With the erectile dysfunction (ED) market expected to reach 3.4 billion dollars (USD) by 2019, this is a lucrative area to invest in, and not much grabs the attention of a guy watching a commercial during a Monday night football game than the promise to easily cure this problem with one pill as needed. But is this the answer for everyone? What causes ED? For the guy with no apparent risk factors like depression or diabetes, hypothyroidism, injury or stress issues, erectile dysfunction or loss of libido (which don’t necessarily go hand in hand) can be confusing and frustrating for a guy as well as his partner.
What if we look at erectile dysfunction as something that can be addressed as a condition other than a “pill for every ill”. What if we actually look at a nutrient level that directly correlates to a medical condition and follow the science to give a directive on its recommendation? Well it turns out taking a simple zinc supplement won’t help 100% of the time, but it certainly helps some of the time.
There are two things that need to be looked at in recommending a supplement for a medical condition: what is the physiology of the medical condition and what is the pharmacology of the supplement you are using. There then is a search for a link between the two that leads to a tie in with a therapeutic approach. In some ways this is like a logic course that says A causes B, B causes C therefor A causes C. We then must apply this to the scientific method and finally the ultimate test: clinical response and safety. This is often made out to be the gold standard for our typical Rx meds that I dispense every day, but often ridiculed when it crosses the barbed wired “nutraceutical” boarder. If it is a nutrient then we must be getting the right amount in our food after all right? Regardless of 1)what the real amount is in the food we eat, not to mention 2)the depletion that may be taking place of that nutrient due to a prescription drug we are taking (an absolute science based cause and effect) – we blindly accept what our food has in it and the level our bodies maintain – this is an incorrect assumption. In fact it is quite ironic that the anti-nutraceutical court is still hanging onto this assumption when both are established by science.
So what causes erectile dysfunction? Sometimes it is a circulation problem. Sometimes it is a low testosterone issue. Sometimes it is not. Testosterone (T) supplementation can help ED and low libido in cases of low T and even if there is a normal T level at baseline, ED can be helped. In cases where thyroid under or overactivity is causing T levels to be less than optimal. Aging is also a problem as T levels drop after mid 20’s and as adipose tissue increases and aromatase enzyme conversion of T to Estrogen correspondingly increases. This causes an unfavorable E:T ratio which equates to low T.
When men are given supplemental testosterone it can have positive effects on erectile dysfunction as well as the “grumpy old men” syndrome of low energy, loss of drive, low libido, and loss of endurance as well as “man boobs”. Zinc has a direct effect on the two main enzyme systems that act on testosterone: conversion of testosterone to estrogen via aromatase and the conversion of testosterone to DHT by 5 alpha reductase. Zinc blocks the testosterone to estrogen pathway leading to more testosterone. It turns out that only at really high zinc levels does zinc inhibit the 5 alpha reductase enzyme so when we give mild to moderate zinc supplements, DHT actually increases because there is more testosterone to feed into this pathway. This actually benefits things because DHT has 2-3 times the times the androgen receptor affinity than testosterone. In any case, we see an increase of testosterone and androgenic activity from DHT with zinc supplements and whether a guy has low or normal T to begin with, there is a positive change in erectile dysfunction and libido in some men due to the increased androgenic activity and less estrogen pulling in the opposite direction. Conversely we see testosterone levels drop when a diet is low in Zinc as well as a drop in DHT. It is important to note that this effect of increased testosterone with zinc supplementation, while well established, does not always lead to an improvement of ED and increased Libido.
Clinically I have seen these results in doses of just 20 mg twice daily. It is important to note that prolonged zinc supplementation can lead to lowered copper levels so it is not advisable to continue this therapy unless it is in a cyclical nature. For those on long term zinc there are combination products with Zinc and Copper. In cases where some prescriptions that lower zinc are given, like acid lowering meds, thiazide diuretics and ACE inhibitors, or in renal dialysis patients, this chronic monitoring of zinc may lead to longer term supplementation.
So, in establishing physiology, pharmacology, clinical results and safety, zinc is a good choice when you look at cost and side effect profile as well as ease of availability and interaction profile with other meds and other medical conditions. Having said all of this, there is no bulletproof evidence out there guaranteeing that increasing your zinc consumption either in food or via a supplement will improve ED or increase libido. Even if a patient experiences an increase in testosterone from such a supplementation, this is not a certain gateway to resolution of theses symptoms as there is more to it than just one hormone level. However for those that are experiencing problems in these areas, it is certainly worth a try for them. The patient should be mindful however that supplements should be treated like any other medication and trying to increase your testosterone shouldn’t be done without consultation with your doctor and pharmacist. You should also check for any interactions with any meds or medical conditions before trying any supplement as well.
Jalali GR1, Roozbeh J, Mohammadzadeh A, Sharifian M, Sagheb MM, Hamidian Jahromi A, Shabani S, Ghaffarpasand F, Afshariani R. Impact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis. Ren Fail. 2010 May;32(4):417-9.
Michael F. Leitzmann, Meir J. Stampfer, Kana Wu, Graham A. Colditz, Walter C. Willett and Edward L. Giovannucci Zinc Supplement Use and Risk of Prostate Cancer journal of the National Cancer Institute. Volume 95 , Issue 13 pp 1004-1007