Can carnivore diet cause erectile dysfunction? Here’s how!

Can carnivore diet cause erectile dysfunction? Absolutely.

Let me show you how. It has to do with a drop in DHEA, free testosterone and likely DHT as well.

Let’s dive in.

Hormones needed for erections

Most hormones and neurotransmitters play a role in erectile function. The important ones to focus on include:

• DHEA and DHEA-S
• Free testosterone
• DHT
• Noradrenaline and adrenaline
• Thyroid hormone T3

So can carnivore diet cause erectile dysfunction by altering these hormones? Absolutely. These are the markers I look at when some doing keto or carnivore has erectile dysfunction.

Carnivore diet on DHEA (for erectile function)

DHEA on erectile function

DHEA-sulfate (DHEA-S), which is the storage form of the adrenal steroid DHEA, is the only steroid investigated that was inversely correlated with ED prevalence according to the Massachusetts Male Aging Study, which investigated 17 hormones in total.

This data was later confirmed by another study, which demonstrated that DHEA-S levels were significantly lower in men with ED in comparison to age-matched normal controls (R). (orange line is DHEA-S levels of men with ED)

Oral or topical DHEA may be of benefit to patients with ED who have hypertension or to people without organic issues such as vascular, metabolic or neurological disorders.

There are no ED-related benefits to DHEA supplementation on patients with diabetes mellitus or neurological disorders (R).

Ketogenic diets on DHEA levels (scientific evidence)

There is one study that I could find on this. 7 days of a ketogenic diet increased DHEA-S from 242 to 323mcg/dl in people with Rheumatoid arthritis (R). Cortisol also increased from 325 to 371nmol/L. This could simply be a short-term effect since low carb intake stimulates the adrenals, releasing both DHEA and cortisol. If DHEA went up and cortisol down, that would have been good, but it didn’t happen in this case (at least short term).

Over time with prolonged stress (low carb), DHEA starts to go down. Which is what I’ve seen in most keto and carnivore peeps’ blood work.

DHEA levels in people doing carnivore or keto (anecdotal evidence)

Here are 3 examples of DHEA levels of men I’ve worked with that either did keto or carnivore for a while.

Example 1 – 38 year old male

He did carnivore for about a year and started experiencing zero libido. He then did some tests and reached out to me.

His DHEA-S was quite low.

Example 2 – 41-year-old male

This guy didn’t do a carnivore diet, but was doing keto for at least 2 years after which, his DHEA-S ended up on the low end.

Example 3 – 52 year old male

He did carnivore for close to 2 years after which, his DHEA-S was also on the low end.

In all cases, DHEA-S was on the low side.

Can carnivore diet cause erectile dysfunction by lowering DHEA-S? Since DHEA is involved in sexual function and erections, it’s highly likely that if your DHEA is low, it contributes to either low T and/or ED.

Carnivore diet on free testosterone (for erectile function)

Importance of free testosterone on erectile function

Testosterone is most well-known for promoting libido and erections. Testosterone promotes erections through nitric oxide-dependent and independent pathways.

Testosterone is necessary for normal erectile function, and low testosterone produces decreased firmness, ability to maintain erections, and number of erections achieved, all of which are improved with testosterone treatment.

The severity of ED is significantly associated with decreases in total and bioavailable testosterone. Individuals with low bioavailable testosterone have a three times higher risk of severe ED compared with men with bioavailable testosterone greater than 1ng/mL (R).

Men with low free T have a 3 fold great risk of experiencing severe ED. pic.twitter.com/clYzkiCUVJ

— Hans Amato || testosterone optimization (@HansAmato) August 21, 2023

Research also found that Viagra responders appear to have higher testosterone than those that don’t (R).

In a randomized, placebo‐controlled study with 120 men with ED who failed sildenafil treatment (100‐mg dose) on six consecutive attempts, had much lower testosterone than the responders. One month after treatment with oral testosterone and sildenafil on demand, there was a significant improvement in ED (R). It also increased sexual activity from 0.5 to 3-4 per month.

