You can have high libido and still have erectile dysfunction. You can have good erectile function and still have premature ejaculation.
Dopamine stimulates libido. High prolactin can cause low libido and erectile dysfunction, even when testosterone is normal.[1, 2]
Oxytocin contributes to arousal and orgasm. Serotonin can delay or speed up ejaculation, depending on which receptors and nerve pathways it activates. GABA reduces nerve excitation, and some neurosteroids strengthen its effects. Androgens, estrogens and thyroid hormones influence libido, erections and ejaculation through their actions in the brain and other tissues.[3, 4, 5, 6, 7]
The oral microbiome affects blood-vessel function. Bacteria in the mouth convert nitrate into nitrite, which the body can use to make nitric oxide.[8] Treating gum inflammation has also improved erectile function in men with both gum problems and ED.[9]
The gut microbiome may influence sexual function through inflammation and hormone signalling. The guides cover bacterial overgrowth, endotoxin, food reactions and histamine, including their possible links with testosterone production, pelvic pain and premature ejaculation.[10, 11, 12]
These six guides progress from food, sleep, exercise and sexual habits to supplements, hormone treatments and prescription medicines. They cover more than 140 supplements, hormones, medicines and combinations, plus 21 approaches without medication.
Contents
Identify your main symptom
Find the guide for your symptom
Food, body composition, sleep and exercise
Medication and supplement side effects
Porn, pressure and sexual habits
Hormones in the blood and tissues
Track what improves
1. Identify your main symptom
When it started. Worse sleep, extreme dieting, more training, a new drug or a hormone dose change.
When it happens. Alone, with a partner, every time or only sometimes.
What else changed. Libido, morning wood, erection quality, sensation, orgasm or semen volume.
What you’ve tried. The treatment, dose, timing, result and side effects.
If ED persists, have blood pressure, blood sugar and hormone levels tested. Pain or a sudden loss of erections or sensation needs prompt medical attention. If the problem began after a drug change, start with that change.[13]
2. Find the guide for your symptom
Part 1: Erectile Function and Morning Wood. Improve erectile function and morning wood through sleep, glucose metabolism, insulin sensitivity and blood flow. Includes oral health, body fat, pelvic muscles, performance anxiety, nutrients and treatments for erections.
Part 2: Libido and Sexual Arousal. Improve libido and arousal, from food intake, daylight, stress and sexual habits to dopamine, prolactin, thyroid function, androgens, estrogens and neurosteroids. Includes gut inflammation and the nutrients needed to produce and regulate dopamine.
Part 3: Premature Ejaculation. Improve ejaculation control through edging, breathing, pelvic-floor training and targeted treatments. Covers prostate and bladder symptoms, gut problems, histamine, GABA, glutamate, noradrenaline and serotonin.
Part 4: Delayed Orgasm, Reduced Sensation and Sexual Pain. Treat delayed or weak orgasms, genital numbness and sexual pain. Covers medication effects, sexual habits, nerve injury or compression, pelvic tension and painful erections during sleep.
Part 5: Refractory Period and Post-Orgasm Symptoms. Understand the refractory period, including dopamine, prolactin, energy intake and the return of libido and erections. Covers fatigue, illness-like symptoms and low mood after orgasm.
Part 6: Semen Volume and Dry Orgasms. Identify the causes of low semen volume or dry orgasms, including hydration, nutrient intake, medication, hormone changes and semen flowing into the bladder. Compare food, supplements and targeted treatments.
For fertility and PCT (post-cycle therapy), use my PCT, ICT and HRT guide.
3. Food, body composition, sleep and exercise
Enough food, a lean body and regular activity
Eat enough carbs and calories for your activity and training. I prioritise resistance training to build and preserve muscle, with walking for daily activity. Short HIIT sessions can fit when recovery allows. Part 1 compares their effects on glucose use and erectile function.[14, 15]
Lose excess abdominal fat gradually. If you are under-eating or overtraining and your sleep, energy and libido are getting worse, eat more and reduce the training load.[16, 17, 18]
In men with obesity and type 2 diabetes, diet and exercise helped prevent a decline in erectile function. Benefits can appear before visible abs.[16]
Daylight and sleep
Get outside in the morning, keep a steady waking time and dim the lights at night.[19] Part 2 explains daylight and the body clock.
Pay attention to sleep quality, repeated waking and how you feel the next day.[18] Loud snoring, pauses in breathing and daytime sleepiness can point to sleep apnea.[20] Part 1 covers sleep problems and missing morning wood.
4. Medication and supplement side effects
Antidepressants, antipsychotics, opioids, blood-pressure medicines and bladder treatments can affect libido, erections, orgasm or ejaculation. If symptoms follow a prescription or dose change, discuss reducing the dose or replacing the drug.[13]
Finasteride and dutasteride reduce DHT production and can cause sexual side effects. They are used for hair loss or an enlarged prostate and may be included in compounded scalp preparations.[21, 22] Sexual symptoms have also been reported with preparations containing saw palmetto.[23] If symptoms began after an optional hair-loss treatment, I would stop it before adding hormones or ED medication. Treatment for urinary symptoms may need a replacement.
If libido or erectile function declines after starting topical minoxidil for hair loss, I would stop it and see whether libido and erections recover. Sexual side effects have been reported during use.[24] Oral minoxidil prescribed for severe hypertension needs a replacement before stopping.[21, 25] Part 1 covers these treatments in detail.
5. Porn, pressure and sexual habits
I recommend stopping porn and masturbation alongside improving food, sleep and exercise.[26, 27]
For men with premature ejaculation, Part 3 explains edging and stop-start practice, including how to use pauses with a partner.
For four weeks, remove saved porn, block the sites you return to and keep your phone out of bed. Include sexual browsing on social media. If boredom or stress triggers the habit, plan another activity for that time.
Notice whether comparisons with videos or pressure to perform interfere with sex. If the habit feels difficult to control, a therapist who treats compulsive sexual behaviour can help.
6. Hormones in the blood and tissues
A blood test shows how much hormone is circulating. What happens inside a tissue also depends on its enzymes and receptors. For example, fat cells can produce different amounts of aromatase, the enzyme that makes estrogen, even when blood estradiol is similar. Excess prolactin may interfere with nitric oxide signalling in penile blood vessels. This helps explain why people with similar blood results can have different symptoms. Parts 1 and 2 examine these tissue effects in more detail.[28, 29, 30]
I suspect estradiol, or E2, can contribute to compulsive libido, particularly during androgen use. Symptoms alone cannot identify the responsible hormone. Lowering estrogen too much can reduce libido, as it did in men receiving testosterone when estrogen production was blocked.[6] Use blood tests alongside symptoms before changing hormone treatment. My guide to lowering estrogen and aromatase explains the options when E2 is elevated.
7. Track what improves
Try optional treatments one at a time. Record the dose and start date, then compare libido, erection quality, ejaculation control and orgasm after the period given in the entry. Stop an optional supplement if it causes side effects. If a prescribed treatment causes side effects, discuss a lower dose or a replacement.
Check for duplicate ingredients before combining supplements. Specific interactions are listed beside each treatment.
If one symptom improves while another persists, use the guide for the remaining problem. If a treatment has no effect despite the correct dose and schedule, reconsider the cause before adding another.
References
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