek T, Presser D, Fuhrman B. (2000). Pomegranate juice consumption reduces oxidative stress and atherogenic modifications to LDL… J Nutr, 11011819.

https://pubmed.ncbi.nlm.nih.gov/11011819/

Esposito K, Giugliano F. (2014). Mediterranean diet and endothelial function: role of antioxidants from pomegranate juice… J Am Coll Cardiol, 24703752.

https://pubmed.ncbi.nlm.nih.gov/24703752/

Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Lok A, et al. (2003). Model for end-stage liver disease (MELD) to predict survival… Hepatology, 12721689.

https://pubmed.ncbi.nlm.nih.gov/12721689/

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Q.

This “Watermelon” Supplement for ED—Worth It or Hype?

A.

“Watermelon” L-citrulline supplements can modestly improve mild ED by boosting nitric oxide; 1.5 to 3 g daily for 4 to 6 weeks shows small but meaningful gains and is generally safe, though results are weaker than prescription options. There are several factors to consider. Key details on dosing, product quality, side effects, interactions with nitrates or PDE5 inhibitors, and when to see a doctor are outlined below to guide your next steps.

References:

Matsumoto M, et al. (2011). Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction: a randomized, double-blind, placebo-controlled trial. J Sex Med, 21700576.

https://pubmed.ncbi.nlm.nih.gov/21700576/

Schwedhelm E, & Böger RH. (2008). Pharmacokinetic and pharmacodynamic properties of oral L-citrulline in healthy humans. Br J Clin Pharmacol, 19030149.

https://pubmed.ncbi.nlm.nih.gov/19030149/

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

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Q.

Watermelon (Citrulline) for ED: What It Can and Can’t Do

A.

Watermelon provides L-citrulline that can modestly boost nitric oxide and blood flow, but typical servings deliver far less than the therapeutic 3 g used in studies, often requiring 1 kg or more, so benefits are limited to mild ED and it will not replace prescription options. There are several factors to consider, including dosing and timing, possible blood pressure effects and GI upset, and the need to evaluate underlying heart, metabolic, or hormonal causes; see below for complete details on supplements, lifestyle supports, and when to seek medical care.

References:

Perkins-Veazie P, Collins JK, Roberts WM. (2006). Arginine and citrulline content of watermelon (Citrullus lanatus) cultivars: implications for dietary supplementation… J Food Sci, 16719585.

https://pubmed.ncbi.nlm.nih.gov/16719585/

Schwedhelm E, Atzler D, Lücker PW, Mitschke J, & Böger RH. (2008). Pharmacokinetic and pharmacodynamic study of oral L-citrulline and L-arginine in healthy subjects… Br J Clin Pharmacol, 18070215.

https://pubmed.ncbi.nlm.nih.gov/18070215/

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease… Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

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Q.

Women: He Bought “Royal Honey” for ED—Here’s What I’d Check First

A.

Before he takes “royal honey” for ED, there are several factors to consider: many products are adulterated with hidden PDE5 drugs that can interact dangerously with nitrates and blood pressure meds, and ED itself can signal heart disease, diabetes, cholesterol or hormone problems that deserve screening. Evidence for benefit is limited, relationship and mental health factors also matter, and red flags like chest pain, vision changes, fainting, or a prolonged erection need urgent care; see below for step-by-step checks on ingredient safety and third-party testing, medication review, health screening, and what to do next.

References:

Wu C, Li H, & Sung S. (2018). Herbal medicines for erectile dysfunction: a systematic… Andrologia, 26869853.

https://pubmed.ncbi.nlm.nih.gov/26869853/

Singh S, Venkatesh SK, Wang Z, et al. (2016). Transient elastography for diagnosis of clinically… J Gastroenterol Hepatol, 27440703.

https://pubmed.ncbi.nlm.nih.gov/27440703/

Bosch J, Abraldes JG, & Groszmann RJ. (2009). Clinical use of hepatic venous pressure… J Hepatol, 19563177.

https://pubmed.ncbi.nlm.nih.gov/19563177/

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Q.

Is Baking Soda for ED Dangerous? Red Flags Women Should Know

A.

Using baking soda for ED is unproven and can be dangerous, particularly for men with heart, kidney, or liver problems, because sodium loading and alkalosis can trigger electrolyte disturbances, high blood pressure, and severe stomach upset while also masking underlying disease. Red flags women should watch for include confusion, tremors or seizures, ankle swelling, new shortness of breath or chest discomfort, and ED that persists despite the “trick”; there are several factors to consider, and safer proven options and urgent warning signs are detailed below.

References:

Carr AJ, Hopkins WG, & Gore CJ. (2011). Effects of sodium bicarbonate ingestion on exercise performance: a meta-anal… Int J Sport Nutr Exerc Metab, 21077966.

https://pubmed.ncbi.nlm.nih.gov/21077966/

D’Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… J Hepatol, 16581185.

https://pubmed.ncbi.nlm.nih.gov/16581185/

Castera L, Forns X, & Alberti A. (2005). Noninvasive evaluation of liver fibrosis using transient elastography (FibroScan)… Hepatology, 15862119.

https://pubmed.ncbi.nlm.nih.gov/15862119/

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Q.

Important warning about baking soda trick for men with ED

A.

The baking soda trick for ED is unproven and can be dangerous, with risks such as metabolic alkalosis, electrolyte disturbances, blood pressure spikes from high sodium, kidney strain, and interactions with common medications; relying on it can also delay diagnosis of underlying heart disease, diabetes, or hormonal issues. Safer next steps include lifestyle changes, proven treatments like PDE5 inhibitors under medical guidance, and evaluation for root causes; see below for who is at higher risk, red flag symptoms that need urgent care, and a simple symptom check tool to help you plan what to do next.

References:

Galla JH. (2000). Metabolic alkalosis… J Am Soc Nephrol, 10639528.

https://pubmed.ncbi.nlm.nih.gov/10639528/

Schuppan D, & Afdhal NH. (2008). Liver cirrhosis… Lancet, 18280309.

https://pubmed.ncbi.nlm.nih.gov/18280309/

Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastography… J Hepatol, 18258482.

https://pubmed.ncbi.nlm.nih.gov/18258482/

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Q.

3 reasons to avoid the baking soda trick for men

A.

The top three reasons to avoid the baking soda trick are clear: it can trigger metabolic alkalosis and electrolyte shifts, flood you with sodium that drives fluid retention and high blood pressure while straining kidneys and the heart, and cause GI upset that may also worsen liver problems like ascites or encephalopathy. There are several factors to consider, especially if you have hypertension, kidney disease, or any signs of liver trouble, and certain warning symptoms need urgent care; see below for the complete explanation, red flags, and safer next steps to discuss with your clinician.

