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• Why researchers chose this study method — Mendelian randomization is a way to test if a gene causes erectile dysfunction risk, rather than just being linked to it. To make the results stronger, researchers also used two other tools:⁶

• A large genetic dataset was analyzed — The study examined data from 95,178 men, including 1,154 diagnosed with ED and 94,024 without, and then combined these findings with published datasets totaling more than 1 million individuals. Data came from the All of Us (AoU) biobank, which included participants of European and African ancestry.

Researchers used electronic health records (EHRs) or prescriptions for ED drugs called phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra), to identify cases.⁹ Many men do not respond to these medications, highlighting the need for genetic research.¹⁰

• 263 genes were linked to ED risk — Many of these genes are involved in lipid metabolism (how the body processes fats), immune function, and cell structure. These processes affect blood flow and tissue health, which are vital for normal erections. Functional analyses also imply beta-catenin biology, which influences vascular and tissue integrity.¹¹

• The discovery of a protective gene — Among all genes, Thyroid Hormone Receptor Interactor 10 (TRIP10) stood out with an odds ratio (OR) of 0.58, meaning higher TRIP10 activity was linked to a lower risk of ED. This gene helps regulate lipid metabolism, insulin signaling, and cytoskeletal remodeling — all important for vascular health.¹²

• Key gene involvement in ED — The strongest genetic signal involved Single-minded homolog 1 (SIM1), a gene linked to energy balance, obesity, and sexual behavior. Genes linked to brain circuits and hormone regulation were also involved, highlighting the complex neuroendocrine pathways underlying ED.¹³

Researchers also found moderate genetic correlations between ED and traits such as depression, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), Type 2 diabetes, heart failure, and substance-use disorders (especially cannabis and opioids).

• There are many factors at play — ED is a polygenic condition with many genes, including SIM1 and TRIP10, increasing risk. Future treatments may use these as biomarkers or target pathways like beta-catenin to aid non-responders.¹⁴

• About 40% of men at age 40 and up to 70% of men at age 70 experience it — Many never talk about it, so the real numbers are likely higher. Erectile dysfunction used to be called “impotence,” but that term is outdated and stigmatizing. Today, it’s recognized as a medical condition with physical, hormonal, and psychological causes, not a character flaw.¹⁶

• Erections run on blood flow and nitric oxide — A normal erection starts in the brain when a man feels aroused. Nerves in the penis release nitric oxide, a tiny signaling molecule that relaxes smooth muscle and lets blood rush into the spongy tissue of the penis. This process uses a messenger called cyclic guanosine monophosphate (cGMP), which keeps the muscles relaxed long enough for an erection.¹⁷

• The main types of ED — Clinically, doctors group ED into a few main buckets:¹⁸

• A red flag for heart health — A 2013 Australian study known as the 45 and Up Study, published in PLOS Medicine — an open-access journal from the nonprofit Public Library of Science — followed 95,038 men age 45 and older and found that the more severe a man’s ED was, the higher his risk of serious heart problems and early death.¹⁹

Compared with men who reported no erectile dysfunction and had no history of heart disease, those with severe ED had about a 60% higher risk of blocked heart arteries, eight times the risk of heart failure, nearly twice the risk of poor circulation in the legs, a 35% higher risk of any cardiovascular hospitalization, and a 93% higher risk of dying from any cause over two to three years of follow-up. Men who already had heart disease and severe ED faced similar or greater risks.²⁰

“… Erectile dysfunction is a risk marker for cardiovascular disease, not a risk factor that causes cardiovascular disease … Nevertheless, these findings provide useful information for clinicians … Men with erectile dysfunction, even at mild or moderate levels, should be screened and treated for cardiovascular disease accordingly,” the study’s researchers concluded.

• Obesity raises ED risk — A 2023 cross-sectional study published in Frontiers in Endocrinology examined 878 men from an andrology clinic in Central China to see how body weight relates to ED. Men were grouped by body mass index (BMI) as underweight, normal weight, overweight, or obese.²¹

ED was very common in this relatively young group, affecting 53.1% of participants. Men with ED had a significantly higher BMI than those without, and obesity stood out.²² When the researchers looked specifically at ED severity, the link with obesity became even clearer, according to researchers:²³

“In conclusion, the findings in this study indicate that obesity is associated with an increased risk of moderate/severe ED. Given the high prevalence of ED in obese men, clinicians could pay more attention to moderate/severe ED patients to maintain a healthy body weight to improve erectile function.”

• Compromised sleep quality and ED — A 2023 cross-sectional study in Frontiers in Public Health examined how poor sleep affects ED risk. Researchers surveyed 381 male university students in Peru (ages 18 to 30) and found that about half had poor sleep quality. Those with poor sleep were nearly six times more likely to report ED compared to good sleepers, even after adjusting for age, weight, and sleep apnea. The researchers concluded that:²⁴

“Poor sleep quality was independently associated with erectile dysfunction in young university students. This finding suggests that male students are at risk for sexual problems due to possible academic demands and relationship issues.”

