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Erectile Dysfunction associated with low vitamin D in several studies

Lower vitamin D ==> lower Nitrous Oxide ==> lower erection - April 2017

The role of vitamin D supplementation on erectile function - Invited Review
Turk J Urol 2017; 43(2): DOI: 10.5152/tud.2017.76032
Raidh A. Talib1,2 riad_talib at yahoo.com, Kareim Khalafalla1, Onder Canguven1-2
'Hamad Medical Corporation, Department of Urology, Doha, Qatar
2Weill Cornell Medical College, Department of Urology, NY, USA

In the last few years growing evidence highlighted vitamin D (VD) deficiency is one of the several dynamics that associates with increased atherosclerotic cardiovascular (ASCV) diseases.
ASCV diseases and erectile dysfunction (ED) share common risk factors such as

  • diabetes mellitus,
  • hypertension,
  • smoking,
  • hyperlipidemia, and a
  • sedentary lifestyle.

The aim of this review was to summarize current progress in VD research by focusing effect of low VD level on different body systems and erectile function. Here we examine research linking VD deficiency and ED and discuss how VD influences ED and its classic risk factors-factors that also associate to increased ED risk. We also summarize research indicating that VD associates with reduced risk of several nonvascular contributing factors for ED. Available literature demonstrates relatively high rates of low VD serum levels in ED patients. Based on the preclinical and clinical data available in the literature, to date, we infer that VD play a critical role in maintaining erectile function in humans. Nevertheless, this should also be tested through randomized controlled studies on the effect of VD supplementation with larger population.
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Clipped from the PDF
One mechanism linking low VD levels with ED may be via reduced synthesis of NO. Recently Barassi et al demonstrated a higher presence of VDD in arterial ED patients compared with non-arterial-ED patients and a lower serum VD levels in more severe ED patients.[18]
Both observational and interventional studies have established the presence of an association between VD levels and ED. This relation is more than a simple relation, because there are many risk factors (Figure 2) in the etiology of ED which might be directly caused by VDD.
Vitamin D and nitric oxide production
Penis is a vascular organ, and erections have a vascular basis. NO pathway is known to mediate penile erection. NO is a physiologic signal essential for penile erection, and disorders that reduce NO synthesis or release in the erectile tissue are commonly associated with ED. Sexual stimulation releases neurotransmitters from the corpus cavernosa as well as NO from the endothelial cells of the penis.[17]
Another important mechanism of action of VD seems to be via NO- mediated vascular dilation. NO synthases are a family of enzymes that catalyze the production of NO from L -arginine. Activated VD stimulates the production of substantial quantities of NOS and NO in macrophages produced in bone and in endothelial cells in response to tuberculosis. NO is vital to vascular dilation and thereby important for the inhibition of ED.[17] Because of the presence of VD and VDR in the endothelial cells and the pivotal role of NO and eNOS in the endothelial activity, it is conceivable that an interaction between VD and NO is capable of influencing vascular function.[51] Molinari et al.[51] demonstrated that VD is able to stimulate NO production in human umbilical vein endothelial cells through eNOS activation. The finding of an involvement of VD in NO production by endothelial cells is quite relevant. NO is an essential molecule and serves multiple functions including vasodilatation and many anti-atherogenic properties. Indeed, dysregulation of eNOS activity is thought to contribute to the pathogenesis of certain vascular diseases such as atherosclerosis and hypertension.
Activated VD stimulates the production of NO in endothelial cells and NO synthases which catalyze the production of NO from L-arginine[51], is a key to vascular dilation and thereby critical for the prevention of ED. Interestingly, the latter study showed that VD response occurs within seconds and, for this reason, it appears that VD has a non-genomic direct effect on endothelial cells. Recently, Andrukhova et al.[52] reported that VD receptor mutant mice are characterized by lower bioavailability of the vasodilator NO due to reduced expression of the key NO synthesizing enzyme i.e. eNOS. Reduction in eNOS ends with endothelial dysfunction, increased arterial stiffness, increased aortic impedance, structural remodeling of the aorta, and impaired systolic and diastolic heart function at advanced ages, independent of changes in the renin-angiotensin system.[52] The latter group demonstrated that VD is a direct transcriptional regulator of eNOS.[52] This may also clarify why endothelium derived, and NO-evoked dilation is reduced nearly 50% in arteries from VD deficient male rats.[16] Under the light of recent scientific researches, unsurprisingly, there exists a higher prevalence of ED among VD deficient patients compared to those with optimal levels.[9]

