Can high cholesterol cause erectile dysfunction?

Can high cholesterol cause erectile dysfunction? Yes — too much "bad" cholesterol narrows and hardens the arteries, including the ones that carry blood to the penis. healthdirect lists high cholesterol among the conditions that can contribute to erectile dysfunction, and says erection problems are often the first sign of it. Statins are sometimes blamed as well, but in randomised trials erections got slightly better on them, not worse.

How does high cholesterol affect erections?

Through the blood supply. Too much LDL ("bad") cholesterol "can cause fatty deposits called plaque to form in the walls of your arteries. This leads to a narrowing and hardening of the arteries" (healthdirect — cholesterol). Reduced blood flow to the penis from clogged arteries is one of the physical causes of erectile dysfunction that healthdirect names (healthdirect — erectile dysfunction). The same process is behind can clogged arteries cause erectile dysfunction? and can high blood pressure cause erectile dysfunction?

What did the studies find?

That higher cholesterol goes with more erection problems. A US clinic followed 3,250 men who had no erection problems for an average of 22 months, and 71 of them developed erectile dysfunction. Each 1 mmol/L rise in total cholesterol went with 1.32 times the risk, and men above 6.21 mmol/L had 1.83 times the risk of men below 4.65 mmol/L. HDL ("good") cholesterol ran the other way: each 1 mmol/L more went with 0.38 times the risk (Wei et al., Am J Epidemiol 1994). The differences held after other factors were allowed for, but a study of this kind shows a link, not proof of cause.

Can erection problems be a sign of high cholesterol?

Yes. healthdirect says erectile dysfunction is often the first sign of problems such as cardiovascular disease, high blood pressure and high cholesterol (healthdirect — erectile dysfunction), and men with erectile dysfunction are at higher than normal risk of coronary heart disease and stroke (Healthy Male). High cholesterol has no obvious symptoms, so the way to know is a blood test, a "lipid profile" (healthdirect — cholesterol). More on the heart: is there a link between erectile dysfunction and heart disease?

Does cholesterol affect testosterone?

Your body uses cholesterol to build cells and to make hormones (healthdirect — cholesterol). What has been measured is the effect of statins, which cut how much cholesterol the body makes: in five placebo-controlled trials of 501 men, mostly middle-aged with high cholesterol, statins lowered testosterone by 0.66 nmol/L on average (Schooling et al., BMC Med 2013). Those trials did not measure erections, and this page found no source showing that high cholesterol itself lowers testosterone.

Can statins cause erectile dysfunction?

In some men they may, but it is uncommon. healthdirect counts some medicines for high cholesterol among the causes of erectile dysfunction (healthdirect — erectile dysfunction). The Australian product information for atorvastatin lists erectile dysfunction among the uncommon events (0.1% to 1%) reported in its trials, adding that "not all the events listed have been causally associated with atorvastatin therapy" (Lorstat product information). The rosuvastatin product information does not list it (Crestor product information), and neither consumer leaflet mentions erections (Crestor CMI; Lorstat CMI). In France, 1.1% of suspected side-effect reports in men on statins were erectile dysfunction, against 0.4% of other reports, and in 56.9% of those men it went away when the statin was stopped (Do et al., Drug Saf 2009) — a signal, not a rate. More in can statins cause erectile dysfunction?

Can statins improve erections?

On average, a little. Pooling 11 randomised trials, erection scores (the five-item IIEF) rose 3.4 points more on statins than on the comparison treatment — a third to a half of the gain reported with sildenafil-type medicines (Kostis and Dobrzynski, J Sex Med 2014). A second review of six trials with 462 men found no clear difference between a statin alone and a placebo, but a statin added to sildenafil did better than a placebo added to sildenafil (Cui et al., J Sex Med 2014). Statins are prescribed to lower the risk of a heart attack or stroke, not to treat erections, and healthdirect's advice is not to stop one on your own but to talk to your doctor or pharmacist first (healthdirect — statins).

What can you do about cholesterol and erections?

See your GP about both. Some causes of erectile dysfunction can be prevented if you stop smoking, exercise more, lose weight and eat healthy food (healthdirect — erectile dysfunction); for cholesterol, healthdirect adds cutting saturated and trans fats, more soluble fibre such as oats and beans, and a blood fat test at least every 5 years from age 45 (healthdirect — cholesterol). Erectile dysfunction medicines need a prescription in Australia (healthdirect — ED medicines); taking one with a cholesterol medicine is answered in can Viagra be taken with statins?

The short answer

High cholesterol can cause erectile dysfunction by narrowing the arteries, and an erection problem can be its first sign, so it is worth a blood test. Statins are an uncommon cause at most, and in trials erections improved slightly on them; do not stop one without talking to your doctor. Other causes are in our guide to which medicines and conditions can cause erectile dysfunction.