How Genetics Affects Men's Risk of Erectile Dysfunction
Think erectile dysfunction (ED) is just about age or habits? Discover why and how genetics might have a say.
STORY AT-A-GLANCE
About 24.2% of U.S. men today screen positive for erectile dysfunction (ED), while global rates range from 3% to 76.5%, showing it’s a common health problem that affects men of all ages
A 2025 study in the American Journal of Clinical and Experimental Urology found that ED is influenced by genes that also raise risk for obesity, diabetes, heart disease, and addiction, tying erection problems to long-term heart health
ED is usually multifactorial, with vascular, neurogenic, hormonal, and psychogenic forms, and is strongly associated with conditions like heart disease, obesity, sleep apnea, and depression, making it a powerful early warning sign that something deeper is wrong
While drugs like Viagra can temporarily improve erections, they don’t work for everyone and may be unsafe for men taking heart and lung medications
Instead of relying solely on pills, addressing root causes with a heart-focused check-up, a metabolic-friendly diet, pelvic floor training, restorative sleep, enough sunlight and mindful supplementation can help restore sexual function without more drugs
Men have long carried the weight of being providers, fathers, brothers, and partners. That pressure doesn’t just affect the mind; it can show up in the body. One example is erectile dysfunction (ED), the inability to achieve or maintain an erection during sexual activity,1 and it’s far from rare. Research from the 2021 National Survey of Sexual Wellbeing found that 24.2% of U.S. men screened positive for ED,2 and global rates range from 3% to 76.5%, depending on the population studied.3
Doctors often point to diabetes, heart disease, stress, or lifestyle habits as the leading causes of ED,4 and while those factors matter, they don’t explain everything. Many men who eat well, exercise, and avoid smoking still struggle. Why? New research shows genetics may also play a role, as it affects blood vessel health, hormone balance, and even how the body responds to stress.
What This Genetic Study Reveals About Erectile Dysfunction
A new study in the American Journal of Clinical and Experimental Urology explored how genes may influence ED.5 Instead of relying on observational studies, researchers used Mendelian randomization (MR) to identify which genes might protect against ED or increase its risk.
Why researchers chose this study method — Mendelian randomization is a way to test if a gene causes erectile dysfunction risk, rather than just being linked to it. To make the results stronger, researchers also used two other tools:6
A large genetic dataset was analyzed — The study examined data from 95,178 men, including 1,154 diagnosed with ED and 94,024 without, and then combined these findings with published datasets totaling more than 1 million individuals. Data came from the All of Us (AoU) biobank, which included participants of European and African ancestry.
Researchers used electronic health records (EHRs) or prescriptions for ED drugs called phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra), to identify cases.9 Many men do not respond to these medications, highlighting the need for genetic research.10
263 genes were linked to ED risk — Many of these genes are involved in lipid metabolism (how the body processes fats), immune function, and cell structure. These processes affect blood flow and tissue health, which are vital for normal erections. Functional analyses also imply beta-catenin biology, which influences vascular and tissue integrity.11
The discovery of a protective gene — Among all genes, Thyroid Hormone Receptor Interactor 10 (TRIP10) stood out with an odds ratio (OR) of 0.58, meaning higher TRIP10 activity was linked to a lower risk of ED. This gene helps regulate lipid metabolism, insulin signaling, and cytoskeletal remodeling — all important for vascular health.12
Key gene involvement in ED — The strongest genetic signal involved Single-minded homolog 1 (SIM1), a gene linked to energy balance, obesity, and sexual behavior. Genes linked to brain circuits and hormone regulation were also involved, highlighting the complex neuroendocrine pathways underlying ED.13
Researchers also found moderate genetic correlations between ED and traits such as depression, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), Type 2 diabetes, heart failure, and substance-use disorders (especially cannabis and opioids).
There are many factors at play — ED is a polygenic condition with many genes, including SIM1 and TRIP10, increasing risk. Future treatments may use these as biomarkers or target pathways like beta-catenin to aid non-responders.14
A Deeper Dive Into Erectile Dysfunction
ED is the ongoing inability to achieve or maintain an erection firm enough for sexual activity.15 Occasional difficulty is normal, but persistent ED is considered a medical condition.
