Why I Can’t Get Rock Hard Anymore

Hi!

I'm Dr. Anne Truong, MD

Dr. Anne Truong is a highly respected physician, best-selling author and internationally sought-after speaker on the topics of regenerative cell medicine, pain management, and applications for aesthetics and sexuality.

If you find yourself asking "why I can't get rock hard anymore", you may be experiencing erectile dysfunction. Remember that you're not alone in this- many men experience ED at some point in their lives. At least 30 million men have this issue. But don't worry, there are plenty of ways to treat ED, get rock hard naturally and get your sex life back on track.

If you're looking for a natural way to cure your erectile dysfunction, you've come to the right place. I'm going to share with you some of the most common causes of ED and how you can treat it without having to rely on expensive medications.

I Can't Get Rock Hard Anymore Episode Contents

I Can't Get Rock Hard Anymore Episode Video

The Common Problem When You Get Older

I can't get rock hard anymore as I grow older
Photographer: Kjartan Einarsson

Anne: Let's talk about why you're not getting rock-hard erections when you get older. Well, that is a sign of the beginning of erectile dysfunction. Now, erectile dysfunction is defined as inability for a man to get a firm erection for satisfactory sexual relations. That spanned from a spectrum of a longer to get an erection and compared to when you were probably when your mid-20's, late 20's. It takes you longer to get firm or that when you do get firm, it's not 100% like it was when you were younger.

And then the next part is that when it's firm, you lose it during penetration or during the erection or the intercourse. Then also including premature ejaculation, unable to orgasm, as well as unable to ejaculate, all the way to inability to have an erection at all.

Now, if you're able to have an erection at night or in the morning, like a morning erection without stimulation, that means that your mechanism of having an erection is still intact. It's just that when you're getting ready with a partner and you're not able to get an erection, there are other things involved, so I want to stress that an erection spans from able to get an erection and all the way to this end spectrum, not able to get erection at all.

There's a myth that says, "Well, I don't have ED because I still get erection." Well, that's wrong. You can still have ED and have erection, and that, "Well, I can ejaculate orgasm, therefore, I don't have ED." That's also not correct as well.

Women Can Get An Erection As Well

Anne: Let's kind of go back to, what is the natural sexual response for a man and a woman to have an erection? Now, a woman can get an erection as well, that woman has a female penis, which is the clitoris. The clitoris is four inches long and it looks like a wishbone, and it is an organ purely for sexual pleasure.

It has no other function beside for pleasure, so women, you can get an erection as well. It's just that you don't see it. 90% of the clitoris, that's hidden behind the clitoral hood, and it goes back and out like a wishbone, but you can get an erection in the, for woman, the labia majora, as well the labia minora, is also erectile tissue as well. Now, for a man, you have the corpus cavernosum, which is the two muscles that line the shaft, and then underneath that is the corpus spongiosum, which is the muscle that surround the urethra, is the hole where you urinate, and that encompasses the shaft, and then you have the glans, which is the tip.

How You Get An Erection

How You Get An Erection
Photographer: Allef Vinicius

Anne: Now, how do you get an erection? It's a very intricate, complicated process that involves six systems in your body, but we just take it for granted because it could appear so naturally. All these systems have to work perfect and synchronize with one another, but it all starts right here in the brain

So to get an erection, to get the sexual response, it starts here. How did that start? You get sensory input from your eyes, from the smell from your nose, and the taste from your mouth, the sound from your ears, and also from touch, so any type of sensory will stimulate, that feed into the brain, and it goes to the amygdala, which is the part of the midbrain right behind your eyes, and it goes to the limbic system, and that stimulate emotions. The emotions that you may have, that's what senses the arousal, and then hormones start getting released in the pituitary gland

The first system is the brain, second system is the emotion or psychological, and then the third is the hormones. The hormones then stimulate the nerve in your spinal cord here that goes to the sympathetic and the parasympathetic nervous system, which are two nerve chain that goes down along your spinal cord, and also within your spinal cord as well, and that.

