# Erectile Dysfunction

Category: Conditions

Also known as: impotence, ED

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…

9 passages · 3 authors · 2013–2024 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/erectile-dysfunction

## Synthesis

**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. [Source 1, 9] 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. [Source 1, 9] 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. [Source 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. [Source 1, 9] 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. [Source 5, 8] 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. [Source 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. [Source 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. [Source 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. [Source 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. [Source 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. [Source 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. [Source 2]

## People also ask

### How does thyroid function relate to erectile dysfunction?

Ray Peat argued that restoring thyroid function is a primary physiological solution because it improves natural circulation, libido, and potency, addressing the systemic energy and hormonal imbalances underlying the condition.

### Why might aspirin be considered an alternative to Viagra for ED?

Georgi Dinkov highlighted that aspirin, an anti-nitric oxide agent, was found in human studies to be more effective than Viagra as a monotherapy at 100mg daily, and it may also improve the underlying cardiovascular disease causing ED.

### What hormonal imbalances besides low testosterone can cause erectile dysfunction?

Peat and Dinkov emphasized that elevated prolactin or estradiol can cause ED even when testosterone levels appear normal, and Peat described progesterone deficiency as an often-overlooked factor correctable with a small dose.

## Related concepts

- [Benign Prostatic Hyperplasia (BPH)](https://bioenergeticoracle.com/md/concepts/benign-prostatic-hyperplasia-bph/index.md)
- [Bohr effect](https://bioenergeticoracle.com/md/concepts/bohr-effect/index.md)
- [Copper](https://bioenergeticoracle.com/md/concepts/copper/index.md)
- [Cori Cycle](https://bioenergeticoracle.com/md/concepts/cori-cycle/index.md)
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- [Free Fatty Acids (FFAs, NEFA)](https://bioenergeticoracle.com/md/concepts/free-fatty-acids-ffas-nefa/index.md)

## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — Nitric Oxide

Ray Peat · Interview · 2014 · http://l-i-g-h-t.com/files/herb-doctors-nitric-oxide.mp4

> **Andrew Murray:** One thing at a time ma'am.
>
> **Ray Peat:** Aging men have decreased amounts of testosterone and progesterone and increasing amounts of oestrogen and that increased oestrogen and the decreased amounts of the protective steroids I think, will increase the tendency to have erectile problems. And one of the really odd side effects of increased nitric oxide is that it decreases the ability to make testosterone and, at least in women, it lowers the progesterone synthesis. But those are synthesised very similarly, so I think in both men and women, nitric oxide is opposing and lowering those protective steroids while increasing oestrogen.
>
> **Caller:** Well what about Cialis? Is that just the same as Viagra? There's several products on the market that are supposed to help men with their erection.
>
> **Andrew Murray:** It's another version.
>
> **Caller:** Are they all the same?
>
> **Andrew Murray:** Yeah, pretty much.
>
> **Caller:** Alright, well thank you.
>
> **Andrew Murray:** Thanks for your call. OK, Dr Peat, I wanted to ask you some more questions about nitric oxide and/or some of the articles that I've seen about it promoting cancer. What are your thoughts on the cancer promoting effects of nitric oxide?

### Source 2 — #31: Estrogen for Libido? | PUFA and Hypogonadism | Overpopulation Hoax | Parabiosis | Cancer with Georgi Dinkov

Georgi Dinkov (with Georgi Dinkov) · Interview · Jul 19, 2020 · https://open.spotify.com/episode/6mO0fuDYLfG6rZQYQs1oT5