About 40% of men at age 40 and up to 70% of men at age 70 experience it — Many never talk about it, so the real numbers are likely higher. Erectile dysfunction used to be called “impotence,” but that term is outdated and stigmatizing. Today, it’s recognized as a medical condition with physical, hormonal, and psychological causes, not a character flaw.16
Erections run on blood flow and nitric oxide — A normal erection starts in the brain when a man feels aroused. Nerves in the penis release nitric oxide, a tiny signaling molecule that relaxes smooth muscle and lets blood rush into the spongy tissue of the penis. This process uses a messenger called cyclic guanosine monophosphate (cGMP), which keeps the muscles relaxed long enough for an erection.17
The main types of ED — Clinically, doctors group ED into a few main buckets:18
Vascular — Comes from problems in the blood vessels or the tiny valves that keep blood trapped in the penis. This is the most common type and is strongly linked to high blood pressure, high cholesterol, diabetes, obesity, and atherosclerosis (plaque in the arteries).
Neurogenic — This happens when nerve signals can’t travel properly from the brain and spinal cord to the penis. It can happen after pelvic surgery, prostate surgery, radiation, spinal injuries, stroke, or neurological diseases like multiple sclerosis.
Hormonal — It involves low testosterone or, less often, thyroid problems. Hormones influence both libido and blood vessel function.
Psychogenic — It’s driven by stress, depression, anxiety, low self-esteem, or fear of intimacy. Even when the original cause is physical, it’s the emotions that take the air out of the man’s sails.
ED is common, but it isn’t trivial and it isn’t something to just “tough out.” It’s often the first visible sign that the body is sending out an SOS signal. The upside is that addressing those deeper problems can help improve not only a man’s sex life, but his long-term health and lifespan.
What Erectile Dysfunction Reveals About Men’s Health
ED is more than an inconvenience — It often points to deeper health issues. Because penile arteries are smaller, they can show damage long before larger vessels do. Persistent ED can be an early warning sign of heart disease, metabolic problems, sleep disorders, or mental health challenges.
A Red flag for heart health — A 2013 Australian study known as the 45 and Up Study, published in PLOS Medicine — an open-access journal from the nonprofit Public Library of Science — followed 95,038 men age 45 and older and found that the more severe a man’s ED was, the higher his risk of serious heart problems and early death.19
Compared with men who reported no erectile dysfunction and had no history of heart disease, those with severe ED had about a 60% higher risk of blocked heart arteries, eight times the risk of heart failure, nearly twice the risk of poor circulation in the legs, a 35% higher risk of any cardiovascular hospitalization, and a 93% higher risk of dying from any cause over two to three years of follow-up. Men who already had heart disease and severe ED faced similar or greater risks.20
“... Erectile dysfunction is a risk marker for cardiovascular disease, not a risk factor that causes cardiovascular disease ... Nevertheless, these findings provide useful information for clinicians ... Men with erectile dysfunction, even at mild or moderate levels, should be screened and treated for cardiovascular disease accordingly,” the study’s researchers concluded.
Obesity raises ED risk — A 2023 cross-sectional study published in Frontiers in Endocrinology examined 878 men from an andrology clinic in Central China to see how body weight relates to ED. Men were grouped by body mass index (BMI) as underweight, normal weight, overweight, or obese.21
ED was very common in this relatively young group, affecting 53.1% of participants. Men with ED had a significantly higher BMI than those without, and obesity stood out.22 When the researchers looked specifically at ED severity, the link with obesity became even clearer, according to researchers:23
“In conclusion, the findings in this study indicate that obesity is associated with an increased risk of moderate/severe ED. Given the high prevalence of ED in obese men, clinicians could pay more attention to moderate/severe ED patients to maintain a healthy body weight to improve erectile function.”
