The following is an excerpt from a new book project I’m working on that looks at the causes and remedies of issues with erectile health.

Here we’re aiming to find what is the root cause, or causes, to the function of getting and keeping an erection, or what can stop it from happening in the first place. This is the big picture overview of what can go wrong.

These are either lifestyle choices, external toxins, internal stress response (often what is called disease), structural issues, and psychology. These then contribute to dysfunction in circulation, nerve signaling, hormone balance, and mind-body effects.

By grouping them in these five ways, this is aimed at simplifying the 39 total ED triggers I’ve identified for this book.

Lifestyle Stressors

Daily habits, physical exertion levels, and lifestyle patterns that lead to physiological stress, hormone imbalance, and poor vascular and nerve health. These are the things you are doing or not doing that may impact your sexual health.

1. Poor Diet (increased inflammation and nutrient deficiencies)
2. Poor Sleep (reduced testosterone, vascular strain)
3. Excessive Sitting (blood flow restriction and nerve compression)
4. Lack of Physical Activity (reduced circulation and cardiovascular health)
5. Long-Distance Cycling (blood vessel and nerve compression)
6. Overtraining (elevated cortisol, reduced testosterone)
7. Chronic Stress (elevated cortisol, interference with arousal)
8. Porn (dopamine desensitization and altered arousal response)

External Stressors (aka Exogenous Toxins)

External substances and environmental exposures that increase oxidative stress, damage tissues, and disrupt hormone and nerve function. In a way, this is a subset of lifestyle, but more focused on specific ED-causing toxins.

1. Smoking (vascular and nerve damage)
2. Alcohol (neurotoxic effects, impacts hormone balance)
3. ED Causing Medications (e.g., blood pressure meds, antidepressants, opioids, radiation treatments)
4. Endocrine disruptors (e.g., BPA, phthalates, pesticides)
5. Heavy metal exposure (e.g., lead, mercury – neurotoxic effects)
6. EMF exposure (potential nerve signaling interference)

Internal Stress Response

Metabolic, endocrine and physiological conditions within the body that disrupt hormone balance, damage tissues, and impair nerve and vascular health. These are tied into lifestyle and external stressors, but here the focus is on how changes take place within the body.

1. Aging (more time for other changes to take place)
2. Obesity (increased inflammation, aromatase activity converting testosterone to estrogen)
3. Cardiovascular Issues (atherosclerosis, high blood pressure, etc.)
4. Diabetes and Metabolic Syndrome (nerve and vascular damage)
5. Chronic Inflammation (vascular and nerve impact, often due to autoimmune disorders)
6. Chronic Fatigue (lower testosterone and nerve responsiveness)
7. Neurological Conditions (multiple sclerosis, parkinson’s, stroke, etc.)
8. Chronic Pain and Neuropathy (reduced nerve function & psychological impacts)
9. Low Testosterone (reduced libido and erectile quality)
10. Low DHT levels (reduced libido and erectile quality)
11. High Prolactin (low dopamine, impaired arousal)
12. Thyroid Dysfunction (hormone imbalance and energy disruption)

Structural Issues

In these few triggers, the damage may go beyond just vessels and into the structures themselves. These can be harder to treat because of the extent of the changes to the physical structures themselves.

1. Peyronie’s Disease
2. Prostate Issues (BPH, prostatitis, prostate cancer)
3. Damage from Trauma (penile, groin and low back injuries)
4. Damage from Surgery (e.g., prostatectomy, cystectomy, etc.)
5. Venous Leak or Insufficiency

Psychological Stressors

Mental and emotional factors that affect arousal, confidence, and mental focus, impacting both psychological and physiological readiness for sexual activity.

1. Performance Anxiety (fear of failure disrupting focus and arousal)
2. Depression (reduced libido and energy)
3. Lack of Purpose (reduced libido and energy)
4. Low Self-Esteem and Body Image Concerns (reduced confidence)
5. Relationship Issues (reduced emotional connection and arousal)
6. Past Sexual Trauma or Abuse (psychological blocks to intimacy)
7. Other Trauma (psychological blocks to intimacy)
8. Guilt or Shame (mental inhibition of arousal)

There is obviously overlap between these categories. For instance diet is put into lifestyle, but obviously is a source of certain toxins, and then massively impacts internal stress response with something like obesity, cardiovascular issues or diabetes.

Still, this structure helps to identify both the specific areas of threat and the underlying pathways through which these stressors impact bodily systems.

Depending on the stressors causing the issue, the solutions to the problems can be completely different.

What fixes porn-induced erectile dysfunction is very different from what fixes medication-induced erectile dysfunction. What fixes performance anxiety is different from what fixes low testosterone or DHT.

There are several articles on the blog that dive deeper into some of these. For example:

And if you need even more help, stay tuned for the new project coming soon.