Diabetes is one of the most common chronic medical conditions in the United States. Globally, it is estimated that more than 460 million people are affected by type 2 diabetes, while the number is expected to rise to over 550 million by 2030.

Erectile dysfunction (ED) is one of the potential risk factors of diabetes because high blood sugar can damage the small penile blood vessels and nerves, affecting men’s ability to get or maintain an erection.

Men with diabetes are three times more likely to have erectile dysfunction (ED) than those who do not have diabetes, according to VeryWell Health.

Controlling high blood glucose levels with a widely used diabetes drug, metformin, could help reverse ED. Sold under the brand name Glucophage and others, metformin was once thought to help men with ED.

However, recent studies have shown that ED could also be one of the side effects of metformin, as it may significantly lower testosterone levels.

Dr. Shamard Charles, a public health doctor, has published an article on VeryWell Health, explaining the connection between metformin and erectile dysfunction.

He wrote, “Metformin is capable of improving ED by managing some of the side effects of diabetes that can cause ED.”

Dr. Charles, who was a senior health journalist for NBC News, referred to a recent study of metformin treating ED by “activating the nitric oxide response required to increase blood flow to the penis.” 

He said the diabetes drug could also treat ED by “moderating sympathetic nerve activity.”

“However, other studies have found that metformin may be associated with a reduced output of testosterone, which can cause reduced sex drive and may contribute to ED.” Dr. Charles wrote. “More research is needed to determine the effect of metformin on erectile function.”

He went on to explain that ED treatments are generally well tolerated by men with diabetes if they are in otherwise generally good health.

The first-line ED treatment options include oral phosphodiesterase-5 inhibitors (PDE5i), such as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil).

Although these oral ED drugs work, it is important to control your diabetes with medicines and lifestyle changes.

Oral ED drugs are contraindicated in men who have severe cardiovascular disease or who are undergoing treatment with nitrates or alpha-blockers. Therefore, men with diabetes should check with their doctor before using any oral ED drug.