The next system is the blood vessel, so the nerve will stimulate the blood vessel and the heart, the heart starts beating a little bit faster. Your blood vessels start to open up, so that way, you can get more increasing blood, which flows down to the penis, and then the last system is the muscle, which is the corpus spongiosum and the corpus cavernosum, the muscle of the penis, and for a woman, the woman do have corpus spongiosum and corpus cavernosum, which is the clitoris itself and also the labia. There's increasing blood flow, and then that's how the sexual organ gets engorged and how you can get arousal that will stimulate you to get to an orgasmic state, and then ejaculatory state.

Women can also have ejaculation as well. There are six system that needs to start, and if you go on my website, truongrehab.com, you can see the six systems that interplay with one another, like the brain, the emotion, the hormone, the nerve, the blood vessels, and then the muscle. That needs to all happen in order for you to get a sexual aroused response for a man as in an erection. Now, if you take Viagra, Viagra, all it does is, is to prevent you from reabsorbing nitrous oxide. Nitrous oxide open up blood vessels to promote more blood flow.

Skipping To Step 6

When you take Viagra, it works on your penis and give you an erection, but essentially, if you're taking Viagra, you're hijacking your natural response to create an erection, so you're just going to step six, which is the muscle, and you're skipping step one to five. You're skipping the brain, the emotion, the nerve, the blood vessels, and step one to five, which is critical to create sexual response. That's why over time, when you're taking these ED medications, you essentially lose your natural ability to have an erection because your body just gets confused. It doesn't know how to do it anymore. It doesn't know how to go from step one to six because you're already taking medication for step six to happen.

Yeah, it feels good to have a short-term relief that you're able to get an erection with Viagra and the medication, but in the long run, you're shooting yourself in the foot and you're going to end up in a black hole, and you're hijacking your natural response to have an erection

Back To The Basics

So back to the basics. Those are the six system that needs to occur in order to get an erection. Well, that's the cost, so sometime if you're not spending time to get the sensory arousal to get your brain aroused and produce that hormone, yeah, you may not be able to get an erection because it starts in the brain. So you have to be in the mood. You have to be aroused by the sensory

In my previous podcast episode, you will hear us talking about sensory arousal, getting into the mood, planning it out and not being stressed, and spending the time to communicate, touch, kiss, and even using aphrodisiac food to stimulate your sensory of the vision, the smell, the taste, the sound, and the touch. If you do that, your brain will be overloaded and you'll be aroused, so if you find out that you have ED, the cause may be that you're distracted. You're not spending enough time for sensory arousal.

The next part is emotion, that if you're too stressed, you're not thinking about sex or that you're not getting enough sleep, or there's underlying anxiety, and that will play a role in the transmission of the arousal and that needs to go through the brain that can transfer down to the nerve, so it could be that emotion, anxiety, depression, distraction, stress.

That system number three is the hormones. The hormones responsible for a male libido and erection is testosterone. Is the testosterone level normal? Is it low? Then, it may play a role in erectile response as well.

Then, number four is the nerve. Mainly, for a man to get an erection, he has to be relaxed. In order for him to get relaxed, the muscle of the penis have to be relaxed actually to get an erection. When the muscle of the penis, corpus cavernosum is actually contracted, it's actually in its flaccid state.

Yeah, I know it sounds like a contradiction because you're like, "Well, when the penis muscle is in the non-erectile state, actually the muscles, the corpus cavernosum is in a contracted state." When you have an erection, those muscles, the corpus cavernosum, corpus spongiosum have to be relaxed in order for it to expand, and that goes to the parasympathetic nervous system, which is responsible for erection. The sympathetic nervous system, which is the nerve, is responsible for fight-or-flight or emergency that save you from an emergency situation. That's responsible for ejaculation, and if you're stressed or you're not getting enough sleep, the sympathetic nervous system overrides the parasympathetic nervous system, and therefore, it may contribute to you not able to get an erection. That's the nerve.

The next part is the blood vessels. Well, in the blood vessel, that's where, if the blood vessels are not able to relax and expand to allow the blood to flow into the penis, then you're going to have decreased blood flow problems. Imagine a pipe when you're younger. Your pipe is this big, but then as you get older, your pipe may get smaller. However, other condition that affect how the opening of the pipe or your blood vessels are high blood pressure, high cholesterol, diabetes. Those are the main thing, and smoking.

