Lose weight, quit smoking, and keep blood pressure and blood sugar under control; erectile function can improve along with them

Cost

Free, and may even save money. The hard part is the long haul: watching what you eat, getting active and quitting smoking.

What you get

A meta-analysis pooled 6 randomized controlled trials with 740 men. The intervention was lifestyle change, or drugs to control cardiovascular risk factors, with follow-up of at least 6 weeks. Result: the erectile function questionnaire (IIEF-5) score rose by 2.66 points on average (95% CI 1.86 to 3.47, the plausible range). Taking out the 2 trials that used statins (143 people), the remaining 4 trials that relied on lifestyle change alone (597 people) still showed an increase of 2.40 points (1.19 to 3.61). The IIEF-5 is a questionnaire of 5 questions with a total of 5 to 25 points. The original paper splits scores into five levels: 22 to 25 means no dysfunction, and 5 to 7 means severe.

Notes

The interventions in these 6 trials were different: some were weight loss plus exercise, some used drugs to control blood pressure and lipids. There were only 740 people in all. So the direction is clear, but how much each person improves varies. The benefit is rated “small” because the end point is only a questionnaire score, not a figure for how many fewer diseases follow. The same actions have hard end points elsewhere: for quitting smoking see §2.1 (quit smoking, the earlier the better), for weight loss see §2.32 (keep BMI between 20 and 25), and for blood pressure see §1.7 (check your blood pressure, and take medicine if it's high). Taking medicine itself is not off limits, as long as it is a prescription from a doctor. “Supplements” sold online often have these ingredients secretly added, at unknown doses; for how to tell, see §28.4 (don't buy diet pills that promise fast weight loss).

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL (2011). The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Archives of Internal Medicine, 171(20), 1797-1803. https://doi.org/10.1001/archinternmed.2011.440
2. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM (1999). Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. International Journal of Impotence Research, 11(6), 319-326. https://doi.org/10.1038/sj.ijir.3900472

Translated from the Chinese original. Original book, section 1, tip 29. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer