A lot of research has focused on ways of raising nitric oxide (NO) which is required for erection. This is how Viagra works. Raising NO naturally can make a big difference. The other absolute essential is to correct testosterone deficiency. Correcting testosterone deficiency also helps boost NO. I interviewed Dr Malcolm Carruthers for the ‘Testosterone Revolution’ special report to bring to public attention how common decreasing testosterone levels are with increasing age.
As with most hormones you can’t just measure levels in the blood and leave it at that. A lot of circulating testosterone becomes bound to something called Sex Hormone Binding Globulin (SHBG) and unable to function as such. So you have to know the level of this to work out how much actual testosterone is available. Saliva levels reflect available testosterone but are not always that reliable. Also, much like the way we become insulin resistant, you can become testosterone resistant and show apparently ‘normal’ levels of testosterone but it isn’t working. In much the way that recently diagnosed diabetics usually have normal, or raised insulin levels, but the insulin isn’t doing its job.
Hormones also compete for absorption and, with increasing weight comes increasing oestrogen production, which competes with testosterone at hormone receptor sites. Testosterone itself can be turned into oestrogens when a person’s body chemistry isn’t in balance. Methylation, determined by your homocysteine level, is also vital for hormonal balance and eliminating excess oestrogens. Having a raised homocysteine level is strongly associated with inhibiting nitric oxide. 
I strongly recommend getting evaluated for your testosterone level but don't just rely on a standard blood test – instead complete the questionnaire at www.centreformenshealth.co.uk and read my Special Report ‘Testosterone Revolution’. Natural testosterone therapy, which is delivered as a skin cream, can be incredibly effective. The Centre for Men’s Health, which has clinics in London, Manchester and Edinburgh, has medical experts who can help you get the dose right. (By the way, if you are prescribed natural testosterone cream elsewhere it is at least ten times more effective applied to the scrotal area.)
Decreasing muscle mass, due to a lack of exercise, and increasing fat, plus excessive alcohol consumption, is a recipe for testosterone deficiency. Other factors, such as prolonged stress and burnout, are also contributors.
In terms of general health advice it is vital to get one’s weight and blood sugar under control and following my low GL diet is the best way to do that.
Also, increase your protein intake. A low protein, low cholesterol, vegan diet is a killer for testosterone as it raises SHGB. Testosterone is made from cholesterol. Eggs are perhaps the best source. I would recommend 2 eggs a day, although some say more. Red meat and fish are also good. Have two servings a day, plus high protein nuts and seeds such as almonds and chia. Some say Brazil nuts are particularly effective.
Testosterone’s direct precursor is the adrenal hormone DHEA which is often measured in hormone tests. Supplementing DHEA may raise testosterone , but there are mixed results in studies, and some concern about the long-term effects of supplementing DHEA. I would not recommend more than 50mg for more than 3 months, but it is worth a try if your level is low. There’s some interesting research giving HCG (growth hormone) to stimulate testosterone production, but I wouldn’t do this unless you are under medical supervision and diagnosed with very low testosterone and being monitored. The balance of these hormones, and hence the dosage, is vital. As far as hormones are concerned you can have too much of a good thing.
Exercise focusing on muscle building is vital. We lose half a pound of muscle mass a year from age 40. See my Special Report ‘How to Build Muscle in 15 Minutes a Week’. The exercise programme in Burn Fat Fast, devised by gladiator Kate Staples, is also a great way to build up your muscle mass and burn fat.
Also get your homocysteine level measured. If it is high then you are going to need to lower it with therapeutic levels of B6, B12 and folic acid, plus zinc and NAC. There are supplement formulas designed to do just this.
The best remedies for raising NO naturally are the combination of the amino acids arginine  and possibly citrilline with pycnogenol  (pine bark extract). Another amino acid, N-acetyl cysteine (NAC – from which the body makes glutathione) has been shown to raise NO . The combination of arginine (at 1.7 grams a day) with pycnogenol (40-120mg a day) was shown in one study to improve erectile function in over 90% of men.This combination was recently confirmed in a placebo controlled trial.