References:

de Brito-Ashurst I, Varagunam M, Raftery MJ, & Yaqoob MM. (2009). Bicarbonate supplementation slows progression of chronic kidney disease and improves nutritional status… J Am Soc Nephrol, 19571213.

https://pubmed.ncbi.nlm.nih.gov/19571213/

Castera L, Forns X, & Alberti A. (2005). Prospective comparison of transient elastography, FibroTest, APRI, and histology for the assessment of liver fibrosis in chronic hepatitis C… Gastroenterology, 15684443.

https://pubmed.ncbi.nlm.nih.gov/15684443/

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24429185.

https://pubmed.ncbi.nlm.nih.gov/24429185/

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Q.

The truth about erectile dysfunction in teens

A.

Erectile dysfunction can happen in teens, but it is uncommon and usually related to stress, anxiety, or lifestyle habits rather than serious illness; ongoing problems for 3 months or more deserve a medical check. There are several factors to consider, including mental health, expectations shaped by pornography, medications, hormones, weight and metabolic health, and substance use, plus when to seek urgent care and evidence-based treatments. See below for the complete answer and how these details can guide your next steps.

References:

Prause N, Janssen E, & Hensel D. (2016). Is pornography a cause of sexual dysfunction? Results from an… Journal of Sexual Medicine, 26743631.

https://pubmed.ncbi.nlm.nih.gov/26743631/

D’Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review… Journal of Hepatology, 16733621.

https://pubmed.ncbi.nlm.nih.gov/16733621/

European Association for the Study of the Liver. (2022). EASL Clinical Practice Guidelines on decompensated cirrhosis: management of… Journal of Hepatology, 35275488.

https://pubmed.ncbi.nlm.nih.gov/35275488/

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Q.

5 important differences between erectile dysfunction and nervous energy

A.

There are five key differences: erectile dysfunction is a persistent inability to achieve or maintain an erection due to vascular, neurologic, or hormonal problems and often tied to cardiometabolic risks, while nervous energy is a short-lived fight-or-flight state with jitteriness from stress, caffeine, or poor sleep; ED tends to recur across encounters for 3 months or more and responds to lifestyle changes, PDE5 medicines, hormone evaluation, and counseling, whereas nervous energy is event-triggered and improves with relaxation techniques, cognitive behavioral therapy, rest, and cutting stimulants. There are several factors to consider that could change your next steps, including overlapping symptoms and when to seek medical care; see the complete answer below for red flags, nuanced triggers, and links to symptom-checking and treatment options.

References:

Lue TF. (2000). Erectile dysfunction. N Engl J Med, 10882775.

https://pubmed.ncbi.nlm.nih.gov/10882775/

Foucher J, Chanteloup E, Vergniol J, et al. (2006). Diagnosis of cirrhosis by transient elastography: a prospec… Hepatology, 16837960.

https://pubmed.ncbi.nlm.nih.gov/16837960/

Ripoll C, Groszmann RJ, Garcia-Tsao G, et al. (2007). Hepatic venous pressure gradient predicts clinical decompensation in patients with compen… Gastroenterology, 17241847.

https://pubmed.ncbi.nlm.nih.gov/17241847/

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Q.

5 important things to know about micro penis

A.

Micro penis is a rare condition defined as a stretched penile length more than 2.5 standard deviations below the age norm, typically under about 2.5 cm at birth or 7 cm in adults, and it must be measured accurately by a clinician to distinguish it from other conditions. There are several factors to consider, including hormonal or genetic causes, early diagnostic testing and hormone treatment options, psychological support and realistic expectations for sexual function with many men having normal erections and sensation, and when to seek specialist care; see below for the complete details that could shape your next steps.

References:

Rey RA, & Sultan C. (2014). Congenital micropenis: diagnosis, etiologies and management… Journal of Endocrinological Investigation, 25093818.

https://pubmed.ncbi.nlm.nih.gov/25093818/

Ziol M, Handra‐Luca A, Kettaneh A, Christidis C, Mal F, et al. (2005). Noninvasive assessment of hepatic fibrosis by transient elastography… Hepatology, 15649750.

https://pubmed.ncbi.nlm.nih.gov/15649750/

Friedrich‐Rust M, Ong MF, Herrmann E, Dries V, Samaras P, et al. (2008). Performance of transient elastography for the diagnosis of liver fibrosis and cirrhosis… Gastroenterology, 18054860.

https://pubmed.ncbi.nlm.nih.gov/18054860/

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Q.

Baking Soda and Apple Cider Vinegar: Benefits and Risks for men

A.

Baking soda and apple cider vinegar may offer modest benefits for men, including occasional heartburn relief, small improvements in post-meal blood sugar with ACV, and possible exercise buffering with baking soda that can indirectly support weight and vascular health relevant to erections. There are several factors to consider, including risks like enamel erosion, digestive irritation, electrolyte and blood pressure changes, drug interactions, and no proof either directly improves ED; see below for safe doses, how to time or separate them, red flags that warrant medical care, and other lifestyle steps that matter more.

References:

Lapeyre K, Provost K, & Evans M. (2021). Sodium bicarbonate overdose: a case report and narrative review… Clinical Toxicology (Philadelphia), 34057767.

https://pubmed.ncbi.nlm.nih.gov/34057767/

Ostman E, Granfeldt Y, Persson L, & Björck I. (2005). Vinegar improves postprandial glycemia in healthy adults… European Journal of Clinical Nutrition, 15860408.

https://pubmed.ncbi.nlm.nih.gov/15860408/

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok AS. (2003). A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C… Hepatology, 12761151.

https://pubmed.ncbi.nlm.nih.gov/12761151/

See more on Doctor's Note

Q.

Baking Soda for ED: Should You Try It?

A.

There is no credible evidence that baking soda improves erections, and mixing it with apple cider vinegar neutralizes the vinegar’s active acid; while ACV may modestly aid weight and blood sugar, it has not been shown to help ED. There are several factors to consider. See below for important risks, who should avoid these remedies, and proven treatments that are safer and more effective; if your ED is persistent or sudden, seek a medical evaluation for possible cardiovascular or metabolic causes.

References:

Johnston CS, Kim CM & Buller AJ. (2004). Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes… Diabetes Care, 16237144.

https://pubmed.ncbi.nlm.nih.gov/16237144/

Kondo T, Kishi M, Fushimi T, Ugajin S & Kaga T. (2009). Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects… Biosci Biotechnol Biochem, 19679037.

https://pubmed.ncbi.nlm.nih.gov/19679037/

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS & Lok AS. (2003). A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C… Hepatology, 12939622.

https://pubmed.ncbi.nlm.nih.gov/12939622/

See more on Doctor's Note

Q.