Men who are Viagra non-responders tend to have significantly lower total and free testosterone compared to Viagra responders.

Giving these men TRT dramatically improved erectile responses to Viagra.

(Y axis is testosterone levels) pic.twitter.com/QrmSuu0cof

— Hans Amato || testosterone optimization (@HansAmato) August 21, 2023

Additionally, when ED was induced by high estradiol levels (excess aromatase), testosterone therapy did not help restore erections as long as the high estradiol was maintained (R).

Just increasing bioavailable testosterone with TRT (not increasing total T) has been shown to improve erectile function (R).

🥒 A breakdown of all the hormones needed for proper erections

Ketogenic diets on free testosterone levels (scientific evidence)

Carbs and insulin suppresses SHBG production and on a low-carb diet, insulin drops a lot, which then increases SHBG production.

According to this 2023 study, a very low-calorie ketogenic diet

• Significantly increased total testosterone after 7 days (+35 ± 64 ng/dl) and 28 days (+74 ± 97 ng/dl)
• Significantly increased SHBG after 7 (+2.1 ± 4.1) and 28 days (+7.7 ± 10.0). However,

Both calculated free testosterone and LH did not change after 7 or 28 days of this diet.

More total T, but no increase in free T.

Free testosterone levels in people doing carnivore or keto (anecdotal evidence)

Example 1 – 51 male

He did a carnivore diet for 2 years after which his testosterone was 732.

But as you can see his free testosterone is 10.5pg/ml. Very close to the lower end of the range. His testosterone will likely be even higher if his LH increased more, but the low-carb diet is keeping his LH low. Also, he lost 30 lbs despite being already slim, so likely he was undereating, which was keeping his LH suppressed.

Example 2 – 38 year old male

He did carnivore for about a year and started experiencing zero libido. He then did some tests and reached out to me. His total testosterone was just over 900ng/dl, but his SHBG was very high and his free testosterone was also close to the bottom of the range.

Example 3 – 41-year-old male

This guy didn’t do a carnivore diet but was doing keto for at least 2 years. His testosterone was almost 1000ng/dl, but his SHBG was very high, which tanked his free testosterone.

Can carnivore diet cause erectile dysfunction by lowering free testosterone? Since men with low free T are at a higher risk of severe ED and low bioavailable T correlates with sexual dysfunction, low free T can definitely contribute to ED.

Carnivore diet on DHT (for erectile function)

DHT is the alpha male hormone, much more potent than testosterone itself. It’s been shown that serum DHT concentration is the sole independent predictor of orgasm frequency, a surrogate for overall male sexual function (R).

DHT has a higher affinity for the androgen receptors and is more effective at increasing nitric oxide (NO) synthase expression than total testosterone.

Blocking it with 5-alpha reductase (5-AR) inhibitors, such as finasteride or dutasteride worsens ED and lowers libido and orgasm quality. The use of finasteride causes ED in 20% to 40% for men aged <69 years and this % increases much more in men in their 70s and 80s (R).

Here’s a graph of the average DHT levels with age for reference for the anecdotes below.

Ketogenic diets on DHT levels (scientific evidence)

There aren’t any studies looking at ketogenic diets and DHT, but it has been shown that insulin and NADPH (produced from glucose) stimulate 5-alpha reductase.

Also, there is evidence to suggest that DHT is higher on a high carb vs a low carb diet.

Make sure you eat enough carbs if you want to maximize your DHT.

Low-carb diets lower DHT by:
– lowering insulin
– lowering NADPH pic.twitter.com/TQWlspAQ5u

— Hans Amato || testosterone optimization (@HansAmato) July 10, 2023

DHT levels in people doing carnivore or keto (anecdotal evidence)

Even though these 2 guys’ DHT isn’t considered low (based on the reference range provided), compared to other men their age (see graph above), theirs are much lower.

Example 1 – 51 male

Example 2 – 41-year-old male

Can carnivore diet cause erectile dysfunction by lowering DHT? It depends on how sensitive someone is to their androgens and how much of the DHT is free to bind to the androgen receptor. But oftentimes, men with low DHT are more prone to sexual dysfunction than men with high DHT.