Those are the main factors that can actually make the blood vessels smaller or constricted, that is not able to expand, and therefore, you're not able to get more blood flow to the penis muscles.

That's why lifestyles, such as what you eat, how you exercise, all that play a big role in affecting the opening of the blood vessels. The next system then is the muscles, the muscles of the penis. Like I mentioned before, in order for the penis to have an erection, it needs to be in relaxed state, and that it needs to be able to expand, so if you don't have a frequent erection, your muscle will actually atrophy or get smaller, and then the plasticity or the expansion of the penis muscle is not as flexible as it used to be, so that will affect it as well too, and so that's why I keep saying, well, you don't use it, you lose it. You don't use it, the muscle's not going to be as flexible.

It's not going to be responsive and that you if you don't use it, you're not going to get that blood flow that is needed to go into the penis because you're not exercising your muscle. Kind of like when you go to the gym, you don't go to the gym often, then your muscles in your arms and your legs will atrophy, will get smaller, but you go to the gym frequently, which is at least three times a week, then it's going to be a challenge, so every time you go to the gym, you get more blood flow to the muscles, and therefore, it expands, and then the muscle rips, and then it's how you get bigger muscles.

Well, the penis muscle doesn't rip, but if you continue to get blood flow down to the penis muscle, the responsive capability of the muscle to respond is a lot better. Having said that, those are the six response and those multiple steps can be involved. If it's not working well, then it's going to be a desynchrony of the erection part.

Treating ED By System

Treating ED By System
Photographer: Natasha Connell

How do you treat that? Well, you treat it by looking at the six systems. Well, first, let's look at the first system, the brain, The largest sexual organ, right? Are you spending enough time in sensory arousal during or before intercourse, use your five sensory responses to get aroused, and two, how's your emotion?

Are you anxious, depressed? Or are you just focusing on performance only? Now, you can still have a good sexual response and have orgasm without concentrating on just the end result of getting erection and penetration. We'll talk about that more in our episodes as well about performance anxiety and focusing more on emotional bond and communication.

Hormones

Number three is hormones. What's your hormones level? If your testosterone level's low, which can be easily be done with measuring your blood level and make sure that you don't have any other causes. I also want to mention that cortisol level is the stress hormone that gets released it. If the cortisol level is high, it's going to affect the other hormones as well.

It's going to affect thyroid, it's going to affect insulin, and therefore, stress. Stress is what raises the cortisol level and continuous stress raise the cortisol level for too long, and then it becomes too low, and then your hormones are not responsive at all, so cortisol level is important. That's related to stress, and stress is also going to affect your hormones, and stress is going to affect your sleep, and stress is going to affect your emotional state. We're on hormones, so check get your testosterone level check, and is it low? Well, there are certain things that you can actually increase it.

How? Well, you can increase your own testosterone level by sleeping better, like get restful sleep for seven hours a day, go to bed by, between 10:00 to 6:00. That's when your body heals, is at least sleep seven hours. How do you raise your testosterone level? Well, weight loss.

I've seen many of my patients that has low testosterone level, and they lose about 10 to 20 pounds and they exercise about three times a week with just high interval training. Their testosterone level double without any additional supplemental testosterone treatment. Now, if you find out that your testosterone level is low, change your diet to a Mediterranean diet or doing high interval training, which is HIIT training. All you need to do is about 30 minutes three times a week, and then see what your weight is, and then try to get seven hours of sleep, and don't focus on just the performance. Focus on bonding, communication.

See what does that. See what happens because you'll find out that your testosterone level may raise enough to a level that may affect your erection. That's hormones, but if you do that and your levels are still low, then your doctor who is experienced in doing hormone replacement therapy is able to give you additional hormone, such as testosterone, either can be taken as an injection or through a pellet.

Nerve

The next part is the nerve, and the nerve is a parasympathetic and sympathetic. In order for you to get an erection, the parasympathetic nervous system has to be in dominance over the sympathetic nervous system, which the parasympathetic is called the breed-and-eat because it's a system that help you reproduce.