Considering the baking soda vinegar trick for ED; Is the problem all in your head?

A.

No, the baking soda plus apple cider vinegar trick does not cure ED, and it can pose health risks; blood pH is tightly regulated and there is no clinical evidence this improves erections. ED is not simply in your head, as most cases involve physical factors along with stress or anxiety. There are several factors to consider and proven treatments that can help; see below for how to tell physical from psychological causes, safer evidence-based options, and key risks to avoid and when to seek care.

References:

Lue TF. (2000). Erectile dysfunction. N Engl J Med, 10829055.

https://pubmed.ncbi.nlm.nih.gov/10829055/

Burnett AL, Nehra A, & Breau RH. (2018). Erectile dysfunction: AUA guideline. J Urol, 29903715.

https://pubmed.ncbi.nlm.nih.gov/29903715/

European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… Journal of Hepatology, 29131803.

https://pubmed.ncbi.nlm.nih.gov/29131803/

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Q.

Do penis pumps really work?

A.

Penis pumps (vacuum erection devices) can help many men get and keep an erection, with studies showing about 60 to 80 percent effectiveness and mostly mild side effects. They are often most useful for mild to moderate ED, for men who cannot take pills, and after prostate surgery. There are several factors to consider, like underlying causes, medication interactions, proper technique and ring time limits, and when to combine treatments or see a clinician; see the complete details below to choose the right next steps.

References:

Meng Y, Wang R, & Yuan J. (2019). Vacuum erection devices in the treatment of erectile dysfunction: a systematic review … Asian Journal of Andrology, 30918385.

https://pubmed.ncbi.nlm.nih.gov/30918385/

Raina R, Lakin MM, & Brock G. (2006). Vacuum therapy for erectile dysfunction following radical prostatectomy: … Journal of Sexual Medicine, 16783432.

https://pubmed.ncbi.nlm.nih.gov/16783432/

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver stiffness: unfolding the natural history of cirrhosis. Journal of Hepatology, 24602165.

https://pubmed.ncbi.nlm.nih.gov/24602165/

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Q.

Does medicare cover erectile dysfunction treatment?

A.

Medicare may cover erectile dysfunction treatment, but coverage depends on the specific therapy and medical necessity, with oral drugs typically under Part D if on your plan formulary, injections and vacuum devices often under Part B, and penile implant surgery under Part A or B. There are several factors to consider, including prior authorization, step therapy, cost sharing, Medicare Advantage plan rules, and exclusions like over the counter supplements; see the complete details below to understand what applies to you and which next steps to take with your doctor and plan.

References:

Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Montorsi F, Salonia A, Vardi Y, Wespes E, Zohar Y. (2010). EAU guidelines on erectile dysfunction: diagnosis and initial… Eur Urol, 20193680.

https://pubmed.ncbi.nlm.nih.gov/20193680/

Tsochatzis EA, Bosch J, Burroughs AK. (2014). Liver cirrhosis. Lancet, 25331465.

https://pubmed.ncbi.nlm.nih.gov/25331465/

D’Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in patients with cirrhosis: a systematic… J Hepatol, 16399030.

https://pubmed.ncbi.nlm.nih.gov/16399030/

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Q.

Does radiation treatment for prostate cancer cause erectile dysfunction?

A.

Radiation for prostate cancer can cause erectile dysfunction, often developing gradually as nerves and blood vessels are affected, with about 40 to 60 percent of men experiencing some degree within two years, depending on treatment type, age, baseline function, health conditions, and whether hormone therapy is used. There are several factors to consider, and many treatments can help, from lifestyle changes and pills to devices and implants; early conversation with your care team matters. See below for key timelines, risk factors, and practical next steps that can influence your decisions.

References:

Sanda MG, & Dunn RL. (2008). Quality of life and satisfaction with outcome among prostate-ca… N Engl J Med, 18354160.

https://pubmed.ncbi.nlm.nih.gov/18354160/

Merrick GS, & Butler WM. (2008). Ten-year outcome of potency after permanent prostate brachytherapy: se… Brachytherapy, 19030510.

https://pubmed.ncbi.nlm.nih.gov/19030510/

Sandrin L, & Fourquet B. (2003). Transient elastography: a new noninvasive method for assess… Radiology, 12955176.

https://pubmed.ncbi.nlm.nih.gov/12955176/

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Q.

How can I tell if I have erectile dysfunction or whisky dick?

A.

Erections that fail only when you have been drinking and return to normal when sober point to alcohol-related “whisky dick,” while persistent problems for 3 months or more across at least half of attempts, including when sober, suggest erectile dysfunction with possible vascular, hormonal, neurologic, or psychological causes. Track patterns, try the IIEF-5 screener, consider risks like diabetes, high blood pressure, smoking, or medications, and see a doctor if difficulties persist or occur when sober. There are several factors to consider. See complete details below to understand more and choose the right next steps.

References:

Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. (1999). Development and evaluation of an abridged, 5-item version of the Int… Int J Impot Res, 10625731.

https://pubmed.ncbi.nlm.nih.gov/10625731/

Mumenthaler MS, Taylor JL, O’Hara R, Yesavage JA. (1999). Alcohol and human sexuality… Alcohol Health Res World, 10605926.

https://pubmed.ncbi.nlm.nih.gov/10605926/

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok ASF. (2003). A simple noninvasive index can predict both significant… Hepatology, 12883497.

https://pubmed.ncbi.nlm.nih.gov/12883497/

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Q.

How does penis enlargement surgery work?

A.

Penis enlargement surgery increases length or girth by either cutting the suspensory ligament so more of the shaft hangs outside the body, or by adding volume with fat transfer, dermal or synthetic grafts, or temporary hyaluronic acid fillers; some people combine procedures, and post-op traction or an extender is critical because gains are usually modest. There are several factors to consider, including recovery time, risks like infection, scarring, asymmetry or sensation changes, variable fat reabsorption, costs, and choosing an experienced surgeon. See complete details below to guide your next steps.

References:

Yang DY, Park JK, Cho CJ, Park JH, Ko GH, Lee SH. (2018). Injectable hyaluronic acid gel for penile girth augmentation: clinical outcomes and patient satisfaction. J Sex Med, 29555852.

https://pubmed.ncbi.nlm.nih.gov/29555852/

Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg C, et al. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

Shi Y, Lin S, Huang Y. (2016). Diagnostic accuracy of transient elastography in detection of liver cirrhosis: a systematic review and meta-analysis. Hepatol Int, 27591814.

https://pubmed.ncbi.nlm.nih.gov/27591814/

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Q.

