Type 2 Diabetes and Erectile Dysfunction
Erectile dysfunction (ED) is one of the most common complications of type 2 diabetes, and it is rarely "just a plumbing problem." Diabetes impacts erections through reduced nitric oxide signaling and endothelial function, accelerated atherosclerosis, and diabetic neuropathy, often years before someone develops obvious cardiovascular symptoms.
Why Diabetes Affects Erections
An erection depends on healthy blood vessel dilation, intact nerve signaling, and responsive smooth muscle in the penis. In type 2 diabetes, chronic hyperglycemia and insulin resistance impair endothelial nitric oxide bioavailability and damage small nerves, which reduces blood inflow and makes it harder to achieve and maintain rigidity.
ED Is Also A Cardiovascular Warning Sign
ED is strongly linked with cardiovascular disease risk and can function as an early marker of systemic vascular dysfunction. In our clinic, ED in a man with type 2 diabetes triggers a cardiometabolic risk review, not just an ED prescription.
When glucose control improves and visceral fat decreases, erectile function often improves because vascular and inflammatory stress decreases and testosterone dynamics can improve. Prioritize an evidence-based metabolic plan that targets A1c, blood pressure, lipids, sleep apnea risk, and body composition, is the best choice, because these are the upstream drivers of diabetic ED.
Erection Medications Are Helpful, But Not The Whole Plan
PDE5 inhibitors (like sildenafil or tadalafil) are first line pharmacotherapy for ED and have evidence of benefit in men with diabetes, although response rates can be lower than in men without diabetes because the underlying vascular and nerve injury is greater. While PDE5 inhibitors can be helpful, pairing them with metabolic optimization is key, so the medication has a better physiologic environment to work in.
There is emerging evidence that certain diabetes medications, including GLP1s, can indirectly help erectile function. Therefore, these are often the first-line medication choice in managing type 2 diabetes in men with ED.
Testosterone And Hormone Optimization
Men with type 2 diabetes have a higher prevalence of testosterone deficiency, and low testosterone can worsen body composition, energy, libido, and erectile quality. Screening for low testosterone and treating when indicated is helpful, because hormone optimization can support lean mass, reduce visceral fat when paired with training and nutrition, and improve sexual symptoms in selected men. The ADA Standards of Care explicitly added guidance to screen men with diabetes or prediabetes for ED, which aligns with this integrated approach.
Performance Focused Lifestyle: Strength Training And Nutrition As ED Therapy
Resistance training and structured nutrition are not "optional add-ons." They improve insulin sensitivity, endothelial function, and body composition, which are all mechanistically tied to erections. For many men, the fastest durable gains come from combining a targeted training plan with medical metabolic therapy rather than escalating ED meds alone.
When Pills Are Not Enough: Next Steps
For many men, combining technologies that target two key drivers of diabetes associated erectile dysfunction can be helpful: impaired penile blood flow and impaired neuromuscular function. Precision shockwave therapy is used as a cornerstone modality to support vascular signaling and penile tissue health over time. Class IV laser and therapeutic ultrasound are used as supportive modalities aimed at local tissue recovery and circulation, particularly for patients with higher tissue sensitivity or slower healing capacity.
Addresses the mechanics of erections is also important. This is accomplished by treating the pelvic floor and surrounding neuromuscular system. Pelvic focused strengthening and neuromuscular retraining are paired with PEMF to support relaxation, tissue recovery, and improved muscle activation patterns. The intent is to improve rigidity, sensation, and sexual function while reducing reliance on medication alone, especially in men whose diabetes has created both vascular and nerve related contributors to ED.
If you have type 2 diabetes and ED, we can build a personalized plan that addresses performance, confidence, and long-term cardiovascular risk. We improve your A1C while also improving erectile fuction. Reach out for more information!
References
Burnett A, et al (2018). Erectile Dysfunction: AUA Guideline. J Urol. Sep;200(3):633-641.
American Diabetes Association. Standards of Care in Diabetes 2025, including screening update for ED. Diabetes Care. 2025.
Balhara Y, et al (2015). Phosphodiesterase 5 inhibitors for erectile dysfunction in diabetes mellitus: systematic review and meta analysis. Indian J Endocrinol Metab. Jul-Aug;19(4):451-61.
Kohler T, et al (2024). The Princeton IV Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease. Mayo Clin Proc. Sep;99(9):1500-1517.