> **Danny Roddy:** Great stuff. Thank you, Georgi. Thank you, Gregory. Lennon, Paiva, thank you so much, Lennon, for 2R. Is that rupee maybe? Balancing glycine with methionine has the same effect in reference to our conversation a little bit earlier? Can you get the same effects of methionine restriction when you balance it with glycine?
>
> **Georgi Dinkov:** Yeah, actually, the more glycine you take, glycine directly interferes with methionine absorption. from the diet. So if you're taking gelatin with your food, and if that food contains methionine, you will absorb a lot less methionine if there is also gelatin taken at the same time, or glycine. Also, aspirin has been shown to interfere with the absorption of methionine and tryptophan. So taking aspirin with your food, aside from its other benefits, also interferes with the absorption of methionine. So you may be able to get by by eating your normal food, but simply forcing your body not to absorb as much methionine by using gelatin slash glycine slash aspirin.
>
> **Danny Roddy:** Good stuff. Thanks for that, Georgi. Thanks for that, Lennon. Harry Burgos, just for $10. So many of these people continually support the show, so we sincerely appreciate that. That allows these things to keep happening, so thank you so much, Harry, and everybody else that is just a chronic supporter of the show. John ZGR for $20. Thanks, John. He says, what is your opinion on porn-induced erectile dysfunction? If it is real, what is actually happening in the brain? Is it related to dopamine receptor downregulation? Many recover from ED a few months after stopping porn use.

### Source 3 — Some Effects of Progesterone in Men

Ray Peat · Article · 2021

> # Some Effects of Progesterone in Men
>
> Classifying progesterone as a “pregnancy hormone” and a “female sex hormone” has seriously limited understanding of its function in both men and women. It is a stabilizer of cellular structure and function in all organs, similarly in men and women. This stabilizing effect is especially important in the nervous system, where it is protective against stress. In both men and women, a progesterone deficiency is associated with problems including seizures and bipolar disorder, irritability/elation, aggression, and depression, as well as sex-related problems.
>
> In the 1970s, an acquaintance told me that he had become impotent following his vasectomy. I was familiar with the progesterone deficiency produced in women by tubal ligation and by intrauterine contraceptive devices, and I had seen a study of men’s hormones following a vasectomy, in which an isolated deficiency of progesterone sometimes occurred, so he decided to try some progesterone. He later said that a single dose had corrected his erectile problem. Other young men with erectile dysfunction, from other causes, had similarly good results with small amounts of progesterone.
>
> When a problem is quickly and permanently corrected with a small amount of progesterone it seems likely that the progesterone acted in the brain to shift the balance, maintained by endorphins, away from the stress induced inhibition of progesterone and testosterone synthesis. At the same time, though, that progesterone is lowering cortisol, it is also reducing inflammation, partly by acting as an antagonist to aldosterone. Increased aldosterone is associated with erectile dysfunction (Chang, et al., 2019; Wu, et al., 2018, 2016), and it interacts locally as a testosterone antagonist. In this, and other situations involving testosterone antagonists (estrogen, cortisol, aldosterone), progesterone can have a directly testosterone-supporting effect.
>
> After the age of 35 or 40, many men experience a decline in their resistance to stress, corresponding to the decline in protective substances such as DHEA and progesterone. Often a small amount of progesterone, 5 or 6 mg (for example, a drop of Progest-E the size of an unpopped kernel of popcorn) can make a difference, sometimes lasting for a few days or more. Paying close attention, the effects are usually noticeable within about half an hour.

