Table of ContentsView AllTable of ContentsDiabetes and Erectile DysfunctionMetformin and ED in FocusED Drugs and Diabetes
Table of ContentsView All
View All
Table of Contents
Diabetes and Erectile Dysfunction
Metformin and ED in Focus
ED Drugs and Diabetes
Diabetes mellitus, or type 2 diabetes, is one of the most common chronic diseases in the United States, and it is becoming increasingly more prevalent around the world.
Diabetes is associated with many health conditions, including increased risk of cardiovascular disease and obesity, but its connection to sexual dysfunction is being discussed with greater regularity.
Diabetes is an established risk factor for erectile dysfunction because the disease can damage the tiny blood vessels and nerves that work together to trigger an erection.
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Diabetes alone can lead to ED because high blood sugar levels are toxic to nerves and blood vessels, which are necessary to achieve and maintain erections, but treatment can help. Metformin, a commonly prescribed diabetes medication, may have conflicting effects on erectile function.
However, more recent research shows that sexual dysfunction may be a side effect of metformin, and that it may cause a significant lowering of testosterone levels.
This article will discuss what the research shows about metformin and ED.
The development of erectile dysfunction in people with diabetes is a gradual process that includes both vascular and neurological mechanisms.
Normal erections require blood flow into the penis. During sexual arousal, neurological signals from the brain are sent to the penis. Nitric oxide, a potent vasodilator that promotes blood flow, is activated.
Nitric oxide causes rapid and short-term increases in penile blood flow and short-term relaxation of the penile smooth muscle. As blood fills up the penis, the outflow of blood is restricted, allowing a man to acquire and maintain a firm erection.
Diabetes contributes to ED in three distinct ways:
Some men with longstanding diabetes may also have hypogonadism (low testosterone and/or low sperm production). Diabetes management is important in preventing the development of hypogonadism. By preventing low testosterone, this helps to prevent ED
The combination of these two effects should help improve ED.
However, other studies have found that metformin may be associated with a reduced output of testosterone, which can cause reduced sex drive and may contribute to ED.
More research is needed to determine the effect of metformin on erectile function.
If you are taking metformin for diabetes and notice reduced sex drive or increased ED, don’t hesitate to talk with your healthcare provider. The options below can help you get your sex life back on track, while also managing your diabetes.
Phosphodiesterase type 5 inhibitors (PDE5i), like Cialis (tadalafil) andViagra (sildenafil), are the first-line treatment options for people with diabetes and ED.
Penile injections of vasoactive drugs, like alprostadil, are commonly used as a second-line medical treatment when PDE5i has failed. Alprostadil is also available as a urethral suppository for those who prefer a non-injectable form of therapy.
Despite the effectiveness of drug therapy for ED, it is important to manage your diabetes with medication and lifestyle changes; otherwise, your ED will likely progress in spite of drug treatment. Additionally, ED drugs may increase your heart rate or interact with other drugs that you are taking, so you should never start taking these drugs without first consulting with your healthcare provider.
ED drugs are generally not recommended for people with severe cardiovascular disease or urinary tract issues. Therefore, people with diabetes should talk with their healthcare provider about their risk for kidney problems and heart disease prior to starting any ED medication.
A Word From Verywell
Making lifestyle changes such as eating a healthy diet, exercising regularly, and quitting smoking increases the potential effectiveness of metformin both in managing diabetes and ED.
