Men who have high cholesterol are at greater risk of developing erectile dysfunction, so it makes sense to assume that taking statins, which lower cholesterol, can improve blood flow and thus benefit men who have erectile dysfunction. However, statins also reportedly lower testosterone levels, which can have a negative impact on getting an erection. So what’s the story? Are statins one of the causes of erectile dysfunction or do they improve a man’s ability to get and maintain an erection?
To help answer this question, a team of investigators from the University of Catania, Italy, reviewed the published studies that explored the use of statins and the reported impact on erectile dysfunction. When they looked at statin use, testosterone and erectile dysfunction, they found that the studies of the relationship between statin use and testosterone production had contrasting results, and that most of the studies involved a limited number of patients.
In one recent study, however, researchers evaluated a large group of men who were seeking erectile dysfunction treatment. Among the group, 244 (7%) were using statins. The investigators found that compared with the rest of the men in the study, those taking statins had significantly lower total and free testosterone levels, and that use of statins was significantly associated with a reduced testicular volume and a higher prevalence of symptoms related to hypogonadism (low testosterone).
In contrast, however, the literature that showed a beneficial effect of statins on erectile dysfunction was more positive. In particular, studies with the statin drug atorvastatin (Lipitor) showed that men had good erectile function when taking the drug, and that the statin plus sildenafil (Viagra) produced better erectile function than did Viagra alone.
Overall, the authors of this latest review concluded that “the pharmacological use of statins for the treatment of hypercholesterolemia [high cholesterol] improves the quality of erection in patients with erectile dysfunction.”
How do statins improve erectile function? The authors proposed that the drugs increase the bioavailability of nitric oxide (a substance necessary for a successful erections), improve nitrite-nitrate concentrations, and other contributing factors.
However, the authors also pointed out that the potential drop in testosterone levels seen in some men who use statins needs to be studied further, and that the decline in testosterone may explain why some studies report erectile dysfunction in men who are taking statins.
Corona G et al. The effect of statin therapy on testosterone levels in subjects consulting for erectile dysfunction. J Sex Med. 2010; 7:1547-56
Herrmann HC et al. Can atorvastatin improve the response to sildenafil in men with erectile dysfunction not initially responsive to sildenafil? Hypothesis and pilot trial results. J Sex Med 2006; 3:303-8
La Vignera S et al. Statins and erectile dysfunction: a critical summary of current evidences. J Androl 2011 Nov 3