Erectile dysfunction is becoming more and more common. It used to be the most common in older men, but now a large percentage of young men are also suffering from it.
Older men experience erectile dysfunction (ED) at an increased frequency and severity compared to younger men. This is due to a decrease in nitric oxide production and bioavailability and an increase in reactive oxygen species.
The first option for sexual dysfunction is usually male enhancement pills (e.g. Viagra, etc.). Next in line is dietary supplements, such as vitamin supplements.
One of those vitamins is vitamin C (aka ascorbic acid), which is what we’ll cover in this article.
2 main ED symptoms include:
- Inability to get stiff enough for penetration
- Inability to keep an erection long enough (losing an erection quickly)
Health Benefits of Vitamin C
Vitamin C is a natural anti-oxidant found in our diet. Since we can’t synthesize it ourselves, it’s essential that we consume it through our diet.
Vitamin C is involved in:
- Collagen synthesis (for better skin, hair, nails, vascular health, etc.)
- Neurotransmitter synthesis (to improve mood)
- Proper functioning of the immune system
- Energy production
- Fat loss (helps with carnitine synthesis)
Linus Pauling has popularized vitamin C to help with many health conditions, such as heart disease, cancer, etc.
Vitamin C sources
Vitamin C rich foods include:
- Citrus fruits
- Black currant
- Kakadu plums
Vitamin C for erectile dysfunction
Interestingly, no direct study has been done on vitamin C and penile erection. Meaning, no one (scientists) has given men vitamin C supplements to see if their erections improve or not. This is odd since vitamin C is one of the most supplemented vitamins out there.
But the absence of evidence is not evidence of absence.
Vitamin C can help to improve erections through a variety of mechanisms. Let’s dive into those.
Vitamin C and nitric oxide
Nitric oxide (NO) is the main vasodilator that plays a major role in erections.
NO is produced by endothelial, neural and inducible nitric oxide (eNOS, nNOS, and iNOS respectively). All 3 enzymes are found in the penis.
Nitric oxide production requires a specific cofactor, namely BH4. BH4 is created in the Tetrahydrobiopterin salvage pathway, which is coupled with the folate cycle. Let’s look at some biochemical pathways.
For optimal NO production, you need vitamin B2, B3, B6, B9 (folate) and B12.
Vitamin C helps to increase folate and BH4.
Vitamin C and eNOS
eNOS produces NO in the penis allowing for proper relaxation of the muscles in the penis. This allows more blood to flow in and it also prevents blood from flowing out. Hence, getting an erection.
eNOS has two “states”; coupled and uncoupled.
Coupled eNOS produces NO, whereas uncoupled eNOS produces superoxide (a free radical). We want eNOS in its coupled state.
Free radicals, such as superoxide, uncouple eNOS. Vitamin C, by neutralizing superoxide, prevents eNOS uncoupling.
Although vitamin C doesn’t directly stimulate NOS, it can still increase eNOS by increasing BH4, 5-MTHF and neutralizing superoxide.
Nitric oxide and erections
Vitamin C and BH4
BH4 is a cofactor for dopamine and NO synthesis, both of which are needed for erections.
BH4 is also an antioxidant, so if you have oxidative stress, BH4 will most likely be low, which will lead to low NO and dopamine.
This study found that 8-Isoprostane (a free radical reaction product) content in endothelium and smooth muscle was significantly higher in ED peeps compared to non-ED peeps. Oxidative stress depletes BH4, which then uncouples eNOS to create free radicals, instead of NO.
Relative to the placebo, a single dose of 200 mg BH4 increased the duration of (> 60%) penile rigidity to 33.5 min at the base and 29.4 min at the tip.
A 500 mg dose increased the duration of > 60% penile rigidity to 36.1 min at the base and 33.7 min at the tip (R).
BH4 is pretty expensive so I’d rather focus on lowering oxidative stress and eating a nutrient-dense diet. Other anti-oxidants, such as vit C can increase BH4 through a sparing mechanism.
Vitamin C and folate
Low folate is an independent risk factor for ED. Men with severe ED have much lower folate compared to men with mild ED (R).