There are also some important foods, and food extracts to consider. Beetroot raises NO and thereby lowers blood pressure.
An easy way to get a beetroot effect is to have a glass of BeetActive, a concentrate of beetroot juice to which you add water. Also, eat it whenever you can.
Broccoli is another important food because it provides indole-3-carbonol (I3C) which is vital for detoxifying excess oestrogens. Some supplements contain I3C.
Also, do supplement the basics that I always recommend, namely a high potency multivitamin, extra vitamin C and essential fats with an emphasis of omega 3. The essential fatty acids DHA, DPA, vitamin C and E have also been shown to boost NO. it is also vital to get your vitamin D level up to optimum. Natural Health Practice do an Advanced Fertility Support for Men supplement.
All these recommendations are also helpful for cardiovascular and prostate health. Common myths abound about eating eggs increasing heart disease, and too much testosterone increasing prostate cancer risk, but these are not true.
Do let me know what works for you. 100% Health club member Joe G shared his experience: “When I retired at 65 I was overweight and showed all the signs of middle-aged spread. In addition, for a few years I had had erectile dysfunction and my sex life was non-existent. As I now realise this lack of testosterone shows itself in low libido or sexual desire, few sexual thoughts and no erection in the morning.
I read some of the books by Patrick Holford about low-GL diets and started to take a little exercise, mostly in the form of brisk walking up a steep hill. Over a year I dropped my weight from 85kg (13st) to 65 kg (10st) and reduced my waist by 2 trouser sizes.
However, the most surprising change was that my libido went through the roof. I would wake up in the morning with a raging hard-on and my brain was full of sexual thoughts. The benefit was that my sexual performance was revitalised and my wife and I now have a sex life like we did when we were in our thirties.
What an amazing result in 1 year from a change in diet and a little exercise!”
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2. Liu TC et al, ‘Effect of acute DHEA administration on free testosterone inmiddle-aged and young men following high-intensity interval training.’ Eur J Appl Physiol. 2013 Jul;113(7):1783-92see also Corona G et al., ‘Dehydroepiandrosterone supplementation in elderly men: a meta-analysis study of placebo-controlled trials.’ J Clin Endocrinol Metab. 2013 Sep;98(9):3615-26
3. Bode-Böger SM, Scalera F, Ignarro LJ., ‘The L-arginine paradox: Importance of the L-arginine/asymmetrical dimethylarginine ratio.’ Pharmacol Ther. 2007 Jun;114(3):295-306
4. S. Zibadi, ‘Reduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementation’, Nutrition Research, 2008;28:315–2000_
5. K.R. Gibson, T.J. Winterburn, et al., ‘Therapeutic potential of N-acetylcysteine as an antiplatelet agent in patients with type-2 diabetes’, Cardiovascular Diabetology, 2011 May;10:43.
6. Stanislavov R1, Nikolova V. ‘Treatment of erectile dysfunction with pycnogenol and L-arginine.’ J Sex Marital Ther. 2003 May-Jun;29(3):207-13
7. Aoki H et al., ‘Clinical assessment of a supplement of Pycnogenol® and L-arginine in Japanese patients with mild to moderate erectile dysfunction.’ Phytother Res. 2012 Feb;26(2):204-7
8. A.J. Webb, et al., ‘Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite’, Hypertension, 2008 Mar;51:784–790; also see F. J. Larsen, et al., ‘Dietary inorganic nitrate improves mitochondrial efficiency in humans’, Cell Metabolism, 2011;13(2):149–59 and D. A. Hobbs et al., ‘Blood pressure-lowering effects of beetroot juice and novel beetroot-enriched bread products in normotensive male subjects’, Br J Nutr. 2012 Dec 14;108(11):2066-74
9. T. A. Mori, ‘Omega-3 fatty acids and hypertension in humans’, Clinical and Experimental Pharmacology and Physiology, 2006 Sep:33(9):842-6