Vitamin D and Erectile Dysfunction - Aug 2014

Alessandra Barassi MD1,*, Raffaele Pezzilli MD2, Giovanni M. Colpi MD3, Massimiliano M. Corsi Romanelli MD4,5 and Gian Vico Melzi d'Eril MD1
The Journal of Sexual Medicine, Article first published online: 5 AUG 2014, DOI: 10.1111/jsm.12661
© 2014 International Society for Sexual Medicine

Introduction: Endothelial dysfunction has been demonstrated to play an important role in pathogenesis of erectile dysfunction (ED) and vitamin D deficiency is deemed to promote endothelial dysfunctions.

Aim: To evaluate the status of serum vitamin D in a group of patients with ED.

Methods: Diagnosis and severity of ED was based on the IIEF-5 and its aetiology was classified as *arteriogenic (A-ED),

  • borderline (BL-ED), and
  • on-arteriogenic (NA-ED)

with penile-echo-color-Doppler in basal condition and after intracaversous injection of prostaglandin E1. Serum vitamin D and intact PTH concentrations were measured.

Main Outcome Measures: Vitamin D levels of men with A-ED were compared with those of male with BL-ED and NA-ED.

Fifty patients were classified as A-ED, 28 as ED-BL and 65 as NA-ED, for a total of 143 cases. Mean vitamin D level was 21.3 ng/mL; vitamin D deficiency (<20 ng/mL) was present in 45.9% and only 20.2% had optimal vitamin D levels. Patients with severe/complete-ED had vitamin D level significantly lower (P = 0.02) than those with mild-ED. Vitamin level was negatively correlated with PTH and the correlation was more marked in subjects with vitamin D deficiency. Vitamin D deficiency in A-ED was significantly lower (P = 0.01) than in NA-ED patients. Penile-echo-color-Doppler revealed that A-ED (PSV ≤ 25 cm/second) was more frequent in those with vitamin D deficiency as compared with those with vitamin >20 ng/dL (45% vs. 24%; P < 0.05) and in the same population median PSV values were lower (26 vs. 38; P < 0.001) in vitamin D subjects.

Our study shows that a significant proportion of ED patients have a vitamin D deficiency and that this condition is more frequent in patients with the arteriogenic etiology. Low levels of vitamin D might increase the ED risk by promoting endothelial dysfunction. Men with ED should be analyzed for vitamin D levels and particularly to A-ED patients with a low level a vitamin D supplementation is suggested.

Independant marker for ED in Diabetics = low vitamin D level - Jan 2016

Hypovitaminosis D is associated with erectile dysfunction in type 2 diabetes
Endocrine, pp 1-8, First online: 12 January 2016
Nicola Caretta , Saula Vigili de Kreutzenberg, Umberto Valente, Gabriella Guarneri, Alberto Ferlin, Angelo Avogaro, Carlo Foresta

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Diabetes is an established risk factor for erectile dysfunction (ED). The pathophysiology of ED in diabetic men is multifactorial, but it mainly involves a vascular disorder related to a reduction of endothelial function. Recently, several studies have correlated ED risk factors with vitamin D deficiency. In this study, we evaluate the relationship between 25-hydroxyvitamin D [25(OH)D] levels, erectile dysfunction, and vascular disease, in type 2 diabetes mellitus men (T2DM). In this observational study, 92 T2DM males (58.83 ± 9.73 years) underwent medical history collection, International Index of Erectile Function (IIEF-5) questionnaire, that allows the identification and grading of DE, physical examination, biochemical/hormonal blood tests, and penile echo-color Doppler ultrasonography. T2DM patients with lower 25(OH)D levels (<25 nmol/l) showed higher penile IMT (p < 0.05), waist circonference (p < 0.05), glucose concentrations (p < 0.05), and lower IIEF-5 score (p < 0.005), testosterone concentrations (p < 0.05), and cavernous peak systolic velocity (PSV) (p < 0.05), compared to patients with 25(OH)D >50 nmol/l. 25(OH)D levels were directly correlated with IIEF-5 (R = 0.39; p = 0.0001), testosterone (R = 0.24; p = 0.02), and PSV (R = 0.24; p = 0.04) and inversely with waist (R = −0.33; p = 0.002), HbA1c (R = −0.22; p = 0.03), triglyceride (R = −0.21; p = 0.06), and penile IMT (R = −0.30; p = 0.009). At multivariate analysis, 25(OH)D deficiency remained an independent predictor of DE. We demonstrate a significant association between 25(OH)D deficiency and erectile dysfunction in T2DM men. This association may be due to the influence of 25(OH)D deficiency on cardiovascular risk factor (glycaemia, HDL cholesterol, and triglycerides), testosterone plasma levels and endothelial dysfunction.

