What are simple remedies for an adult male with erectile dysfunction?

Simple Remedies for Erectile Dysfunction

Start with lifestyle modifications—smoking cessation, weight loss to achieve BMI <30 kg/m², increasing physical activity, and limiting alcohol consumption—as these are the foundation of ED treatment and can reverse erectile dysfunction, particularly in men without established comorbidities. 1, 2

Immediate Lifestyle Interventions (First-Line Simple Remedies)

Lifestyle modification is where treatment begins, not an afterthought:

• Stop smoking immediately – tobacco use directly impairs erectile function through vascular mechanisms 1, 2
• Lose weight if BMI ≥30 kg/m² – weight loss reverses ED through decreased inflammation, increased testosterone levels, and improved vascular function 2
• Exercise regularly – physical activity improves erectile function through multiple mechanisms including improved cardiovascular fitness and endothelial function 1, 2
• Limit alcohol consumption – excessive alcohol impairs erectile function and reduces treatment response 1
• Optimize diabetes control – precise glycemic control in diabetic men prevents and reduces sexual dysfunction 2

These modifications are most effective in men without established cardiovascular disease, diabetes, or other comorbidities, where they can actually restore erectile function rather than just improve it 2.

Critical Cardiovascular Assessment Before Any Treatment

Before pursuing any ED treatment, assess cardiovascular fitness by asking if the patient can walk 1 mile in 20 minutes on flat surface or climb 2 flights of stairs in 20 seconds without symptoms. 1

• Men unable to perform this level of exercise are at high risk for adverse events during sexual activity and must be referred to cardiology before any ED treatment 1
• Sexual activity is equivalent to moderate physical exertion, and cardiovascular risk stratification is mandatory 1

Psychosocial Factors (Often Overlooked Simple Remedy)

Screen for and treat psychological contributors, as these frequently coexist with organic ED and significantly impact treatment response:

• Depression and anxiety – these conditions both cause and worsen ED, and treating them can alleviate erectile symptoms 1
• Relationship issues – couples therapy can often resolve ED symptoms when relationship conflict is present 1
• Sex therapy referral – appropriate for men with psychological overlay, which is pronounced in most ED cases 1

The psychological component is present in the vast majority of ED cases, even when organic causes predominate 1.

Medication Review (Simple but Critical)

Identify and modify medications that worsen ED:

• Antihypertensives, antidepressants, opioids, and hormone therapy can all contribute to erectile dysfunction 1
• Work with the patient's other providers to switch to medications less likely to cause sexual side effects when treating hypertension and depression 2

Testosterone Evaluation and Replacement

Measure testosterone levels in all men with ED, especially those who fail initial treatments:

• Low testosterone is present in 36% of men seeking consultation for sexual dysfunction 1
• Testosterone replacement therapy combined with other ED treatments is more effective than either alone in men with documented testosterone deficiency 3, 4
• However, testosterone alone is NOT effective monotherapy for ED 4

The recommendation to check testosterone in all men with ED differs from some guidelines but is supported by accumulating evidence linking low testosterone to both ED and cardiovascular disease 1.

When Simple Remedies Are Insufficient

If lifestyle modifications, psychosocial interventions, and medication adjustments do not restore erectile function, oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) are the next step:

• These medications are effective in 60-65% of men with ED, including those with hypertension, diabetes, spinal cord injury, and other comorbidities 5
• PDE5 inhibitors require sexual stimulation to work – this is a common cause of apparent treatment failure 3, 4
• An adequate trial requires at least 5 separate attempts at maximum dose before declaring treatment failure 1, 3

Critical Safety Warning

PDE5 inhibitors are absolutely contraindicated with any form of nitrate use (including recreational "poppers") due to potentially fatal hypotension. 1, 6

Common Pitfalls to Avoid

• Declaring lifestyle modification ineffective without adequate trial – weight loss, exercise, and smoking cessation require sustained effort over months to show benefit 2
• Ignoring psychological factors – even when organic causes are present, psychological overlay significantly impacts treatment success 1
• Failing to check testosterone – this treatable condition is present in over one-third of men with ED 1
• Not addressing relationship issues – partner involvement and couples therapy improve outcomes 1

The evidence strongly supports that simple remedies—lifestyle modification, psychosocial intervention, medication review, and testosterone optimization—should be thoroughly implemented before concluding they are ineffective 1, 2.