### Source 4 — Hair Like a Fox: A Bioenergetic View of Pattern Hair Loss

Danny Roddy · Book · 2013

> Finasteride, as a side effect, also regrew hair. Merck lowered the dose of Proscar from 5mg to 1mg, and, in 1997, introduced the world to Propecia – the first FDA-approved drug for male-pattern baldness – to immediate popularity. Despite this, Finasteride has been continuously steeped in controversy due to its unconscionable side effects. Some of the most serious side effects that have been attributed to the use of Finasteride include, but are not limited to, the following:
>
> - Gynecomastia3
> - Depression4
> - Suicide5
>
> Finasteride is potent in that the typical 1 mg dose prescribed to patients by physicians for male pattern baldness can reduce DHT levels by about 70% within 24 hours.6 DHT is anywhere from 4 to 10 times as potent as testosterone, and normally maintains male secondary sex characteristics, as well as the ability to become sexually aroused. While all these symptoms are obviously disturbing, the side effect that most men find to be particularly egregious and horrifying is permanent erectile dysfunction. Visiting websites such as propeciasideeffects.com or propeciahelp.com will reveal many anecdotes of men who are now unable to recover their ability to obtain an erection after using the drug for only a short period of time. After years of allegations, Merck finally responded by updating the package insert that accompanies Finasteride, stating therein that Finasteride could cause "sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, decreased libido and ejaculation disorders (e.g. reduced ejaculate volume).”7 Independent research on the side effects of Finasteride found that in a small study of 72 participants, 94% developed low libido, 92% developed erectile dysfunction, 92% developed decreased arousal, and 69% developed problems with orgasm.8 These problems would maybe be tolerable, if only the use of Finasteride was guaranteed in all cases to restore hair growth; or at least to slow the progression of hair loss. But that’s unfortunately not the case. When compared to Hamilton’s eunuchs and Dr. Imperato-McGinley’s pseudohermaphrodites, all of whom were protected from baldness 100 percent of the time, Finasteride is effective for only about 40 percent of those who take it, suggesting that there are other factors at play in pattern baldness.

### Source 5 — Aspirin as effective as Viagra for ED, but with much fewer side effects

Georgi Dinkov · Article · Sep 12, 2019 · https://haidut.me/?p=542

> Yet another blockbuster drug may turn out to be nothing more than a well-marketed gimmick, which while not entirely a scam can be replaced with cheaper, safer alternatives that also have much lower potential for side effects. The drug in question is Viagra, and the humble, just-as-effective substitute is aspirin. A group of doctors out of Turkey has been conducting studies comparing the effects of aspirin on sexual performance in men diagnosed with erectile dysfunction (ED). The experiments go back at least a decade but up until 2018 they were done primarily on animals. However, the last two studies coming out of that group are with humans and the results are quite impressive, especially considering that the aspirin dose was just 100mg daily and the treatment lasted for only 6 weeks. An additional aspect that the popular press articles do not discuss is the potential for aspirin to actually be a so-called “disease modifying therapy”. ED is known to be caused by cardiovascular disease (CVD). While Viagra has never been shown to improve the pathology of CVD and no such claims have ever been made about that drug, aspirin HAS been shown to have a long term beneficial effect on CVD. As such, the benefits of aspirin may actually be much longer-lasting and may even be (dare I say) “curative”. In other words, after those 6 weeks of aspirin therapy the improvements in erection and sexual function may very well be persistent compared to the people taking Viagra. And as the study found, even if one has to use Viagra, taking aspirin with it significantly lowers the risk of side effects from that drug. Not bad for a tiny pill with more than 3 thousand years of human medical history, and dirt-cheap compared to Viagra.
>
> [references]

### Source 6 — Microplastics – known endocrine disruptors- found in blood, gonadal organs

Georgi Dinkov · Article · Jul 17, 2024 · https://haidut.me/?p=2572

> The findings of this study are particularly alarming as they suggest there are now endocrine disruptors, likely present in the majority of people, capable of causing structural changes and physical damage long before the long-term endocrine effects get a chance to accumulate and cause harm on their own. Namely, the study below found microplastics in four (4) out of five (5) male patients diagnosed with erectile dysfunction (ED). Now, as is probably obvious to all readers, these microplastics did not get lodged into the male reproductive organs directly. They got transported there by the vascular system and their origin is likely the various foods and drink we consume that were packaged in plastic containers/bags. As such, all other highly vascular organs (and especially the heart, as a study author noted) are likely to have similar accumulations of microplastics. As suggested above, putting their endocrine disrupting effects aside, those microplastics directly cause endothelial damage by physically injuring the blood vessel walls, which results in a chronic low-grade inflammation response in said vessels. That low-grade vascular inflammation is a known cause of cardiovascular disease (CVD), dementia, mental conditions, and even cancer. In some cases, if the microplastic particles are big enough, they can cause blockage of a specific vessel and lead to an ischemic event, which in the case of an organ such as the heart (e.g. heart attack) or brain (e.g. stroke), can be lethal. Unfortunately, since there is no known way to trigger the removal of those plastic particles, the only “solution” (as the study authors themselves state) is to avoid using plastics as much as possible in our daily lives. Given just this issue alone, it is little wonder there is an infertility epidemic in most “developed” countries, where the usage of plastics is ubiquitous. Those microplastics in our bodies are both chemical (through their endocrine effects) and physical (through the physical damage/blockage they cause) contraceptives, in both men and women.
>
> [references]