Compromised sleep quality and ED — A 2023 cross-sectional study in Frontiers in Public Health examined how poor sleep affects ED risk. Researchers surveyed 381 male university students in Peru (ages 18 to 30) and found that about half had poor sleep quality. Those with poor sleep were nearly six times more likely to report ED compared to good sleepers, even after adjusting for age, weight, and sleep apnea. The researchers concluded that:24
“Poor sleep quality was independently associated with erectile dysfunction in young university students. This finding suggests that male students are at risk for sexual problems due to possible academic demands and relationship issues.”
The researchers also touched on results of earlier studies saying that: “93.3% of studies with poor sleep quality experienced some sort of ED.” And that men with sleep disorders such as sleep apnea are predisposed to end up developing ED.25
Mental health and erections are tightly connected — A 2018 systematic review and meta-analysis in The Journal of Sexual Medicine analyzed 49 studies to see how depression and ED influence each other.26 27 They found that men dealing with depression had 39% higher odds of developing ED.
Meanwhile, men with ED had nearly three times the odds of later developing depression. In simple terms, low mood makes ED more likely — and ED itself strongly increases the risk of becoming depressed.28
Erectile dysfunction isn’t just an awkward bedroom problem to shrug off and ignore — it can be an important indicator that something is not right with the body.
Who Should Avoid Taking Viagra?
While Viagra remains a drug of choice for erectile dysfunction, it’s not without faults. Some of it’s more serious side effects include sudden vision loss, heart attack, stroke, irregular heartbeat and death.29 It may also increase men’s chances of developing melanoma, the deadliest kind of skin cancer.30
Viagra relaxes blood vessels and can lower blood pressure, which is why some men should avoid it entirely and others need extra caution and a lower dose, especially adults 65 and older.31 Below are some contraindications associated with Viagra use:
Taking certain heart and lung medications — Viagra should never be taken with nitrates (such as nitroglycerin or isosorbide dinitrate) or guanylate cyclase stimulators like riociguat (Adempas). These combinations can cause a dangerous drop in blood pressure. Some alpha blockers used for blood pressure or prostate problems can also lower blood pressure further, so they may require careful timing and dose adjustment if Viagra is used at all.32
Certain serious eye conditions — Albeit rare, Viagra has been linked to vision changes such as blurred vision, color shifts, and light sensitivity. Men with nonarthritic anterior ischemic optic neuropathy (NAION) or retinitis pigmentosa, both rare but serious eye diseases, may be at higher risk of vision loss with Viagra and are often advised to avoid it.33
Severe kidney or liver problems — The liver and kidneys help clear Viagra from the body. When they are not working well, sildenafil can build up and increase side effects.34
Heart problems — Men who have had a heart attack, stroke, or life-threatening heart rhythm problem in the past six months,35 or have ongoing chest pain, a significant heart obstruction, or uncontrolled high or low blood pressure are not advised to take Viagra.
9 Drug-Free Ways to Manage Erectile Dysfunction
Prescription drugs like Viagra may offer quick relief, but they don’t fix the root causes of ED — plus, they come with serious side effects. Instead of masking symptoms, I recommend these natural strategies to help men restore their sexual function and improve overall well-being:
Start with a heart check-up — ED is often an early warning sign of a bevy of conditions, the most alarming being cardiovascular disease. Before trying supplements or making any lifestyle changes to support heart health, work with a medical professional.
Try a metabolic-friendly diet — Normalize insulin levels by avoiding processed foods and seed oils high in linoleic acid (LA), which damage mitochondria and impair vascular health. Instead, choose stable fats like grass-fed butter, ghee, or beef tallow. Pair these with nutrient-dense foods to support hormone balance and circulation. A clean diet improves overall metabolic health, which is critical for sexual function.
