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Integrative Management of Erectile Dysfunction

October 2005


Although the prevalence of erectile dysfunction increases with advancing age, it is not an inevitable consequence of aging. Men can do many things to reduce their risk for ED. Knowledge of the possible causes of this condition can help aging men and their physicians create prevention strategies. Maintaining normal levels of cholesterol, blood pressure, and blood glucose, as well as youthful levels of hormones, can help men avoid problems with sexual function. In addition, successfully managing stress, quitting cigarette smoking, avoiding heavy alcohol consumption, and eating a healthy diet can help promote overall health and well-being. Because certain drugs have been associated with ED, discuss their possible side effects with your doctor before using any prescriptions. Your doctor may choose to prescribe certain antihypertensive, antidepressant, or antipsychotic drugs that are associated with a reduced risk of ED.

The following case report details a patient with chronic, severe erectile dysfunction and an integrative approach that effectively corrected this pathology.


A 54-year-old white male presented in August 2000 with a long history of severe impotence. During his first visit to the clinic, the patient complained of severe erectile dysfunction—no libido, severe difficulty achieving erection, and very poor sex drive. He had had sex only four times in the previous eight months. He also complained of severe fatigue, depression, impaired short-term memory recall, muscle and joint pain, leg cramps, tingling and pain in the feet, and poor sleep. His vital signs were as follows: height, 5’9”; weight, 182 pounds; pulse, 76 beats per minute; blood pressure, 130/80 mmHg.

The patient had experienced erectile dysfunction since the age of 39, when his sex life began to deteriorate. Prior to that, he had been in good health and had never taken medications. His physician could find no obvious cause of or reason for a sexual disorder. For the past 15 years, the patient had been under a urologist’s medical care for his ED. His doctor had prescribed different testosterone replacement therapy drugs available for erectile dysfunction (Testred® capsules, testosterone cypionate, Androderm®, etc.) as well as different delivery systems (pills, gels, injections, and patches). The patient had also used penile injections and Viagra®, but without success. The urologist requested that we evaluate the patient from an anti-aging perspective, as conventional treatment approaches had failed to resolve his problem.

Diagnosis and Treatment

During the patient’s first visit, we took a lipid profile. His total cholesterol was very high at 330 mg/dL (optimal is less than 200). As described in our previous publications,37,38 our experience suggests that elevated total cholesterol can serve as a good marker for a deficiency of basic steroid hormones. After reviewing the lipid profile, we told the patient that we expected that hormonorestoration therapy would have a very good chance of resolving his erectile dysfunction. Because of his long history and treatment failures with different medications, he was both surprised and skeptical.

We explained that our approach is distinctly different from his previous treatments, and that we would follow his cholesterol level as a surrogate biomarker to help evaluate the treatment program’s effectiveness. We expected that with improvement in his cholesterol level, his ED symptoms would improve as well. We performed additional blood tests—for pregnenolone, DHEA-sulfate, total testosterone, estradiol, progesterone, and cortisol—and compared the patient’s hormone levels to those found in healthy men in their twenties, which we consider to represent optimal levels for conferring anti-aging benefits.

We found that the patient’s total testosterone, DHEA-sulfate, and cortisol were significantly below the desirable ranges. Lab results were as follows:

  • total testosterone: 186 ng/dL (optimal: 241-827)
  • DHEA-sulfate: 93 ug/dL (optimal: 280-640)
  • morning cortisol: 0.9 ug/dL (optimal: 4.3-22.4).
  • Progesterone and pregnenolone levels were on the low side of normal, at 0.3 ng/mL (optimal: 0.3-1.2) and 24 ng/dL (optimal: 10-200), respectively.
  • estradiol was high at 56 pg/mL (optimal: 0-53), and PSA level was normal at 0.89 ng/mL (optimal: 0.0-4.0).

[Editor’s note: Free testosterone is also a very important test and frequently used by Life Extension members to help diagnose testosterone deficiency and monitor the proper dose of testosterone replacement therapy.]

The initial treatment for the restoration of all deficient steroid hormones included:

  • pregnenolone: 300 mg in the morning
  • DHEA: 150 mg in the morning and 50 mg at noon
  • micronized testosterone gel (50 mg/ml): 1 ml in the morning
  • micronized progesterone (50 mg/ml): 0.3 ml in the morning
  • androstenedione: 300 mg in the morning.

In addition, we suggested:

  • vitamin E: 1000 IU in the morning
  • vitamin C (as sodium ascorbate): 2000 mg in the evening
  • selenium: 200 mcg in the morning
  • saw palmetto (320 mg) with nettle root (240 mg) in the morning
  • Pygeum africanum: 150 mg in the morning
  • zinc: 30 mg at bedtime
  • Life Extension Natural Sex for Men (containing extracts of oats, yohimbe, Siberian ginseng, and nettle, as well as mineral and glandular extracts): two tablets twice daily, in the morning and evening
  • Nutribiotic® MetaRest® (containing 3 mg of melatonin, 250 mg of kava root extract, and 10 mg of vitamin B6 per capsule): one capsule at bedtime.

We asked the patient to return to the clinic in two weeks. At the follow-up visit, the patient reported that his sex life had improved dramatically in the previous two weeks. He noted that his sexual function had improved markedly within the first five days of treatment, his energy level had likewise improved greatly, and he no longer had muscle aches or pain.

After one month on the program, the patient’s total cholesterol level had decreased to 243 mg/dL, estradiol had fallen to 31 pg/mL, pregnenolone had risen to 43 ng/dL, DHEA-S had increased to 340 ug/dL, total testosterone was up to 396 ng/dL, and cortisol had climbed to 16.2 ug/dL. The patient reported no difficulties with erection or sex drive; the joint pain and tingling in his feet were improved; his sleep had normalized; and his depression was improved. His short-term memory, however, was still problematic. We increased his daily dose of pregnenolone to 400 mg and of DHEA to 250 mg (150 mg in the morning and 100 mg at noon). We also added to his regimen:

  • phosphatidylserine capsules: 200 mg in the morning
  • glucosamine sulfate: 2250 mg in the morning
  • omega-3 fatty acids: 3000 mg in the evening
  • chromium: 200 mcg in the morning
  • B-complex: 1 tablet in the morning.

After six months of treatment, the patient’s total cholesterol was down to 209 mg/dL, while his quality of life had continued to improve. We decreased the dose of micronized progesterone to 0.1 ml (50 mg/ml) daily and added 7-Keto DHEA (50 mg in the morning).

After one year of treatment, his total cholesterol had dropped to 187 mg/dL and his weight was down to 171, two pounds lower than his normal weight at the age of 35. His depression had resolved, and he had no complaints other than minor joint pain. The patient noted during his last follow-up visit that his erectile dysfunction “nightmare” was gone, adding, “I am so much better than I was when I came here that I hate to complain about anything.”