Is micro penis real?

A.

Micropenis is real and medically defined as a stretched penile length more than 2.5 standard deviations below average, roughly under 2.5 inches in adults, with age specific cutoffs for infants and children. There are several factors to consider, including distinguishing it from a buried penis, possible hormonal or genetic causes, how it is diagnosed, treatment options like early testosterone therapy, and when to see a specialist; see below for details that could impact your next steps and support resources.

References:

Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbințeanu-Braticevici C, Strobel D, Cantisani V, Le Bricon T, Bota S, de Lédinghen V. (2010). Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Journal of Hepatology, 17883421.

https://pubmed.ncbi.nlm.nih.gov/17883421/

Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK. (2014). Elastography for the non-invasive staging of liver fibrosis in chronic liver disease: a systematic review and meta-analysis. Alimentary Pharmacology & Therapeutics, 24372235.

https://pubmed.ncbi.nlm.nih.gov/24372235/

European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines on the management of patients with decompensated cirrhosis. Journal of Hepatology, 30346721.

https://pubmed.ncbi.nlm.nih.gov/30346721/

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Q.

Is penis enlargement worth considering as a senior?

A.

There are several factors to consider. For most seniors, enlargement offers modest, sometimes temporary size gains but carries real risks and higher complication rates as you age, so it is usually only worth considering if you are healthy, have realistic expectations, and choose an experienced, board-certified specialist. Many people achieve better confidence and sexual satisfaction using non-surgical options like vacuum devices, traction, pelvic floor work, and counseling, often with fewer risks and lower cost. For specific methods, expected results, safety considerations, and deciding next steps with your doctor, see the complete details below.

References:

Park CJ, Ahn HS, Lee CK, & Lee JC. (2010). Hyaluronic acid gel injection for penile augmentatio… Yonsei Medical Journal, 20126364.

https://pubmed.ncbi.nlm.nih.gov/20126364/

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of surviva… Journal of Hepatology, 16647187.

https://pubmed.ncbi.nlm.nih.gov/16647187/

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver di… Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

See more on Doctor's Note

Q.

Is penis enlargement worth considering as a teen?

A.

Generally not recommended for teens, since most are still developing into their early 20s, most fall within normal size ranges, and there are no safe, proven enlargement methods for minors; many advertised options carry real risks like tissue injury, reduced sensitivity, and emotional distress. There are several factors to consider. See below for details on normal development, common myths, the evidence and risks for pumps, extenders, creams, and surgery, mental health considerations, and when to seek professional guidance.

References:

Veale D, Miles S, Lockwood J, Troglia A, Lamb L, & Muir GH. (2015). Clinical characteristics of men seeking penile girth augmentation s… J Sex Med, 25989115.

https://pubmed.ncbi.nlm.nih.gov/25989115/

Castera L, Forns X, & Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elasto… J Hepatol, 18355986.

https://pubmed.ncbi.nlm.nih.gov/18355986/

Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2014). Elastography for the diagnosis of severity of fibrosis in chronic l… J Hepatol, 24875937.

https://pubmed.ncbi.nlm.nih.gov/24875937/

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Q.

Is penis enlargement worth considering as gay man?

A.

There are several factors to consider. See below for the key numbers, risks, and decision points that might change your next steps. Expect modest gains overall: extenders average 1 to 1.6 cm of length over months, HA fillers add about 1.5 to 2 cm of girth for 9 to 12 months, and surgery brings higher risk for limited improvement; weigh partner preferences, confidence goals, costs, potential complications, and the reality that technique and connection often matter more than size, and consider a consult with a board-certified urologist or a sex therapist.

References:

Gontero P, Di Marco M, Giubilei G, et al. (2009). Use of a penile extender device in the treatment of penile curvature and… BJU Int, 19501223.

https://pubmed.ncbi.nlm.nih.gov/19501223/

Yassin AA, Bazeed MA. (2018). Hyaluronic acid soft tissue filler for penile girth augmentation: safety… J Sex Med, 29518507.

https://pubmed.ncbi.nlm.nih.gov/29518507/

D’Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a… Hepatology, 16632615.

https://pubmed.ncbi.nlm.nih.gov/16632615/

See more on Doctor's Note

Q.

Life after 60: Do penis pumps really work for seniors?

A.

Yes, penis pumps can work for many men over 60, often producing erections suitable for intercourse with few systemic side effects; clinical trials and international guidelines support them as an effective, safe, and cost-effective option, especially when pills are not ideal. There are several factors to consider. See below for details on candidacy, safe use and ring timing, common side effects and red flags, the need to address underlying heart or hormonal issues, and how pumps compare or combine with other ED treatments, which could influence your next steps.

References:

Steers WD, Burnett AL, & Shaw KC. (1990). A prospective randomized evaluation of vacuum constriction device therapy for impotence… Urology, 2267630.

https://pubmed.ncbi.nlm.nih.gov/2267630/

European Association of Urology. (2015). EAU guidelines on male sexual dysfunction: erectile dysfunction… European Urology, 25693740.

https://pubmed.ncbi.nlm.nih.gov/25693740/

Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2012). Elastography for the diagnosis of severity of fibrosis in chronic liver… Journal of Hepatology, 22461093.

https://pubmed.ncbi.nlm.nih.gov/22461093/

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Q.

The difference between true erectile dysfunction and nerves

A.

True, organic ED usually develops gradually, is consistent whether you’re with a partner or alone, and often comes with reduced or absent nocturnal or morning erections, while psychogenic or “nerves” ED tends to be sudden or situational, with normal nocturnal erections and variable performance. There are several factors to consider, including mixed causes, red flags, and how doctors confirm the difference using history, labs, nocturnal penile tumescence testing, and penile Doppler. See below for complete details that can guide the right next steps and treatment options.

References:

Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. (2002). Epidemiology, pathophysiology and diagnosis of erectile dysfunctio… Urology, 12297233.

https://pubmed.ncbi.nlm.nih.gov/12297233/

Wai CT, Greenson JK, Fontana RJ, Taylor-Robinson SD, Johnson PJ. (2003). A simple noninvasive index can predict both significant fibrosis… Hepatology, 12668902.

https://pubmed.ncbi.nlm.nih.gov/12668902/

Castera L, Forns X, Alberti A. (2008). Non-invasive evaluation of liver fibrosis using transient elastograp… J Hepatol, 18723116.

https://pubmed.ncbi.nlm.nih.gov/18723116/

See more on Doctor's Note

Q.

What are the risks and watch-outs for penis pumps?

A.