Eat more flavonoid-rich foods — Harvard research shows men under 70 who regularly eat berries, citrus fruits, apples, and dark chocolate have an 11% to16% lower risk of ED. Flavonoids help blood vessels stay flexible and boost nitric oxide, which relaxes arteries and improves blood flow. These compounds also fight oxidative stress, making them a powerful ally for sexual and heart health.36
Pomegranates keep ED at bay — Pomegranates are packed with antioxidants that protect nitric oxide and enhance its effects. Nitric oxide37 relaxes and widens blood vessels, improving penile blood flow and erection quality. Studies suggest pomegranate juice benefits men with mild to moderate ED. A small glass daily can support vascular health naturally, without the risks of pharmaceutical drugs.38
Strengthen pelvic floor muscles — Strong pelvic muscles help maintain rigidity during erections and keep blood from leaving the penis by pressing on a key vein. In a British study, men who did twice-daily Kegel exercises for three months, combined with biofeedback and lifestyle changes like stopping smoking, losing weight, and quitting alcohol, reported increases in erectile function.39
Prioritize sleep — Getting morning sunlight anchors the circadian rhythm. Create a calming nighttime routine as well: keep lights dim at night, avoid screens, and ensure the bedroom is dark enough. Restorative sleep and stress control are essential for optimal sexual health.
Boost nitric oxide with L-arginine — Studies show pairing L-arginine with pycnogenol dramatically improves ED symptoms.40 Another trial found that combining 6 grams of L-arginine with 6 milligrams of yohimbine (from yohimbe bark) restored sexual function in men with mild to moderate ED. These natural combinations enhance nitric oxide signaling and blood flow, offering a safer alternative to drugs.41
Support neurotransmitter balance with key nutrients — Acetylcholine (ACH) is the neurotransmitter that triggers sexual messages in the brain. Low ACH reduces sexual activity and responsiveness. Supplementing with choline (1,000–3,000 mg) and vitamin B5 (500–1,500 mg) helps boost ACH production naturally. This combination supports healthy nerve signaling and can improve sexual arousal without the risks of synthetic drugs.
Get sunshine every day — Spending time outdoors in bright sunlight is one of the fundamental strategies to regain and maintain your health. Ideally, it’s best to get at least one hour of sun exposure around solar noon to reap the maximum solar benefits. However, consuming a diet high in seed oils can lead to a higher risk of sunburn. Hence, it’s better to avoid high-intensity sun exposure until you’ve been off seed oils for about six months.
Frequently Asked Questions (FAQs) About Erectile Dysfunction and Genetics
Q: What is erectile dysfunction (ED), and how common is it?
A: ED is the ongoing inability to get or keep an erection during sexual activity. It’s very common: One U.S. survey found 24.2% of men screened positive for ED, and global estimates range from 3% to 76.5%, depending on the population studied.
Q: How can genes affect a man’s risk of erectile dysfunction?
A: Genes play a key role in regulating blood flow, hormone balance, nerve function, metabolism, and stress response. Variants in these pathways can make a man more or less prone to ED, even if he eats well, exercises, and avoids obvious risk factors like smoking.
Q: What did the recent genetic study on ED find?
A: Researchers analyzed genetic data from over 95,000 men, combined with larger published datasets, and identified 263 genes linked to ED. Some genes appeared protective, while others were associated with weight, energy balance, and sexual behaviors — showing that ED is influenced by many different genes, not just one.
Q: What can ED reveal about a man’s overall health?
A: Because penile arteries are smaller than coronary arteries, they often show damage first. Persistent ED can be an early warning sign of cardiovascular disease, obesity, insulin resistance, sleep apnea, depression, or other systemic problems. It signals the need to check heart health, hormones, metabolism, and sleep — not just sexual function.
Q: Are there effective drug-free ways to manage or improve ED?
A: Yes. Start with a heart-focused check-up, then support metabolic health by avoiding processed foods and seed oils high in linoleic acid, and choosing stable fats like grass-fed butter, ghee, or beef tallow.
Add flavonoid-rich foods and pomegranate for vascular support, strengthen the pelvic floor, prioritize deep sleep, and consider targeted nutrients such as L-arginine with pycnogenol or yohimbine, choline with vitamin B5, and get enough sunlight. These strategies address root causes instead of simply masking symptoms with medication.
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Genetic variations in the SIM1 gene can actually influence the brain’s melanocortin system, essentially decoupling sexual desire from physical performance. In my view, understanding these biological blueprints is empowering, as it shifts the conversation from personal failure to manageable genetics.