That's why it's called breed, And then systems that, when you're relaxed, you want to eat, you want to enjoy. That has to be at the predominant nervous track, and how do you do that? To relax, enjoy, mindfulness, and know that you need to activate the parasympathetic by enjoying the sensory, like I spoke about before, where activating the arousal system in the brain and meditate. Meditation will help activate the parasympathetic nervous system, as well as slowing down your breathing. When you slow down your breathing and take diaphragmatic breath, diaphragmatic breath is breathing into the nose and hold it for a count of six, and then breathing out to your mouth and holding for a count of six.

It's called diaphragmatic breathing, like yoga breathing. When you do that, you actually will slow down your heart rate, slow down your breath rate, and that will activate the parasympathetic nervous system. Those are just some strategies for you to tap into.

Blood Vessel

Then, the next system is the blood vessels. Well, the blood vessels are under autonomic nervous system control, and so the way that you can help open up those blood vessels more is what you eat, what you put into your body. If you drink sodas or if you eat a lot of carb, that will kind of produce insulin resistance, and insulin resistance will affect your thyroid, and then will raise your cortisol level, and will actually decrease your testosterone, so change your diet.

Decrease the carb. Decrease the red meat, and I suggest a Mediterranean diet. A Mediterranean diet, you're allowed to have a glass of red wine a day and you're even allowed to have multi-grain bread, but not focusing on red meat and not focusing on carb, but getting a lot of fruits and vegetables into your daily diet regimen. I can't tell you how many patients I have that their daily diet regimen is Coke or diet Coke, followed by fast food. Well, that itself will cause insulin resistance, which then will decrease your testosterone level, then increases your cortisol level, and that's what's going to affect your erection.

Blood vessel can be controlled with diet, and then also exercise. If you do high interval training exercise only 30 minute three times a week, you'll be able to allow the blood vessel to expand easier, and it becomes more flexible, right? That's how exercise work. Exercise will also help with the heart. The heart will be able to pump better as well too.

I always tell my patient in order for you to get that erection again, I want you to feel like when you're in your teens, 18 or in your 20's, when you feel horny, when you are aroused so easily and you get that flush feeling, you get the heart rate, and the sweatiness, is that when you're feeling aroused, and that is if you get into that state, you're there. The next system is the muscles. The muscles of the penis, how do you do that? Well, make sure that you use it or lose it, you know?

You can get an erectile response with a vacuum pump, where you use a negative pressure pump with cylinder, where negative pressure will help you get an erection through the pump, and that will help you bring in some more blood vessels into the muscles as well. It's almost like taking your penis to the gym.

That will help with the expansive capability of the penis muscle and getting some feedback into it as well, or have sex more often, then you'll get more blood flow into the penis and help the muscle expand better. There are definitely ways that you can do at home to activate the sexual response or those six systems. Then, if you do all that and still not working well, then time to see a doctor who is able to be the sexual expert that understands the six systems. One way to increase your blood flow is getting treatment with low intensity shockwave therapy, and that will help increase the blood flow, as well as the flexibility of the penis muscles, as well as activating the nerve that are in the penis.

Other Treatments

Anne: Another treatment is platelet-rich plasma, PRP, injected into the penis, which then help create more blood flow, which also rejuvenate the muscles of the penis, as well decrease inflammation in the penis. Then, the third method is hormone replacement therapy, where you get extra additional testosterone that you can't make on your own, which then will help with the testosterone, actually help with nitrous oxide, which help with increasing blood flow to the penis, and diet.

Final Thoughts

Anne: I can't stress to you how important it is for diet and exercise because the diet will help with the insulin resistance, which then help balance the hormones, and also the exercise, which then help with the heart pumping, as well as opening up the blood vessels. That's why we stress on diet and exercise. You start with that first, start with getting enough sleep, and start with de-stresing and not focusing on just the end result.

When you start with that, you'll be surprised that you're going to go get a result and make remarkable progress because I feel that you need to start that part first before you go for additional treatment because I see it work in my patients, and I see the blood levels changes, and even if you just change your diet, your liver function test will also improve, and as well as your cholesterol. If you change your diet and you exercise, your cholesterol levels go down, so you can get rid of taking those anti-high blood pressure medication, those high cholesterol medicine, or even your diabetic pill. When you have diabetes, that's going to affect your erection as well. That's a quick review of the causes of ED and treatment, and answers to question why you're not getting rock-hard erection.

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