The folate cycle helps to create BH4. Without the folate cycle (or during undermethylation), you’d have insufficient BH4 levels, leading to low NO production.
Folate itself is also an antioxidant.
Low folate can lead to higher homocysteine, which is elevated in people with ED and CVD. There is a significant association between ED, folate deficiency and hyperhomocysteinemia. However, there is a lack of correlation between folate and homocysteine (R).
This means that folate deficit may directly impair erectile function. You can have normal homocysteine, but low folate, which leads to low NO and dopamine. The ability of folate to increase NO generation is independent of its ability to lower homocysteine levels (R).
Interestingly, 5MTHF (check enzyme in the folate cycle above) is:
- Not only required to recycle BH2 into BH4, but
- May act as a direct scavenger of reactive oxygen species (ROS): in particular, 5-MTHF seems to prevent BH4 destruction by ONOO− (peroxynitrite (created when NO reacts with superoxide free radical)). Last but not least,
- The chemical structure of 5-MTHF seems to be very similar to that of BH4 and it may be able to bind directly to the pterin site in eNOS stimulating NO production.
Vitamin C has been shown to significantly increased folate levels as well as 5-methyl-tetrahydrofolate (R).
Another benefit of folate is that it can help with premature ejaculation as well.
Vitamin C on NO bioavailability
Superoxide can react directly with NO to produce peroxynitrite, which is one of the most powerful and harmful free radicals.
Vitamin C can deactivate superoxide (convert it to hydrogen peroxide (H2O2)) and spare NO, similar to how it spares BH4 and folate.
H2O2, which is still a free radical, can actually help with vasodilation itself.
Another way vitamin C can help to lower superoxide is to inhibit NADPH oxidase (NOX). NOX becomes upregulated in diabetes, hypertension and on a low-sodium diet.
A low sodium diet increases aldosterone (which helps retain sodium) but increases NOX in the process (R). This leads to vascular damage over time.
Neutralizing superoxide produced by NOX (with vitamin C) spares NO availability.
Vitamin C, reactive oxygen species and NO
As we age, NO production goes down and free radical production goes up. This enhances the need for antioxidants, such as vitamin C, vitamin E, CoQ10, glutathione, etc.
This study found that there is a synergistic effect between vitamin E and sildenafil. Vitamin E and sildenafil on their own only partially restored nNOS expression in the penis of old rats. But when combined, a synergistic elevation in nNOS was observed (R).
Vitamin C helps to recycle vitamin E, and thus also plays a role in enhancing nNOS expression and NO production.
Vitamin C and nitric oxide summary
Vitamin C helps with erections because it can increase NO by:
- Increasing BH4
- Increasing folate and 5-methyl-tetrahydrofolate
- Preventing eNOS uncoupling
- Preventing NO deactivation by free radicals
As a result of higher NO and healthier vasculature, blood vessels dilate better in response to acetylcholine when there is enough vitamin C (R).
Vitamin C and blood flow
Vitamin C can help to improve blood flow by increasing NO and enhancing vascular sensitivity to acetylcholine (which promotes vasodilation). It’s also helpful for people with hypertension (R).
In terms of vascular health, although vitamin C in large doses is unlikely to significantly improve vascular function, a deficiency can worsen it and cause endothelial dysfunction (R).
When someone has hypertension or diabetes, suffer from sleep apnea, smoke, etc., their requirements for vitamin C goes up.
Vitamin C and psychogenic ED
ED isn’t just physical. Meaning, it’s not just due to structural changes. It’s also due to mental changes, such as loss of libido, loss of interest, loss of sensation, etc.
These changes are due to low dopamine, noradrenaline, glutamate, testosterone and oxytocin and high cortisol (R).
Vitamin C, dopamine, noradrenaline and ED
Vitamin C, by increasing BH4, helps to create dopamine (dopamine synthesis requires BH4). Furthermore, vitamin C is a cofactor for the enzyme dopamine-beta-hydroxylase (DBH). DBH converts dopamine to noradrenaline.
Both dopamine and noradrenaline help to increase libido and improve erections.
Apomorphine is a dopaminergic drug often prescribed by a healthcare provider to boost libido and help with erectile dysfunction (R). It’s often recommended with other prescription medications, such as Viagra or Cialis.
