When Erections Stop Working, it's Time to Talk
Let’s Normalise the Conversation
Erectile dysfunction (ED) is common — affecting about 1 in 5 men over 40 — but still not something most guys feel comfortable talking about. Whether it’s occasional or persistent, the important thing to know is: it’s almost always treatable. Even better, it’s often an early sign of something deeper — stress, low testosterone, or even heart disease — and it deserves proper attention.
The Mechanics of an Erection
An erection isn’t just a matter of mood — it’s a finely coordinated response involving the brain, nerves, blood vessels, hormones, and local muscle tissue. In simple terms:
The brain gets aroused and sends a signal via the nerves.
The penis releases nitric oxide, which relaxes blood vessels.
Blood flows into the erectile tissue, and veins compress to keep it there.
Any problem along that chain — mental or physical — can lead to ED.
Why It Happens
There are a few main categories:
Blood Flow Problems
Your penile arteries are tiny. If you have high blood pressure, high cholesterol, diabetes or you smoke, those vessels get narrowed — and the penis is often the first place that shows signs. In fact, ED can be a red flag for early cardiovascular disease, sometimes years before other symptoms appear.
Performance Anxiety or Mental Load
Stress, relationship tension, or a running internal monologue can short-circuit the process. This is often the cause in younger men, especially when the “harder you try” effect kicks in.
Low Testosterone (or other hormones)
If you’ve lost morning erections, feel flat or fatigued, or have low libido, it may be worth checking your testosterone. Other hormones like prolactin and thyroid levels can also play a role.
Medications & Lifestyle
Certain antidepressants, blood pressure meds, and recreational drugs (especially alcohol and cannabis) can interfere with erections. Poor sleep, poor diet, or carrying extra weight also reduce testosterone and nitric oxide levels.
What Can Be Done
Lifestyle Wins
Lose a few kilos — even 5% weight loss helps
Cut back alcohol and quit smoking
Prioritise sleep and regular exercise
Reduce mental stress where you can (yes, easier said than done)
These aren't just “add-ons” — they actually improve erections by supporting blood flow, hormones, and confidence.
Medical Treatments
Viagra/Cialis and friends: These help blood stay where it’s meant to be — effective in most men, but they don’t increase libido and won’t work without arousal.
Testosterone Replacement (if levels are low): Not a magic fix, but can improve energy, libido, and mood — with proper supervision.
Other options: Penile pumps, injections, or implants — rarely needed, but available if pills don’t work.
When to Seek Help
If ED is:
Ongoing (more than 3 months)
Affecting your confidence or relationship
Accompanied by other health concerns like fatigue, low libido, or poor exercise tolerance