Elevated noradrenaline and adrenaline as a cause of ED

Catecholamines play an important role in erections. Too little and it might be difficult to become aroused and get an erection, but too much can completely kill your erection. Common symptoms of excess catecholamines include hard and short flaccid, tight balls and premature ejaculation.

Catecholamines go up during a ketogenic diet to stimulate lipolysis (R).

Rats fed the ketogenic diet had two-fold higher extracellular noradrenaline levels than rats fed the normal diet (R).

Doing a carnivore diet (zero carb) for too long will eventually nip you in the butt due to excess catecholamines.

Thyroid hormone T3 importance for erections

32.9% of patients with hypothyroidism also have hypogonadism (R). And both hypo- and hyperthyroidism lead to a higher chance of ED (R, R, R, R).

Your hormones, such as testosterone and DHT is proportional to your thyroid hormones. When thyroid hormones drop, so do your testosterone and DHT. When thyroid hormones go up…you get the idea.

Thyroid hormones, especially T3, increase testosterone and to a greater extent DHT. If libido is low and you have weak erections, look to PTH and thyroid levels. But don’t just check for TSH alone, check for total and free T4 and T3 and reverse T3 as well.

Ketogenic diets on T3 levels (scientific evidence)

It’s relatively well known that a ketogenic diet suppresses thyroid function. TSH stimulates the thyroid to produce thyroid hormones. T4 is the prohormone to T3, which is the active form. Deiodinase 1 and 2 converts T4 into T3. But T4 can also be converted to rT3. rT3 blocks the effects of T3. So a high rT3 to T3 ratio is non-ideal and can cause thyroid hormone resistance.

In most cases, a ketogenic diet will lower T3 levels (impaired conversion from T4) and increase rT3.

Even a short 3-week duration is enough to lower T3 and decrease the T3 to T4 ratio (R).

Even 3 weeks of a keto diet is enough to lower T3 and worsen the T3 to T4 ratio. pic.twitter.com/P9vsZPSrx9

— Hans Amato || testosterone optimization (@HansAmato) August 22, 2023

If your doctor is only looking at TSH and T4, it might seem like you’re doing better. TSH might go down and T4 up. It looks great right!?

Not so fast, look at T3 and rT3 as well.

Doing a keto diet for 12 weeks has been shown to significantly reduce T3 and fT3 values by 13.4% and 10.6%, respectively. It also increased fT4 by 12.1% and slightly increased rT3 (R). All in all, it dramatically lowers the T3/T4 and T3/rT3 ratio putting you in a more hypothyroid state.

T3 levels in people doing carnivore or keto (anecdotal evidence)

Example – 51 year old male

Example 2 – 41 year old male

It’s not guaranteed that T3 will drop. I’ve worked with carnivores with normal T3 and rT3 and they had no hypothyroid symptoms. But I’d say that it’s best to expect that your T3 will drop, so if you suffer from ED, have it checked.

Summary – Can carnivore diet cause erectile dysfunction?

It’s very possible to experience ED on a carnivore diet.

On one end, in the short term (<1 year), a carnivore diet can help with erections because it:

• Fixes nutritional deficiencies
• Reduces inflammation
• Reduces excess body weight
• Increases total testosterone
• Improves insulin sensitivity

But in the long term, it might contribute to ED by:

• Lowering DHEA
• Lowering free testosterone
• Lowering DHT
• Lowering T3
• Increasing catecholamines

Should I stop the carnivore diet to fix ED?

No, just add more carbs back in that you tolerate well. Carbs like honey, fruit, milk and easy-to-digest staches.

Check out:

• No libido on carnivore? Here’s why!
• Can a carnivore diet increase testosterone?
• Complete guide on how to maximize free testosterone
• Free testosterone with age
• Complete guide on how to increase DHEA
• Testosterone with age: does it really decline?
• Complete guide on how to increase total testosterone

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