Erectile dysfunction is 1.3X more likely if low vitamin D - July 2016

Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction:
The National Health and Nutrition Examination Survey (NHANES) 2001–2004

Atherosclerosis in press, doi:10.1016/j.atherosclerosis.2016.07.921
Youssef M.K. Faraga, b, Eliseo Guallara, Di Zhaoa, Rita R. Kalyanic, Michael J. Blahad, David I. Feldmand, e, Seth S. Martind, Pamela L. Lutseyf, Kevin L. Billupsg, Erin D. Michosa, d, ,

Image Image


  • Both Vit D deficiency and ED have been linked to increased cardiovascular risk.
  • We found in a representative sample of U.S. men that both Vit D deficiency and ED were common, with prevalence of 30% and 15%, respectively.
  • We found Vit D deficiency was independently associated with an increased prevalence of ED after accounting for multiple lifestyle and vascular risk factors.
  • Additional research is needed to evaluate whether treating Vit D deficiency improves erectile function.

Publisher wants $36 for the PDF

Background and aims: Erectile dysfunction (ED) and atherosclerotic cardiovascular disease (ASCVD) share many common risk factors, and vascular ED is a marker for increased ASCVD risk. Low 25-hydroxyvitamin D 25(OH)D concentrations have been associated with increased ASCVD risk, but less is known regarding the relationship of low 25(OH)D with ED. We determined whether 25(OH)D deficiency is associated with ED independent of ASCVD risk factors.

Methods: We performed cross-sectional analyses of 3390 men aged ≥20 years free of ASCVD who participated in NHANES 2001–2004. Serum 25(OH)D was measured by the DiaSorin radioimmunoassay; deficiency was defined as levels <20 ng/ml (<50 nmol/L). Self-reported ED, assessed by a single validated question, was defined as men who reported being “never” or “sometimes able” to maintain an erection. We assessed the relationship between 25(OH)D deficiency and ED prevalence using adjusted Poisson regression methods.

Results: After accounting for NHANES sampling, the weighted prevalence of 25(OH)D deficiency and of ED were 30% and 15.2%, respectively. 25(OH)D levels were lower in men with vs. those without ED (mean 22.8 vs 24.3 ng/mL, respectively; p = 0.0005). After adjusting for lifestyle variables, comorbidities, and medication use, men with 25(OH)D deficiency had a higher prevalence of ED compared to those with levels ≥30 ng/ml (Prevalence Ratio 1.30, 95% CI 1.08–1.57).

Conclusion: In this cross-sectional analysis of a representative sample of U.S. men, vitamin D deficiency was associated with an increased prevalence of ED independent of ASCVD risk factors. Additional research is needed to evaluate whether treating vitamin D deficiency improves erectile function.

Wonder: Is Vitamin D similar or better than Viagra?

ED and depression are both associated with Low Vitamin D, but so what - Jan 2019

A bone to pick with vitamin D deficiency and erectile dysfunction
International Journal of Impotence Research (2019), https://doi.org/10.1038/s41443-018-0100-0
Levi Charles Holland & Joseph Scott Gabrielsen
PDF is available free at Sci-Hub  
Primarily commenting on
The effect of low vitamin D status on sexual functioning and depressive symptoms in apparently healthy men: a pilot study.
Int J Impot Res. 2018;30:224–913 https://doi.org/10.1038/s41443-018-0100-0
Krysiak R, Szwajkosz A, Okopień B.

See also VitaminDWiki

Attached files

ID Name Comment Uploaded Size Downloads
8991 erectile dysfunction Sept 2016.pdf admin 22 Dec, 2017 15:03 706.97 Kb 99
7932 ED and Vit D.pdf PDF 2017 admin 23 Apr, 2017 13:04 308.56 Kb 206
6926 ED T2.jpg admin 02 Aug, 2016 10:50 16.34 Kb 730
6925 ED.jpg admin 02 Aug, 2016 10:39 15.23 Kb 755
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