Does obesity cause erectile dysfunction?

Obesity and erectile dysfunction   

It is quite common for a man to put on several kg’s and notice increasing difficulty getting and maintaining an erection. It is generally accepted that a dependable erection is a sign of good health. On the same token obesity is considered a chronic illness and a sign of poor health. It is no wonder that obesity signifies a series of health and psychological challenges which in turn leads to the onset of erectile dysfunction.

What is ED?

Erectile dysfunction is a common disorder that is characterized by the inability to achieve an erection or maintain it in the way that satisfies the man for his sexual performance (Yafi, et al. 2016).  

The normal function of the penis was always an important issue for men. It is considered by men as “the masculine symbol”.  It is also of great importance to doctors as any sexual dysfunction is often, not always, the first sign of a more serious condition and a wakeup call to men to begin healthier living.  

According to data, about  

• 150 million men worldwide face a type of erectile dysfunction and  
• There are estimations that this number will double by the year 2025 (Kalsi and Muneer 2013). 

On the other hand, obesity is an epidemic that characterizes both developed and developing countries. In 2014–15, more than 60% of Australians aged 18 and over were overweight or obese (www.aihw.gov.au,  2017). 

According to multiple studies, there is a connection between obesity and ED. Furthermore, the severity of ED is associated with several other metabolic diseases (Moon et al, 2019).  

How do you calculate your BMI?  

Being overweight or obese is used to express excessive fat accumulation that can potentially cause health risks. For decades, the body mass index (BMI) is considered as the “golden standard” for measuring overweight and obesity in population surveys. 

BMI is calculated by dividing a person’s weight (in kilograms) by their height (in meters) squared: BMI = kg/m² (Aihg.gov.au,2017). 

What does a high BMI mean for your sex life?  

According to many studies, there is a negative correlation between the sexual quality of life and BMI. Moreover, obesity is associated with  

• lower levels of self-esteem,  
• depression, and  
• anxiety  

Such mood disorders are the causal factors of psychogenic erectile dysfunction and can significantly affect the penis function of a person who has no physical reason for erectile dysfunction (Esfahani and Paul, 2018).   

In a study among obese patients before bariatric surgery, researchers found that  

• 12% of men reported no sexual desire  
• ¼ of the male participants were not sexually active 
• more than half of the male participants were moderately or very dissatisfied with their sexual life 

Factors like being single, older age, depression, and certain medication use is associated with poorer sexual function (Steffen et al, 2017). 

What is the link between obesity and erectile dysfunction?  

There are studies indicating that when ED is accompanied by a person who follows a high caloric diet and has a high BMI, usually it is a result of endothelial damage. Obesity is considered as independent risk factor for ED and men with increased abdominal obesity have a higher incidence rate of ED. The major connections between obesity and ED are derangements of hypothalamic regulation of the neuroendocrine system and endothelial dysfunction (Moon et al, 2019).  

Vasculogenic ED is considered as the most common form of organic ED and can be caused by endothelial dysfunction. On top of that, research shows that vasculogenic ED usually characterizes obese patients at a higher level than the rest of organic ED cases (Moon et al, 2019). 

As ED and coronary artery disease share common risk factors, the concept of endothelial dysfunction has developed. ED is considered another manifestation of vascular disease- specific to small vessels. (Kalsi and Muneer 2013). 

Body fat and testosterone  

Low testosterone is a finding that is very often noticed among obese men no matter their age. Obesity and testosterone have a bidirectional relation. On the one side, low testosterone levels predict the development of abdominal obesity, on the other hand, obesity predicts low total and free testosterone levels (Pelusi and Pascuali, 2012). 

In males, obesity is considered the most important factor associated with low testosterone levels. According to a study, obese men have 30 % lower total testosterone levels compared to lean men. There are human studies indicating that fat-derived adipokines and pro-inflammatory factors can potentially cause the suppression of testosterone production. In addition, testosterone deficiency promotes fat tissue accumulation and reduces the formation of muscles, which are crucial for an increased metabolism (Ng Tang Fui et al, 2016). 