### Source 7 — #61: Bodybuilding and Steroids  |  Progesterone for Men?  |  Basic Bioenergetic Therapies with Ray Peat

Ray Peat (with Danny Roddy) · Interview · Jun 27, 2021

> ## Erectile Dysfunction
>
> **Danny Roddy:** A listener lost the ability to ejaculate and get an erection over a couple of years.
>
> **Ray Peat:** Blood tests would be useful to check cortisol, estrogen, DHEA, testosterone, and thyroid.
>
> **Georgi Dinkov:** Sometimes doctors only test testosterone, but studies show you can have ED and fertility problems with normal testosterone if prolactin or estradiol are elevated.

### Source 8 — #11: Testosterone, DHEA, PUFA, Libido, Aspirin, Progesterone, and Saturated Fat with Georgi Dinkov

Georgi Dinkov · Interview · Sep 20, 2019 · https://open.spotify.com/episode/12hdzF0qSQrADo1cLDop6C

> **Danny Roddy:** Okay, let's run through this. Do you want the aspirin as Viagra?
>
> **Georgi Dinkov:** Yes, this is good research out of a group in Turkey. And they've been doing this for the last, I would say, at least 12 years. Most of the original studies were on animals, but the last two studies were on humans. And actually, they found out that a low dosage of aspirin, just 100 milligrams, was actually more effective than Viagra as monotherapy.
>
> **Danny Roddy:** Wow.
>
> **Georgi Dinkov:** by a small margin, but still more effective, and without any of the side effects. So instead of, here is where, because they were testing also Viagra, I'm pretty sure they had to sign some non-disclosure agreement as well and not bash the drug. So instead of recommending aspirin instead of Viagra, in lieu of Viagra, which is what I would have done if this was my study, then they say, well, let's combine them together because aspirin will protect you from the side effects of Viagra. So, but if you look at the results, they're pretty obvious. Aspirin monotherapy worked better than Viagra for erectile dysfunction.

### Source 9 — Nitric Oxide

Ray Peat · Interview · 2014 · http://l-i-g-h-t.com/files/herb-doctors-nitric-oxide.mp4

> **Caller:** No, I'm talking about Viagra now.
>
> **Ray Peat:** Oh, Viagra.
>
> **Caller:** Yeah, I mean is that totally bad or is it OK you know, to have some of it. Because I'm saying if that improves the sexual function, you know, of an older man, then sexual function is supposed to be a good thing, I mean, is there a balance there or do you think it's totally bad?
>
> **Ray Peat:** I think it would be a better to work on the actual physiological problem, improving natural circulation - for example, restoring good thyroid function will often increase libido and potency.
>
> **Andrew Murray:** Now Dr Peat, I remember now, some time ago, you also mentioning pregnenolone and/or progesterone as being very positive. In the past you've always talked about progesterone potentially being slightly sedative and maybe decreasing, I think and now you have said this, now let me quote you, I think you said, ‘decreasing penis size’, but it does not block the vasodilatory ability and so therefore actually does promote and enables erection and naturally is a reasonably safe way of doing that in males.
>
> **Caller:** But what about testosterone?

_Generated 2026-07-20 from the Bioenergetic Oracle corpus._