Chronic psychological and physical stresses induce erectile dysfunction, possibly due to neurotransmitter changes and reduced blood flow to the penis (R).
Vitamin C, oxytocin and ED
Vitamin C has been shown to increase oxytocin both directly and indirectly. One of the ways dopamine helps with erections is by activating the central oxytocinergic neurons in the brain (R).
Intranasal oxytocin has been shown to positively impact a number of components of sexual function, including libido, erection, and orgasm (R).
Vitamin C, cortisol and ED
Individuals who are stressed and depressed have a higher risk of ED. Who is in the mood for le’ sexy time when you’re down, right?
Vitamin C lowers cortisol and perceived stress in stressful situations (R).
Vitamin C and sexual function
In this study, they gave couples 3g of vitamin C for 14 days and looked at a variety of sexual outcomes.
Interestingly, what changed the most, is the sexual frequency between couples who didn’t live together.
The sexual frequency between couples living together didn’t change much.
This indicates that vitamin C has a powerful effect on libido and desire. When you are not together, vitamin C likely enhances that longing and desire for one another.
The vitamin C group had significantly more sex over these 14 days compared to those that didn’t get vitamin C (8.4 vs. 5.0) (R).
Can Vitamin C Improve Other Aspects of Male Sexual Health?
Yes, such as improving libido, mood, stress tolerance and sperm and testicular health.
Consuming vitamin C significantly improves sperm concentration and mobility (R).
1g of vitamin C twice daily for 2 months significantly improved fertility (R). It increased:
- mean sperm count from 14.3 +/- 7.38 x 10(6) to 32.8 +/- 10.3 x 10(6) sperms/mL
- mean sperm motility from 31.2 +/- 9.61% to 60.1 +/- 8.47%
- mean sperms with normal morphology from 43 +/- 7.87% to 66.7 +/- 4.77%
In rats, vitamin C has also been shown to increase testosterone levels (R). Testosterone is very important for penile health, libido and erections.
If you’d like to optimize your testosterone for better erections, check out the following vid.
10 most important fundamentals for high testosterone
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What other vitamins also help with ED?
As mentioned above, most of the B vitamins, namely, B2, B3, B6, B9 and B12 are needed to create NO and dopamine.
It’s not that you might have a vitamin deficiency, but supplementing large doses (more than you might need), might have additional benefits.
Additionally, people with low vitamin D levels are almost more likely to suffer from ED. It’s most likely not just vitamin D that plays a role, but rather sunlight specifically. People who get less sunlight have lower testosterone, dopamine, NO bioavailability, blood flow, vitamin D, etc. Be sure to get lots of sunlight if you want to have great erections.
If you don’t get any sunlight for many months, then it’s ok to use a vitamin D supplement. It will just likely not have the same benefits as sunlight.
Related articles on sunlight, vitamin D and erections:
- Shedding light on the one thing an Alpha Energy Male needs more of
- Get your penis to work with this big bad steroid
- Viagra not working: do this!
Alternative Ways to Treat Erectile Dysfunction
Alternative ways to improve erectile function include losing weight, improving insulin sensitivity, optimizing sleep, managing stress, improving relationships, shockwave therapy, eliminating ultra-processed foods, getting lots of sunlight, increasing physical activity, etc.
When it comes to improving erectile function, I always focus on diet and lifestyle first. Without optimizing those, supplements might only help a little and likely stop working after a while.
Summary on vitamin C for erectile dysfunction
Vitamin C plays an important role in erections, mainly by:
- Increasing nitric oxide and dopamine
- Improving vascular health (and reducing the risk of cardiovascular disease and hypertension (high blood pressure))
- Lower superoxide and increase H2O2, which promotes vasodilation
In humans, doses of 500mg/day of vitamin C may be required to achieve vasodilation and decrease blood pressure (R).
It’s important that if you want to optimize your erections, it’s best to not only use supplements, but also make lifestyle changes such as activity, stress, sleep, and eat a nutrient-dense balanced diet so that you get enough vitamins and minerals.
Check out this article to learn about more herbal supplements that can help with ED treatment.