There are several risks and watch-outs to consider, including bruising or petechiae, pain, numbness or coldness from the constriction band, skin irritation or discoloration, difficulty ejaculating, device problems, psychological stress, and rarely priapism if the band stays on too long; be especially cautious if you use blood thinners, have bleeding or blood-cell disorders, penile infection or severe curvature, or a spinal cord injury. Reduce risk by using gentle suction with lubrication, following time limits of 10 to 15 minutes for the band and 20 to 30 minutes total, inspecting and cleaning the device, and seeking urgent care for an erection over 4 hours or persistent severe symptoms. Many more safety tips, red flags, and next-step guidance are detailed below.

References:

European Association of Urology. (2013). Guidelines on male sexual dysfunction: erectile dysfunction – 2013 update. European Urology, 23892438.

https://pubmed.ncbi.nlm.nih.gov/23892438/

D’Amico G, Garcia‐Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival… Journal of Hepatology, 16407301.

https://pubmed.ncbi.nlm.nih.gov/16407301/

Friedrich‐Rust M, Rosenberg W, Dries V, et al. (2008). Performance of transient elastography for the… Gastroenterology, 19038547.

https://pubmed.ncbi.nlm.nih.gov/19038547/

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Q.

What does a penis pump do?

A.

A penis pump creates a vacuum around the penis that draws blood into the erectile chambers to produce an erection, and a constriction ring can then help maintain it for up to about 30 minutes. It is a drug-free option used for erectile dysfunction, post-surgery penile rehabilitation, and temporary enhancement, but technique, device choice, and safety considerations matter. There are several factors to consider; see below for key benefits, risks, contraindications, and usage tips that could guide your next steps.

References:

Brant WO, & Montague DK. (2006). Vacuum erection devices: efficacy and patient satisfactio… Curr Urol Rep, 17115304.

https://pubmed.ncbi.nlm.nih.gov/17115304/

Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, et al. (2005). Noninvasive assessment of liver fibrosis by measurement of stiffness in patien… Hepatology, 16188086.

https://pubmed.ncbi.nlm.nih.gov/16188086/

Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, et al. (2007). Liver stiffness measurement predicts severe portal hypertension in patients with compensated HCV-relate… Hepatology, 17503801.

https://pubmed.ncbi.nlm.nih.gov/17503801/

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Q.

What is a micro penis?

A.

A micro penis is a medically defined diagnosis for a penis measuring more than 2.5 standard deviations below the age based average, typically under 2.5 cm in newborns and about 7 cm stretched length in adults. It can reflect hormonal, genetic, or developmental issues and has specific evaluations and treatments that may be time sensitive; there are several factors to consider, so see below to understand measurement details, causes, tests, treatment choices, and when to seek care.

References:

Veale D, Miles S, Read J, & Troglia A. (2015). Penile size and the definition of micropenis: a systematic… BJU International, 24827300.

https://pubmed.ncbi.nlm.nih.gov/24827300/

Moore KP, Wong F, Gines P, et al. (2003). The management of ascites in cirrhosis: report on the consensus… Hepatology, 12775314.

https://pubmed.ncbi.nlm.nih.gov/12775314/

Kim WR, Biggins SW, Kremers WK, et al. (2008). Hyponatremia and mortality among patients on the liver-transplant… Hepatology, 18757800.

https://pubmed.ncbi.nlm.nih.gov/18757800/

See more on Doctor's Note

Q.

What is the best treatment for erectile dysfunction?

A.

Start with oral PDE5 inhibitors like sildenafil or tadalafil plus lifestyle changes. The best choice depends on your other medicines, health conditions, side effects, cost, and preference; see below for key nuances. If pills are not suitable or do not work, options include vacuum devices, injections or intraurethral alprostadil, and for refractory cases penile implants; psychosexual therapy can help at any step. Because ED can signal heart disease, diabetes, or hormonal issues, and PDE5 drugs cannot be taken with nitrates, review the complete guidance below and speak with a clinician if you have red flags like sudden ED, chest symptoms, or an erection lasting over 4 hours.

References:

Goldstein I, & Lue TF. (1998). Oral sildenafil in the treatment of erectile dysfunctio… N Engl J Med, 9632524.

https://pubmed.ncbi.nlm.nih.gov/9632524/

Porst H, & Kim ED. (2004). Long-term safety and efficacy of tadalafil for the treatment… Urology, 15451774.

https://pubmed.ncbi.nlm.nih.gov/15451774/

Castera L, & Foucher J. (2005). Prospective comparison of transient elastography, FibroTes… Gastroenterology, 15685566.

https://pubmed.ncbi.nlm.nih.gov/15685566/

See more on Doctor's Note

Q.

What is the best treatment for micro penis?

A.

The most effective approach is early, tailored androgen therapy such as testosterone or topical dihydrotestosterone after a specialist evaluation to confirm causes, with traction devices or selected surgeries considered if response is limited, and ongoing psychosocial support. There are several factors to consider, including age, hormonal or genetic findings, monitoring for side effects, and realistic goals; see below for dosing examples by age, device and surgical options, expected gains, safety checks, and signs that require urgent care.

References:

Lee PA, Houk CP, Ahmed SF, & Hughes IA. (2006). Consensus statement on management of intersex disorders and atypical genital development including micropenis… J Clin Endocrinol Metab, 16505329.

https://pubmed.ncbi.nlm.nih.gov/16505329/

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.

https://pubmed.ncbi.nlm.nih.gov/11157951/

European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.

https://pubmed.ncbi.nlm.nih.gov/24986678/

See more on Doctor's Note

Q.

What is the latest treatment for erectile dysfunction?

A.

The latest treatments for erectile dysfunction include first-line PDE-5 inhibitors like sildenafil and tadalafil plus the newer udenafil, low-intensity shockwave therapy that improves erections for many men for 6 to 12 months with minimal side effects, and emerging regenerative options such as PRP, stem cells, and gene therapy. There are several factors to consider, including severity, underlying conditions, and costs, and some options remain experimental and may not suit men on nitrates, so see the complete guidance below to decide the safest next steps and when to speak with a doctor.

References:

Kim SW, Park JK, & Paick JS. (2011). Efficacy and safety of udenafil in the treatment of erectile dysfunction: a multi… J Sex Med, 21762545.

https://pubmed.ncbi.nlm.nih.gov/21762545/

Lu Z, Zhang X, Yu S, Zhang X, & Wang Y. (2018). Efficacy and safety of low-intensity extracorporeal shockwave therapy for erectile dys… World J Urol, 29596218.

https://pubmed.ncbi.nlm.nih.gov/29596218/

Kim D, & Kim WR. (2015). Liver stiffness measurement predicts hepatic decompensation in patients with compensated cirrhos… J Hepatol, 26084708.

https://pubmed.ncbi.nlm.nih.gov/26084708/

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Q.