Diabetic Erectile Dysfunction Reversal
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives.Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455Hu Y, Ding B, Shen Y, et al.Rapid changes in serum testosterone in men with newly diagnosed type 2 diabetes with intensive insulin and metformin.Diabetes Care. 2021;44(4):1059-1061. doi:10.2337/dc20-1558Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J.Epidemiology of type 2 diabetes — global burden of disease and forecasted trends.J Epidemiol Glob Health. 2020;10(1):107-111. doi:10.2991/jegh.k.191028.001Hatzimouratidis K, Hatzichristou D.How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment.Curr Diab Rep. 2014;14(11):545. doi:10.1007/s11892-014-0545-6Agochukwu-Mmonu N, Pop-Busui R, Wessells H, Sarma AV.Autonomic neuropathy and urologic complications in diabetes.Auton Neurosci. 2020;229:102736. doi:10.1016/j.autneu.2020.102736Patel JP, Lee EH, Mena CI, Walker CN.Effects of metformin on endothelial health and erectile dysfunction.Transl Androl Urol. 2017;6(3):556-565. doi:10.21037/tau.2017.03.52Al-Kuraishy HM, Al-Gareeb AI.Erectile dysfunction and low sex drive in men with type 2 DM: the potential role of diabetic pharmacotherapy.J Clin Diagn Res. 2016;10(12):FC21-FC26. doi:10.7860/JCDR/2016/19971.8996Diabetes.co.uk.Diabetes and erectile dysfunction.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives.Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455Hu Y, Ding B, Shen Y, et al.Rapid changes in serum testosterone in men with newly diagnosed type 2 diabetes with intensive insulin and metformin.Diabetes Care. 2021;44(4):1059-1061. doi:10.2337/dc20-1558Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J.Epidemiology of type 2 diabetes — global burden of disease and forecasted trends.J Epidemiol Glob Health. 2020;10(1):107-111. doi:10.2991/jegh.k.191028.001Hatzimouratidis K, Hatzichristou D.How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment.Curr Diab Rep. 2014;14(11):545. doi:10.1007/s11892-014-0545-6Agochukwu-Mmonu N, Pop-Busui R, Wessells H, Sarma AV.Autonomic neuropathy and urologic complications in diabetes.Auton Neurosci. 2020;229:102736. doi:10.1016/j.autneu.2020.102736Patel JP, Lee EH, Mena CI, Walker CN.Effects of metformin on endothelial health and erectile dysfunction.Transl Androl Urol. 2017;6(3):556-565. doi:10.21037/tau.2017.03.52Al-Kuraishy HM, Al-Gareeb AI.Erectile dysfunction and low sex drive in men with type 2 DM: the potential role of diabetic pharmacotherapy.J Clin Diagn Res. 2016;10(12):FC21-FC26. doi:10.7860/JCDR/2016/19971.8996Diabetes.co.uk.Diabetes and erectile dysfunction.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives.Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455Hu Y, Ding B, Shen Y, et al.Rapid changes in serum testosterone in men with newly diagnosed type 2 diabetes with intensive insulin and metformin.Diabetes Care. 2021;44(4):1059-1061. doi:10.2337/dc20-1558Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J.Epidemiology of type 2 diabetes — global burden of disease and forecasted trends.J Epidemiol Glob Health. 2020;10(1):107-111. doi:10.2991/jegh.k.191028.001Hatzimouratidis K, Hatzichristou D.How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment.Curr Diab Rep. 2014;14(11):545. doi:10.1007/s11892-014-0545-6Agochukwu-Mmonu N, Pop-Busui R, Wessells H, Sarma AV.Autonomic neuropathy and urologic complications in diabetes.Auton Neurosci. 2020;229:102736. doi:10.1016/j.autneu.2020.102736Patel JP, Lee EH, Mena CI, Walker CN.Effects of metformin on endothelial health and erectile dysfunction.Transl Androl Urol. 2017;6(3):556-565. doi:10.21037/tau.2017.03.52Al-Kuraishy HM, Al-Gareeb AI.Erectile dysfunction and low sex drive in men with type 2 DM: the potential role of diabetic pharmacotherapy.J Clin Diagn Res. 2016;10(12):FC21-FC26. doi:10.7860/JCDR/2016/19971.8996Diabetes.co.uk.Diabetes and erectile dysfunction.
Maiorino MI, Bellastella G, Esposito K.Diabetes and sexual dysfunction: current perspectives.Diabetes Metab Syndr Obes. 2014;7:95-105. doi:10.2147/DMSO.S36455
Hu Y, Ding B, Shen Y, et al.Rapid changes in serum testosterone in men with newly diagnosed type 2 diabetes with intensive insulin and metformin.Diabetes Care. 2021;44(4):1059-1061. doi:10.2337/dc20-1558
Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J.Epidemiology of type 2 diabetes — global burden of disease and forecasted trends.J Epidemiol Glob Health. 2020;10(1):107-111. doi:10.2991/jegh.k.191028.001
Hatzimouratidis K, Hatzichristou D.How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment.Curr Diab Rep. 2014;14(11):545. doi:10.1007/s11892-014-0545-6
Agochukwu-Mmonu N, Pop-Busui R, Wessells H, Sarma AV.Autonomic neuropathy and urologic complications in diabetes.Auton Neurosci. 2020;229:102736. doi:10.1016/j.autneu.2020.102736
Patel JP, Lee EH, Mena CI, Walker CN.Effects of metformin on endothelial health and erectile dysfunction.Transl Androl Urol. 2017;6(3):556-565. doi:10.21037/tau.2017.03.52
Al-Kuraishy HM, Al-Gareeb AI.Erectile dysfunction and low sex drive in men with type 2 DM: the potential role of diabetic pharmacotherapy.J Clin Diagn Res. 2016;10(12):FC21-FC26. doi:10.7860/JCDR/2016/19971.8996
Diabetes.co.uk.Diabetes and erectile dysfunction.
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