The researchers also touched on results of earlier studies saying that: “93.3% of studies with poor sleep quality experienced some sort of ED.” And that men with sleep disorders such as sleep apnea are predisposed to end up developing ED.²⁵

• Mental health and erections are tightly connected — A 2018 systematic review and meta-analysis in The Journal of Sexual Medicine analyzed 49 studies to see how depression and ED influence each other.^26,27 They found that men dealing with depression had 39% higher odds of developing ED.

Meanwhile, men with ED had nearly three times the odds of later developing depression. In simple terms, low mood makes ED more likely — and ED itself strongly increases the risk of becoming depressed.²⁸

• Taking certain heart and lung medications — Viagra should never be taken with nitrates (such as nitroglycerin or isosorbide dinitrate) or guanylate cyclase stimulators like riociguat (Adempas). These combinations can cause a dangerous drop in blood pressure. Some alpha blockers used for blood pressure or prostate problems can also lower blood pressure further, so they may require careful timing and dose adjustment if Viagra is used at all.³²

• Certain serious eye conditions — Albeit rare, Viagra has been linked to vision changes such as blurred vision, color shifts, and light sensitivity. Men with nonarthritic anterior ischemic optic neuropathy (NAION) or retinitis pigmentosa, both rare but serious eye diseases, may be at higher risk of vision loss with Viagra and are often advised to avoid it.³³

• Severe kidney or liver problems — The liver and kidneys help clear Viagra from the body. When they are not working well, sildenafil can build up and increase side effects.³⁴

• Heart problems — Men who have had a heart attack, stroke, or life-threatening heart rhythm problem in the past six months,³⁵ or have ongoing chest pain, a significant heart obstruction, or uncontrolled high or low blood pressure are not advised to take Viagra.

1. Start with a heart check-up — ED is often an early warning sign of a bevy of conditions, the most alarming being cardiovascular disease. Before trying supplements or making any lifestyle changes to support heart health, work with a medical professional.

2. Try a metabolic-friendly diet — Normalize insulin levels by avoiding processed foods and seed oils high in linoleic acid (LA), which damage mitochondria and impair vascular health. Instead, choose stable fats like grass-fed butter, ghee, or beef tallow. Pair these with nutrient-dense foods to support hormone balance and circulation. A clean diet improves overall metabolic health, which is critical for sexual function.

3. Eat more flavonoid-rich foods — Harvard research shows men under 70 who regularly eat berries, citrus fruits, apples, and dark chocolate have an 11% to16% lower risk of ED. Flavonoids help blood vessels stay flexible and boost nitric oxide, which relaxes arteries and improves blood flow. These compounds also fight oxidative stress, making them a powerful ally for sexual and heart health.³⁶

4. Pomegranates keep ED at bay — Pomegranates are packed with antioxidants that protect nitric oxide and enhance its effects. Nitric oxide³⁷ relaxes and widens blood vessels, improving penile blood flow and erection quality. Studies suggest pomegranate juice benefits men with mild to moderate ED. A small glass daily can support vascular health naturally, without the risks of pharmaceutical drugs.³⁸

5. Strengthen pelvic floor muscles — Strong pelvic muscles help maintain rigidity during erections and keep blood from leaving the penis by pressing on a key vein. In a British study, men who did twice-daily Kegel exercises for three months, combined with biofeedback and lifestyle changes like stopping smoking, losing weight, and quitting alcohol, reported increases in erectile function.³⁹

6. Prioritize sleep — Getting morning sunlight anchors the circadian rhythm. Create a calming nighttime routine as well: keep lights dim at night, avoid screens, and ensure the bedroom is dark enough. Restorative sleep and stress control are essential for optimal sexual health.

7. Boost nitric oxide with L-arginine — Studies show pairing L-arginine with pycnogenol dramatically improves ED symptoms.⁴⁰ Another trial found that combining 6 grams of L-arginine with 6 milligrams of yohimbine (from yohimbe bark) restored sexual function in men with mild to moderate ED. These natural combinations enhance nitric oxide signaling and blood flow, offering a safer alternative to drugs.⁴¹

8. Support neurotransmitter balance with key nutrients — Acetylcholine (ACH) is the neurotransmitter that triggers sexual messages in the brain. Low ACH reduces sexual activity and responsiveness. Supplementing with choline (1,000 to 3,000 mg) and vitamin B5 (500 to 1,500 mg) helps boost ACH production naturally. This combination supports healthy nerve signaling and can improve sexual arousal without the risks of synthetic drugs.

9. Get sunshine every day — Spending time outdoors in bright sunlight is one of the fundamental strategies to regain and maintain your health. Ideally, it’s best to get at least one hour of sun exposure around solar noon to reap the maximum solar benefits. However, consuming a diet high in seed oils can lead to a higher risk of sunburn. Hence, it’s better to avoid high-intensity sun exposure until you’ve been off seed oils for about six months.