65+ the truth about the baking soda and apple cider vinegar ED cure

A.

There is no clinical proof that baking soda plus apple cider vinegar cures ED, and for men 65 and older the mix can increase risks like high blood pressure, fluid retention, reflux, and medication interactions. ACV may modestly lower post-meal blood sugar and baking soda can help high-intensity exercise, but neither improves penile blood flow or nerve signaling, so proven options like PDE5 inhibitors, cardiovascular risk control, and pelvic floor exercise are more effective. There are several factors to consider; see the complete answer below for specific risks, dosing pitfalls, safer next steps, and when to seek care.

References:

McNaughton LR, Siegler J, & Midgley A. (2008). Ergogenic effects of sodium bicarbonate: a meta-analysis. Int J Sport Nutr Exerc Metab, 19083339.

https://pubmed.ncbi.nlm.nih.gov/19083339/

Ostman E, Granfeldt Y, Persson L, & Björck I. (2005). Vinegar supplementation lowers glucose and insulin responses and… Eur J Clin Nutr, 16278292.

https://pubmed.ncbi.nlm.nih.gov/16278292/

Kim WR, Biggins SW, Kremers WK, Wiesner RH, & Kamath PS. (2008). Hyponatremia and mortality among patients on the liver-transplant waiti… N Engl J Med, 18199851.

https://pubmed.ncbi.nlm.nih.gov/18199851/

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Q.

At home remedies for ED in men over 65

A.

At-home steps that can improve ED in men over 65 include a Mediterranean-style, heart-healthy diet; regular aerobic and pelvic-floor exercises; weight, blood pressure, and blood sugar control; quitting smoking; limiting alcohol; better sleep; and stress management, with any supplements used cautiously and reviewed by your doctor. Managing diabetes, cardiovascular and liver disease is also crucial, and urgent care is needed for sudden loss of erections, chest pain with sex, or penile pain or changes; there are several factors to consider, so see the complete details below.

References:

Esposito K, Giugliano F, Ciotola M, et al. (2004). Effect of lifestyle changes on erectile dysfunction in obese men: a randomized… Arch Intern Med, 15023865.

https://pubmed.ncbi.nlm.nih.gov/15023865/

European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 29860447.

https://pubmed.ncbi.nlm.nih.gov/29860447/

Gines P, Solà E, Angeli P, et al. (2021). Management of patients with cirrhosis and ascites: update 2021. Journal of Hepatology, 33901750.

https://pubmed.ncbi.nlm.nih.gov/33901750/

See more on Doctor's Note

Q.

Does baking soda and apple cider vinegar help men over 65 with erectile dysfunction?

A.

There is no clinical evidence that baking soda or apple cider vinegar improve erectile function in men over 65. Apple cider vinegar may modestly help weight and blood sugar control, which can indirectly support vascular health, but neither remedy is proven for ED and both carry risks, including electrolyte issues with baking soda and tooth or throat irritation and medication interactions with vinegar. Safer, evidence based options are available; there are several factors to consider, so see below for important details and guidance on next steps.

References:

Kondo T, Kishi M, Fushimi T, Ugajin S, & Kaga T. (2009). Vinegar intake reduces body weight, body fat mass, and serum triglyceride leve… Obesity, 22846233.

https://pubmed.ncbi.nlm.nih.gov/22846233/

Lin ZH, Xin YN, Dong QJ, et al. (2011). Performance of the aspartate aminotransferase to platelet ratio index for staging of liver fibros… J Viral Hepatol, 21722378.

https://pubmed.ncbi.nlm.nih.gov/21722378/

European Association for the Study of the Liver, & Asociación Latinoamericana para el Estudio del Hígado. (2015). EASL–ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severi… Journal of Hepatology, 26073412.

https://pubmed.ncbi.nlm.nih.gov/26073412/

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Q.

Life past 65: What’s the baking soda trick for ED and is it safe?

A.

The baking soda trick means drinking about 1 teaspoon of baking soda dissolved in water before sex to try to boost erections by briefly raising body alkalinity. There is no clinical evidence it works, and a teaspoon delivers about 1,260 mg of sodium that can raise blood pressure and worsen heart or kidney disease, plus it can cause stomach upset and medication interactions. There are several factors to consider and safer, proven treatments; see below for details that could affect your next steps.

References:

Carr AJ, Hopkins WG, & Gore CJ. (2012). Effects of acute alkalosis and acidosis on performance: a meta-analysis… Journal of Sports Sciences, 21768153.

https://pubmed.ncbi.nlm.nih.gov/21768153/

Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, & Hakim LS. (2018). Erectile dysfunction: AUA guideline… Journal of Urology, 29256308.

https://pubmed.ncbi.nlm.nih.gov/29256308/

European Association for the Study of the Liver. (2018). EASL clinical practice guidelines on decompensated… Journal of Hepatology, 30344047.

https://pubmed.ncbi.nlm.nih.gov/30344047/

See more on Doctor's Note

Q.

What is the connection between erectile dysfunction and exercise?

A.

Exercise is strongly linked to erectile function: regular aerobic, strength, and pelvic floor training improves blood flow and endothelial health, supports testosterone, aids weight loss, lowers cardiometabolic risks, and eases anxiety, with studies showing meaningful improvements and even restoration of erections in some men. There are several factors to consider, including which types and amounts of exercise help most and key safety steps or red flags that require medical care; see below for specific routines, precautions, and guidance on when to talk to a doctor.

References:

Esposito K, Giugliano D, Di Palo C, Giugliano F. (2004). Effect of lifestyle changes on erectile dysfunction in obese… JAMA, 15293727.

https://pubmed.ncbi.nlm.nih.gov/15293727/

Corona G, Mannucci E, Fisher AD, et al. (2012). Risk factors for erectile dysfunction: a systematic review and… J Sex Med, 21937872.

https://pubmed.ncbi.nlm.nih.gov/21937872/

European Association for the Study of the Liver. (2019). EASL Clinical Practice Guidelines on non-invasive tests for evalu… J Hepatol, 30469766.

https://pubmed.ncbi.nlm.nih.gov/30469766/

See more on Doctor's Note

Q.

What are some good home remedies for erectile dysfunction?

A.

The best at‑home steps include heart‑healthy lifestyle changes (lose weight, stop smoking, limit alcohol, manage stress, get 7–9 hours sleep), a Mediterranean-style diet rich in flavonoids and omega‑3s, regular aerobic plus pelvic‑floor (Kegel) exercises, and—for some—evidence‑based supplements like Pycnogenol with L‑arginine or Korean red ginseng after discussing with your clinician. There are several factors to consider, including mental health strategies and red flags (ED can signal diabetes, high blood pressure, or heart disease)—see the complete details below for specific steps, dosages, cautions, and when to seek care. With consistent effort, many men notice improvement within weeks to months.

