Erectile Dysfunction

Erectile dysfunction is fundamentally a problem of impaired systemic energy metabolism and hormonal imbalance, not an isolated vascular or psychological defect. Ray Peat argued that restoring thyroid function is a primary physiological solution, as it improves natural circulation, libido, and potency. 2 He identified the core pathology in aging men as a shift in steroid balance: decreased testosterone and progesterone alongside increasing estrogen, which collectively increases the tendency for erectile problems. 2 This is compounded by a decline in protective steroids like DHEA and progesterone after the age of 35 or 40, corresponding to a loss of resistance to stress. 3

The mainstream pharmaceutical approach, particularly nitric oxide-enhancing drugs like Viagra and Cialis, directly opposes this framework. Peat considered nitric oxide a central promoter of cancer growth and metastasis, noting that it actively decreases the ability to synthesize protective steroids like testosterone and progesterone while increasing estrogen. 2 Georgi Dinkov has highlighted that aspirin, an anti-nitric oxide agent, was found in human studies to be more effective than Viagra as a monotherapy for erectile dysfunction at a dose of just 100mg daily, without the harmful side effects. 2 Dinkov notes that aspirin may also act as a disease-modifying therapy by improving the underlying cardiovascular disease that causes ED, an effect Viagra has never demonstrated. 5

A specific hormonal deficiency often overlooked in men is that of progesterone. Peat described cases where a single small dose of progesterone permanently corrected erectile dysfunction, likely by acting in the brain to shift the balance away from stress-induced inhibition of testosterone synthesis and by antagonizing aldosterone, a known testosterone antagonist associated with ED. 3 However, Peat cautioned that in younger men, higher doses of progesterone can antagonize testosterone's effects, an effect that passes within a day of stopping. 3 Dinkov and Peat both emphasized that standard blood tests are often insufficient; a man can have normal testosterone yet still suffer from ED if prolactin or estradiol are elevated. 7

The use of 5-alpha reductase inhibitors like Finasteride for hair loss provides a stark warning about hormonal manipulation. Danny Roddy documented that Finasteride, which reduces dihydrotestosterone (DHT) by about 70%, carries a risk of permanent erectile dysfunction, with one study finding 92% of affected users developed the condition. 4 This iatrogenic damage illustrates the danger of disrupting the very androgens that maintain sexual arousal. Dinkov has also pointed to physical endocrine disruptors, noting a study where microplastics were found lodged in the penile tissue of four out of five men with ED, causing direct endothelial damage and chronic vascular inflammation. 6 Dinkov also addressed porn-induced ED, framing it as a brain desensitization issue where overstimulation leads to a downregulation of dopamine release, similar to tolerance in addiction. 2