Statins and Erectile Dysfunction: What’s the Connection?

Erectile dysfunction (ED), formerly known as impotence, is a condition that affects roughly 40% of people with penises over the age of 40 and 70% over the age of 70. One of the key risk factors for ED is high cholesterol. In fact, some studies suggest that seven of every 10 people with ED meet the clinical definition of high cholesterol (also known as hypercholesterolemia).

Therefore, it may seem reasonable to assume that taking cholesterol-lowering drugs like statins could potentially improve ED. But is the relationship that straightforward?

This article takes a closer look at the potential benefits of statins in people with ED as well as the various factors that can influence a person's ability to get and keep an erection if a statin drug is prescribed.

High Cholesterol and ED

There is no single cause of ED. There are many factors that can contribute, some of which are physical and others of which may be psychological. In most people, multiple factors are involved.

From a physiological standpoint, ED can be caused by the reduced flow of blood to the penis. In people able to achieve an erection, sexual arousal triggers the rush of blood to the penis, causing it to become engorged and stiff. When blood flow is impaired, getting or sustaining an erection can be difficult.

High cholesterol contributes to ED by causing the buildup of fatty plaques in the arteries that service the penis. The buildup of plaques can also lead to high blood pressure, causing blood vessels to narrow and harden over time (referred to as atherosclerosis). All these things can reduce the volume of blood needed to achieve an erection.

High cholesterol and high blood pressure share similar risk factors that can directly or indirectly affect a person's ability to achieve or sustain an erection. They include:

• Older age
• Obesity
• Diabetes
• Lack of exercise
• Poor diet
• Too much alcohol
• Cigarettes

How Statins Work

Statins are the most common cholesterol-lowering drugs prescribed today. Statins are most effective at lowering the "bad" form of cholesterol known as low-density lipoprotein (LDL). This is the type of cholesterol responsible for arterial plaques.

How Statins Work

Statins are also known as HMG-CoA reductase inhibitors. HMG-CoA reductase is an enzyme that regulates the rate at which the liver produces cholesterol. By mimicking this enzyme, statins can "step in" and block the chain of events that leads to the production of cholesterol.

The main action of statin drugs is to reduce LDL levels. While statins are also pretty good at increasing "good" high-density lipoprotein (HDL) cholesterol and lowering triglycerides, they are not as good at this as a class of drugs known as fibrates.

Benefits of Statins

Statins are used for both the prevention of heart disease and to decrease the risk of death from heart disease. They can also help reduce the risk of certain blood clots and help stabilize plaques so that they don't break off and cause a heart attack or stroke.

Because of their benefit in preventing heart disease and its complications, the American Heart Association recommends statins for the following risk groups:

• Adults with a history of heart disease from atherosclerosis
• Adults 40 to 75 with diabetes
• Adults with LDL blood levels greater than 190
• Adults 40 to 75 years with LDL levels of 70 to 189 after a doctor/patient discussion on risks versus benefits
• Children and young adults with familial hypercholesterolemia (an inherited disorder with high LDL and premature coronary heart disease) that cannot be treated with lifestyle changes
• Women with early menopause and/or history of pregnancy-related disorders
  

Types of Statins

There are currently six statin drugs approved for use by the Food and Drug Administration (FDA):

• Crestor (rosuvastatin)
  
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Mevacor (lovastatin)
• Pravachol (pravastatin)

Some statins are classified as high-intensity because they are better able to reduce LDL in the blood.

Can Statins Help ED?

It is possible that statins can improve erectile dysfunction in some people in a number of different ways. With that said, statins are not used to "treat" ED but are only prescribed when a person has (or has risk factors for) atherosclerosis-related heart disease.

Reduced Arterial Plaque Size

There is some evidence that statins can reverse arterial plaques, suggesting that they may help improve blood flow to certain parts of the body. Even so, it's a controversial claim, with some studies reporting significant reductions in plaque volumes and others not.

A 2018 study from China reported that the statin with the highest potential for plaque reversal is Crestor. This effect was seen to be greatest in people with peripheral artery disease (PAD), a vascular disease that causes the narrowing and hardening of arteries in the limbs.

Researchers do not yet know what direct impact the reversal in plaque size has on ED. Up to 77% of people with PAD have ED, with the most severe cases involving the obstruction of the pudendal artery (which services one of the major penile arteries).

Further research is needed.

Improved Vascular Function

One of the factors that influences an erection is the so-called endothelial function of the penile arteries. Endothelial function is the ability of the membranes inside a vessel to contract, increasing the force of blood flow.

Evidence suggests that by reducing LDL, statins can improve the endothelial function of penile arteries and, in turn, improve erections in some people.

Statins may also increase the nitric oxide levels in the bloodstream. Nitric oxide is a molecule that helps trigger an erection by relaxing penile tissues, allowing blood to flow in and engorge the penis.

This is not to suggest that statins have the same level of action as drugs like Viagra or Cialis, which also increase nitric oxide levels. But they may contribute to improved erections in some people.

Statins and Testosterone

Like all drugs, statins have side effects. These include muscle pain, diabetes, liver toxicity, and memory loss or confusion. These side effects are more likely in older adults who take multiple drugs or have liver or kidney disease.

A lesser-known side effect is reduced testosterone levels. Testosterone is a hormone that regulates muscle growth, bone mass, and libido (sex drive). It also influences erections.

The impact of testosterone on erections is not entirely clear. On the one hand, the loss of libido may affect erections by dampening sexual arousal. On the other, low testosterone is thought to decrease nitric oxide levels and, in turn, reduce blood flow to the penis.

(Even so, there is no evidence that testosterone replacement therapy is useful in people with moderate to severe ED.)

At present, it is hard to tell whether a drop in testosterone in statin users is enough to influence erections. The current evidence suggests that the average change is small and may not be clinically significant.

By contrast, the benefits of statins in people at risk of heart disease almost invariably outweigh the risk.

Statins and ED Drugs

Generally speaking, it is OK to take ED drugs like Viagra or Cialis while on statin therapy. There are no known interactions, but this doesn't mean that everyone on statin drugs can take them.

Viagra (sildenafil) and Cialis (tadalafil) belong to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which also include Levitra (vardenafil), Stanyx (vardenafil dissolvable), and Stendra (avanafil).

PDE5 inhibitors work by causing blood vessels to dilate, increasing the flow of blood to the penis. For some people with heart disease, this action can cause adverse and potentially dangerous effects.

Summary

Statin drugs are important drugs for people who have or are at risk of heart disease. There is some evidence that they can also benefit people with ED, but they in no way "treat" ED. They are only prescribed when someone has an increased risk of atherosclerosis-related heart disease. If you take drugs such as Viagra or Cialis for ED, these should not interact with statins.

The best way to help erectile dysfunction is to avoid it by keeping cholesterol in check with diet and exercise.

A Word From Verywell

To treat erectile dysfunction, particularly severe ED, your doctor will need to diagnose the cause or causes of your condition. Based on the findings, your doctor may recommend ED drugs like Viagra, psychotherapy, assistive devices like vacuum pumps and penile rings, and, on rare occasions, surgery.

Lifestyle changes can also factor in, particularly if you have risk factors for high cholesterol, high blood pressure, or diabetes. To this end, statin drugs can help reduce some of the risk factors associated with ED while benefiting your overall heart health as well.