References:

Stanislavov R, & Nikolova V. (2003). Pycnogenol in association with L-arginine improves erectile… J Sex Marital Ther, 14577723.

https://pubmed.ncbi.nlm.nih.gov/14577723/

Hong B, & Ma WH. (2002). Efficacy and safety of Korean red ginseng in the… Int J Impot Res, 15797405.

https://pubmed.ncbi.nlm.nih.gov/15797405/

Giannini EG, Botta F, & Borro PM. (2005). Platelet count/spleen diameter ratio as a… Gut, 15964580.

https://pubmed.ncbi.nlm.nih.gov/15964580/

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Q.

What is the baking soda trick for men with ED?

A.

The baking soda trick for men with ED involves mixing 1/2–1 teaspoon of sodium bicarbonate into 8 ounces of water and drinking it daily for up to a week, aiming to slightly raise blood pH so penile smooth muscle relaxes and blood flow improves. There’s no clinical proof it helps ED, and it can pose risks (high sodium load, metabolic alkalosis, blood-pressure increases, drug interactions), so talk with a clinician—especially if you have heart, kidney, or BP issues. There are several factors to consider, including safe use, red flags, and proven options like PDE5 medications and lifestyle changes; see the complete details below.

References:

Carr AJ, Hopkins WG, & Gore CJ. (2011). Effects of acute alkalosis and acidosis on performance: a meta-analysis… Sports Med, 21437760.

https://pubmed.ncbi.nlm.nih.gov/21437760/

Eardley I, Portsmouth S, & Caldwell D. (2000). Physiological and pharmacological characteristics of the corpora cavernosa and spongiosum… Int J Impot Res, 10886637.

https://pubmed.ncbi.nlm.nih.gov/10886637/

Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, & Merion R. (2003). Model for end-stage liver disease (MELD) and allocation of donor live… Gastroenterology, 14656940.

https://pubmed.ncbi.nlm.nih.gov/14656940/

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Q.

Can smoking weed everyday cause erectile dysfunction?

A.

Some studies suggest that daily cannabis use may be linked to a greater chance of experiencing erectile dysfunction, though effects can differ from person to person.

References:

Pizzol D, Demurtas J, Stubbs B, Soysal P, Mason C, Isik AT, Solmi M, Smith L, Veronese N. Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. Am J Mens Health. 2019 Nov-Dec;13(6):1557988319892464. doi: 10.1177/1557988319892464. PMID: 31795801; PMCID: PMC6893937.

Shiff B, Blankstein U, Hussaen J, Jarvi K, Grober E, Lo K, Lajkosz K, Krakowsky Y. The impact of cannabis use on male sexual function: A 10-year, single-center experience. Can Urol Assoc J. 2021 Dec;15(12):E652-E657. doi: 10.5489/cuaj.7185. PMID: 34171210; PMCID: PMC8631840.

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Q.

Does baking soda and apple cider vinegar help with erectile dysfunction?

A.

There is no strong medical evidence that baking soda and apple cider vinegar can treat erectile dysfunction.

References:

Hadzic M, Eckstein ML, Schugardt M. The Impact of Sodium Bicarbonate on Performance in Response to Exercise Duration in Athletes: A Systematic Review. J Sports Sci Med. 2019 Jun 1;18(2):271-281. PMID: 31191097; PMCID: PMC6544001.

Jafarirad S, Elahi MR, Mansoori A, Khanzadeh A, Haghighizadeh MH. The improvement effect of apple cider vinegar as a functional food on anthropometric indices, blood glucose and lipid profile in diabetic patients: a randomized controlled clinical trial. Front Clin Diabetes Healthc. 2023 Nov 13;4:1288786. doi: 10.3389/fcdhc.2023.1288786. PMID: 38028980; PMCID: PMC10679383.

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Q.

Does diabetes cause erectile dysfunction?

A.

Yes, diabetes is a common cause of erectile dysfunction because high blood sugar can damage nerves and blood vessels needed for a strong erection.

References:

Ledda A. Diabetes, hypertension and erectile dysfunction. Curr Med Res Opin. 2000;16 Suppl 1:s17-20. doi: 10.1185/0300799009117035. PMID: 11329816.

Bahar A, Elyasi F, Moosazadeh M, Afradi G, Kashi Z. Sexual dysfunction in men with type II diabetes. Caspian J Intern Med. 2020 May;11(3):295-303. doi: 10.22088/cjim.11.3.295. PMID: 32874437; PMCID: PMC7442469.

Defeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, Faggiano A, Pozzilli P, Isidori AM, Gianfrilli D. Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes Metab Res Rev. 2022 Feb;38(2):e3494. doi: 10.1002/dmrr.3494. Epub 2021 Sep 21. PMID: 34514697; PMCID: PMC9286480.

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Q.

Does masturbation cause erectile dysfunction?

A.

No, masturbation by itself does not cause erectile dysfunction; it is generally considered a normal sexual activity.

References:

Rowland DL, Castleman JM, Bacys KR, Csonka B, Hevesi K. Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men? Int J Impot Res. 2023 Sep;35(6):548-557. doi: 10.1038/s41443-022-00596-y. Epub 2022 Jul 15. PMID: 35840678.

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Q.

Does porn cause erectile dysfunction?

A.

Some research shows that heavy use of online pornography may be linked with erectile dysfunction, but it is not proven that porn directly causes ED since many factors can influence sexual function.

References:

Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel). 2016 Aug 5;6(3):17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6):E55. doi: 10.3390/bs8060055. PMID: 27527226; PMCID: PMC5039517.

Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill. 2021 Oct 21;7(10):e32542. doi: 10.2196/32542. PMID: 34534092; PMCID: PMC8569536.

Adarsh H, Sahoo S. Pornography and Its Impact on Adolescent/Teenage Sexuality. Journal of Psychosexual Health. 2023;5(1):35-39. doi:10.1177/26318318231153984

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Q.

How long after quitting smoking does erectile dysfunction improve?

A.

Many studies show that some improvement in erectile dysfunction can begin within a few weeks of quitting smoking, with greater benefits appearing over several months.

References:

Guay AT, Perez JB, Heatley GJ. Cessation of smoking rapidly decreases erectile dysfunction. Endocr Pract. 1998 Jan-Feb;4(1):23-6. doi: 10.4158/EP.4.1.23. PMID: 15251760.

Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int. 2004 Dec;94(9):1310-3. doi: 10.1111/j.1464-410X.2004.05162.x. PMID: 15610111.