Although obese men with erectile dysfunction have lower testosterone, hormonal disorders represent only a small percentage, about 3% of ED. Furthermore, even when obese men have normal testosterone levels there is an increased risk of erectile dysfunction (health.Harvard.edu, 2011) 

Body fat and insulin resistance  

There are numerous studies confirming the association between increased adiposity and insulin resistance. Earlier studies suggested that the visceral adipose tissue is the main among the fat tissues that causes insulin resistance. In addition, the mechanisms by which visceral obesity results in insulin resistance appear to be related to excess lipid accumulation in the liver which can potentially lead to impaired insulin signaling and impaired insulin action. On the other hand, subcutaneous adipose tissue seems to have an opposite role by decreasing the risk of Type 2 Diabetes and insulin resistance (Hardy et al, 2012). 

A recently published study highlights the association between body fat percentage and insulin resistance in adults with a normal BMI. Specifically, researchers concluded that the prevalence of insulin resistance was increased in the participants who have elevated body fat percentage compared to the ones who had normal body fat levels (Zeggara-Lizana et al, 2019). 

Can weight loss treat erectile dysfunction?  

Weight loss is one of the suggested lifestyle modifications to improve or even treat the erectile dysfunction. 

The first step is to make small daily changes to your dietry habits.

• Reduce the amount of carbs on your plate
• Increase the amount of vegetables
• Drink more water
• Cut out sugar
• Reduce the amount of take-away you consume
• Increase daily activity

There is a characteristic study concluding that bariatric surgery significantly improves ED in obese men.  Moreover, weight loss through bariatric surgery improves insulin resistance and increases pressure and endothelial functions that are involved in penis erection (Moon et al, 2019). 

It is worth mentioning that not only long-term but also short-term weight-loss studies have demonstrated improvement in ED. In addition, a 4- week study showed that weight loss seemed to have been beneficial on sexual life among men (Esposito et al 2015). 

In an intervention study among obese participants who lost an average of 15% of their body weight, the endothelial, and inflammatory markers all reduced. Moreover, almost one out of three men had erectile function restored after the weight loss intervention (Evans 2005). 

I have lost weight but I still have ED. Now what?  

An experienced sexual health doctor at a reputable clinic will understand that ED can be caused by a combination or variety of factors and will explore all the options.   

Obesity is not the only causal factor of ED. Therefore, we might need to find the causal factor of ED to act accordingly. Weight loss can be beneficial not only for erectile dysfunction but to prevent or treat several other diseases as well. Therefore, keeping a low body weight should be a lifelong goal no matter of the noticed improvement in erectile dysfunction (Kalsi and Muneer 2013). 

The good news.  

The good news is that there are a variety of ways to treat a weak erection quickly and easily. For a permanent improvement in your sexual function we highly advise you first uncover the underlying reason of your ED and then combine lifestyle changes with any potential pharmaceutical intervention that is deemed medically necessary.  

• MEDICATIONS: Nowadays, doctors have medications that can help you improve your erectile function. These medications can be off-the-counter or custom compounded. However, there is a significant percentage of 30%–35% of patients who do not respond to the most common oral treatments, i.e. diabetics.
• EXERCISE: Exercise has a protective role against erectile dysfunction and it improves erectile function of males who face vascular erectile dysfunction. Physical activity can be a useful tool to decrease ED and according to the current recommendations, this can be achieved by 40 minutes of aerobic training (moderate to vigorous intensity) for at least 4 times per week (Gerbild et al, 2018).  
• QUIT SMOKING: Even a short smoking abstinence period of 1-1,5 days in heavy smokers can lead to significant improvements in vascular erectile parameters. When smoking cessation was studied with the use of an 8-week nicotine replacement therapy, researchers reported a significant improvement in erectile function at a 1-year follow-up. However, this improvement was only noticed in younger males with a more minor smoking history who did not have other comorbidities (Kovac et al, 2014). The sooner you quit the better.
• PSYCHOLOGY: As a supplementary but equally important therapy for ED, doctors also suggest psychotherapy. Psychotherapy for ED aims to understand the context in which men make love, to identify the resistances to medical intervention that lead to premature discontinuation, to reduce anxiety and stress related to performance and to implement psychological education involving sexual scripts. Psychotherapy is a useful tool for clinicians as it significantly increases the effectiveness of their treatment interventions for ED (Althof and Wieder, 2004). 

The next step

Now that you have taken the first step in educating yourself about the risks associated with keeping an unhealthy BMI it is time to take the first step towards changing your destiny. At Vityl men’s health clinic we understand that change can be difficult and as such we have created a team of leading doctors and researchers to help you through the process. Our clinic does not just treat the symptoms of ED, it investigates the underlying causes and assists men like you to live their happiest, healthiest lives. Start with a free consultation to see how Vityl men’s health can help you.