Vitamin D and Erectile Dysfunction

A paper just published hypothesizes that vitamin D deficiency may be an important risk factor for erectile dysfunction (ED). Evidence cited supporting the link between low vitamin D and ED include that those with Asthma, depression, falls and fractures, multiple sclerosis, and periodontal disease are at greater risk of having ED. In addition, those with ED are at greater risk of developing cardiovascular disease, diabetes mellitus, and metabolic syndrome. All of these diseases are linked to vitamin D deficiency.

Vascular problems account for about half the cases of ED. There is a large body of research finding that vitamin D can maintain vascular health. The mechanisms appear to include suppressing the activity of the renin-angiotensin system, thereby lowering blood pressure, improving endothelial function, reducing inflammation, and reducing vascular calcification. Solar ultraviolet (UV) light is the primary source of vitamin D for most people. In addition, UV increases nitric oxide concentrations in the blood, which also appears to reduce the risk of ED.

Those diagnosed with ED should consider having serum 25-hydroxyvitamin D [25(OH)D] concentration measured, then adopt a program to increase concentrations to at least 40 ng/ml (100 nmol/l) through vitamin D supplementation and/or increased solar UVB exposure. Serum 25(OH)D concentrations should be re-measured a few months after starting such a program.

Those diagnosed with ED should also have their physician check for signs of early diabetes or cardiovascular disease.

According to Dr. Richard Quinton, Consultant Physician (endocrinologist), The Newcastle upon Tyne Hospitals, England:“Onset of erectile dysfunction is a life-changing event for a man of any age. Fortunately, there are now reasonably successful medical treatments for it. However, as he or she is signing the script, the Physician should remember that ED is frequently an early indicator of systemic disease. The conditions we tend to think of first in relation to ED are diabetes and hypogonadism, but any occult systemic disease can precipitate ED many years before it becomes clinically apparent.

The hypothesis presented in this paper is certainly plausible and deserves to be tested, but even if there turns out to be no direct vascular-related link between ED and hypovitaminosis D, it is highly likely that patients with symptomatic fatigue and/or musculoskeletal aches and pains secondary to the more severe end of the hypovitaminosis D spectrum will exhibit impaired erectile and sexual function.

“We know from the MRC survey that severe hypovitaminosis D is highly-prevalent even among middle-aged Caucasians in the UK, particularly in the West of Scotland. This is almost certainly due to our high latitude, prevalent cloud cover and low fish consumption. So, whilst writing that script for erection-promoting tablet, the Physician should also consider the possibility of hypovitaminosis D, particularly if the following risk factors are present: constitutively darker skin type, conscious or unconscious sun-avoidance behaviour, including culturally or behaviourally-determined forms of clothing, routine use of SPF sunblock in everyday life, shift work, obesity, medication with immunosuppressants or anticonvulsants, or bowel disease predisposing to fat soluble vitamin malabsorbtion.

“Thus, among the lifestyle changes the Physician might typically promote in the context of ED, such as “stop smoking, take more exercise, eat more healthily and lose weight”, “get more sunshine exposure to bare skin” should perhaps also be in the mix. For the purpose of maximising vitamin D photosynthesis, whilst minimising solar skin damage, the mathematically most logical solution is to expose as much skin as possible (without burning) -ie. sunbathing- rather than just exposing forearms, face and neck for a longer period. “However, we all know how hard it is to persuade our patients to make significant and sustained lifestyle changes, which is precisely why bariatric surgery has taken off in recent years. Moreover, not everyone can afford to take a “winter sun” holiday, so for many people, taking an oral vitamin D supplement may be the way forward.”

According to Dr. Stefan Pilz, Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria: "Vitamin D deficiency is associated with various risk factors for erectile dysfunction as reviewed by Marc Sorenson and William B. Grant. A role of vitamin D deficiency in the pathogenesis of erectile dysfunction can be hypothesized. Randomized controlled trials should therefore evaluate whether vitamin D supplementation exerts relevant effects with regard to erectile dysfunction."

According to Marc Sorenson, director of the Sunlight Institute and lead author, “The treatment of choice for ED has been the use of phosphodiesterase-5 inhibitors such as Viagra. While effective in relieving the ED symptoms, these drugs do nothing for the underlying cause and may lose their effectiveness over time. They may also hide from users the possibility of cardiovascular disease; therefore patients may delay seeking help. If proven in further research, vitamin D optimization has the potential to influence the cause of ED to prevent or mitigate the condition.”

According to William B. Grant, Ph.D., director of Sunlight, Nutrition and Health Research Center, a coauthor:_“This paper is the first to hypothesize a link between erectile dysfunction and vitamin D deficiency. While it is not clear what role increasing vitamin D concentrations to 40 ng/ml (100 nmol/l) will have on erectile dysfunction, it will reduce the risk of diabetes, cardiovascular disease, many types of cancer, and several infectious diseases. Thus, a diagnosis of erectile dysfunction not due to prostate surgery or psychological state should be considered a wakeup call to investigate the roles of solar UVB and vitamin D for improving overall health.”