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Q.

How much does erectile dysfunction surgery cost?

A.

Erectile dysfunction surgery, such as penile prosthesis implantation, can cost anywhere from around $10,000 to over $30,000, depending on many factors.

References:

Kohn TP, Rajanahally S, Hellstrom WJG, Hsieh TC, Raheem OA. Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men. Eur Urol Focus. 2022 May;8(3):803-813. doi: 10.1016/j.euf.2021.05.003. Epub 2021 May 24. PMID: 34034995.

Nguyen V, McGovern AM, Rojanasarot S, Patel DP, Bhattacharyya S, Hargens LM, Aworunse O, Hsieh TC. Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis. Int J Impot Res. 2025 Jan;37(1):45-50. doi: 10.1038/s41443-024-00903-9. Epub 2024 Jun 26. PMID: 38926632; PMCID: PMC11706773.

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Q.

How much is the cost of injections for erectile dysfunction?

A.

The cost of injections for erectile dysfunction can vary widely—ranging from a few hundred dollars per session to over a thousand dollars—depending on the treatment type, frequency, and insurance coverage.

References:

Sun P, Seftel A, Swindle R, Ye W, Pohl G. The costs of caring for erectile dysfunction in a managed care setting: evidence from a large national claims database. J Urol. 2005 Nov;174(5):1948-52. doi: 10.1097/01.ju.0000176739.44725.49. PMID: 16217364.

Britt D, Blankstein U, Lenardis M, Millman A, Grober E, Krakowsky Y. Availability of platelet-rich plasma for treatment of erectile dysfunction and associated costs and efficacy: A review of current publications and Canadian data. Can Urol Assoc J. 2021 Jun;15(6):202-206. doi: 10.5489/cuaj.6947. PMID: 33212009; PMCID: PMC8195577.

Masterson TA et al. Platelet-rich plasma for the treatment of erectile dysfunction: A prospective, randomized, double-blind, placebo-controlled clinical trial. _J Urol_ 2023 Jul; 210:154.

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Q.

What are the most likely drugs to cause erectile dysfunction?

A.

Drugs used to treat high blood pressure—like beta blockers and diuretics—are some of the most common medicines linked with causing erectile dysfunction, along with certain antidepressants.

References:

Kaplan-Marans E, Sandozi A, Martinez M, Lee J, Schulman A, Khurgin J. Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database. Sex Med. 2022 Oct;10(5):100543. doi: 10.1016/j.esxm.2022.100543. Epub 2022 Jul 14. PMID: 35843193; PMCID: PMC9537247.

Lou IX, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag. 2023 Nov 3;19:691-705. doi: 10.2147/VHRM.S439334. PMID: 37941540; PMCID: PMC10629452.

Lou IX, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag. 2023 Nov 3;19:691-705. doi: 10.2147/VHRM.S439334. PMID: 37941540; PMCID: PMC10629452.

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Q.

What are the worst foods for erectile dysfunction?

A.

Foods that are high in unhealthy fats, added sugars, and heavily processed ingredients—like fast food, fried items, and processed meats—are linked with an increased risk of erectile dysfunction.

References:

Agarwal, S. K. (2022). The Role of Diet in the Pathogenesis of Erectile Dysfunction. _Cardiology and Angiology: An International Journal_, _11_(2), 19–30. https://doi.org/10.9734/ca/2022/v11i230191

Bauer SR, Breyer BN, Stampfer MJ, Rimm EB, Giovannucci EL, Kenfield SA. Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study. JAMA Netw Open. 2020 Nov 2;3(11):e2021701. doi: 10.1001/jamanetworkopen.2020.21701. PMID: 33185675; PMCID: PMC7666422.

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Q.

What is porn induced erectile dysfunction?

A.

Porn induced erectile dysfunction is a term used when watching too much pornography is thought to make it harder for some men to initiate or maintain an erection in real-life situations.

References:

Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel). 2016 Aug 5;6(3):17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6):E55. doi: 10.3390/bs8060055. PMID: 27527226; PMCID: PMC5039517.

Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill. 2021 Oct 21;7(10):e32542. doi: 10.2196/32542. PMID: 34534092; PMCID: PMC8569536.

Adarsh H, Sahoo S. Pornography and Its Impact on Adolescent/Teenage Sexuality. Journal of Psychosexual Health. 2023;5(1):35-39. doi:10.1177/26318318231153984

See more on Doctor's Note

Q.

What is the best drink for erectile dysfunction?

A.

No single drink is a magic cure for erectile dysfunction, but some drinks—like pomegranate juice, green tea, and watermelon juice—may help improve blood flow and overall health, which can support erectile function.

References:

Neves D, Assunção M, Marques F, Andrade JP, Almeida H. Does regular consumption of green tea influence expression of vascular endothelial growth factor and its receptor in aged rat erectile tissue? Possible implications for vasculogenic erectile dysfunction progression. Age (Dordr). 2008 Dec;30(4):217-28. doi: 10.1007/s11357-008-9051-6. Epub 2008 Apr 18. PMID: 19424845; PMCID: PMC2585648.

Rahimi HR, Arastoo M, Ostad SN. A Comprehensive Review of Punica granatum (Pomegranate) Properties in Toxicological, Pharmacological, Cellular and Molecular Biology Researches. Iran J Pharm Res. 2012 Spring;11(2):385-400. PMID: 24250463; PMCID: PMC3832175.

Rotimi DE, Asaleye RM. Impact of Watermelon (Citrallus lanatus) on Male Fertility. JBRA Assist Reprod. 2023 Jul 7;27(4):702–8. doi: 10.5935/1518-0557.20220075. Epub ahead of print. PMID: 37417854; PMCID: PMC10718552.

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Q.

What level of spinal cord injury leads to erectile dysfunction?

A.

Erectile function is mostly affected when the injury involves the sacral segments (S2-S4) of the spinal cord, since these segments control the reflex needed for an erection.

References:

Shridharani AN, Brant WO. The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol. 2016 Feb;5(1):88-101. doi: 10.3978/j.issn.2223-4683.2016.01.07. PMID: 26904415; PMCID: PMC4739980.

Sinha V, Elliott S, Ibrahim E, Lynne CM, Brackett NL. Reproductive Health of Men with Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2017 Winter;23(1):31-41. doi: 10.1310/sci2301-31. PMID: 29339875; PMCID: PMC5340507.

Alexander MS, Aisen CM, Alexander SM, Aisen ML. Sexual concerns after Spinal Cord Injury: An update on management. NeuroRehabilitation. 2017;41(2):343-357. doi: 10.3233/NRE-172202. PMID: 29036845.

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References