Can ED be reversed? Causes that can improve when treated
The short answer
Sometimes. No single treatment is described as a cure for ED in general, but some causes can improve when they are treated: weight, inactivity, smoking, a medicine that can be changed, stress or anxiety, and low testosterone. ED after prostate surgery may recover partly, fully or not at all. A clinician can sort out which causes apply.
In short: whether ED can be reversed depends on what is causing it. The National Institutes of Health (NIH) says health care professionals treat the underlying cause of erectile dysfunction when possible, and focus on improving sexual function when the exact cause is not known (NIDDK, Treatment for ED). Some causes, such as inactivity, excess weight, smoking, a medicine that can be changed, stress or low testosterone, can improve when they are addressed. Others, such as nerve damage from surgery, may recover only partly or not at all. This guide sets out what the sources say about each, without promising an outcome to anyone.
Can erectile dysfunction be cured?
For some men, ED improves enough that it stops being a problem, but no source we read describes a cure for ED as a whole. The NIH frames treatment around the cause: treat it when possible, and otherwise focus on improving sexual function (NIDDK, Treatment for ED). The American Urological Association (AUA) guideline describes its aim as “restoring sexual function” and enhancing quality of life, and it advises that all men, whether or not they choose ED treatment, address any underlying medical issues that may contribute (AUA, Erectile Dysfunction Guideline). So the honest answer to “can it be cured” is “it depends on why it is happening,” which is why finding the cause comes first.
Is erectile dysfunction permanent?
Not necessarily. In a population study in Adelaide, Australia, 810 men aged 35 to 80 were assessed twice, 5 years apart. Among the men who had ED at the start, 29.0% no longer had it at follow-up, while 31.7% of the men without ED at the start developed it over the same period (Martin et al., J Sex Med 2014). The authors described sexual dysfunction in aging men as “a dynamic disorder” whose onset and remission were predicted by “a range of modifiable risk factors.” Men who were younger, employed and free of diabetes, angina, abnormal blood fat levels and certain urinary symptoms were more likely to see ED resolve. That is an observational finding about groups, so it cannot tell any one man whether his ED will lift, and it does not show that changing one factor caused the change.
Which causes of ED can improve when treated?
Several causes on the NIH list can be changed, managed or treated. The NIH says ED can come from conditions that affect blood vessels, nerves or hormones, from certain medicines, from mental or emotional issues, and from lifestyle behaviors (NIDDK, Symptoms & Causes of ED). The table below pairs each group with what the sources say can be done about it. “Can improve” is the most any of them promises.
| Cause group | What the sources say can be done | How much it may help |
|---|---|---|
| Inactivity, excess weight, smoking, alcohol, drug use | NIH lists quitting smoking, limiting alcohol, more activity, a healthy weight, healthy eating and stopping drug use | Trials show modest average gains in erectile function scores; some men reach the normal range |
| A medicine taken for another condition | A clinician may review it and suggest a different dose or medicine; do not stop it on your own | Depends on whether the medicine is part of the cause |
| Stress, anxiety, depression | NIH says counseling can help when emotional issues affect ED; the AUA says referral to a mental health professional should be considered | Varies by person; no single figure applies |
| Low testosterone | NIH says testosterone may be prescribed with ED pills; the AUA says ED pills may work better combined with testosterone therapy | AUA meta-analysis found a 2.69-point greater gain with the combination than with ED pills alone |
| Diabetes, high blood pressure, heart and vessel disease | Manage the condition; AUA says lifestyle change improves overall health and may improve erectile function | Small positive effects in the AUA’s review; in diabetes, weight loss mostly helped keep function from worsening |
| Nerve damage, including after prostate surgery | Recovery depends on whether nerves were spared; other ED treatments remain options | Recovery is often slow and partial; when nerves are not spared, the AUA expects an unrecoverable loss |
Sources: NIDDK, Treatment for ED, NIDDK, Symptoms & Causes of ED, the AUA Erectile Dysfunction Guideline and the trials cited below.
What can lifestyle changes do for ED?
Lifestyle change can improve erectile function for some men, and the measured gains are modest on average. AUA Guideline Statement 7 says clinicians should counsel men with ED who have conditions known to affect erections that changes in diet and more physical activity “improve overall health and may improve erectile function.” The AUA’s own reading of the research is that these interventions “may have small positive effects on erectile function and broader, positive effects on overall health” (AUA, Erectile Dysfunction Guideline). The NIH adds that “sometimes, changing a daily habit could help prevent or improve your ED” (NIDDK, Treatment for ED).
The trials give a sense of scale:
- Aerobic exercise. A 2023 meta-analysis of 11 randomized trials found aerobic exercise raised scores on the erectile function part of the International Index of Erectile Function (a 6 to 30 scale) by 2.8 points more than in control groups that did not exercise. The gain was larger in men who started with worse function: 2.3, 3.3 and 4.9 points for mild, moderate and severe ED (Khera et al., J Sex Med 2023).
- Weight loss and activity together. In a 2-year JAMA trial of 110 obese men aged 35 to 55 who had ED (a score of 21 or less on the International Index of Erectile Function) and no diabetes, high blood pressure or high blood fats, the average score in the intervention group rose from 13.9 to 17, while the control group stayed level. Seventeen men in the intervention group and 3 in the control group reached a score of 22 or higher, and the authors described improvement in “about one third” of the men (Esposito et al., JAMA 2004).
- Pooled lifestyle trials. A 2011 meta-analysis found that lifestyle change and medicines for heart risk factors improved erectile function scores across 6 randomized trials with 740 men; the 4 lifestyle-only trials, with 597 men, showed an average gain of 2.40 points (Gupta et al., Arch Intern Med 2011).
These are group averages: in the JAMA trial, 38 of the 55 men in the intervention group did not reach a score of 22 or higher. Our guides to exercise and ED and lifestyle factors in ED go through the trials and the NIH advice in more detail.
Can ED linked to diabetes improve?
Sometimes, but in the trial below the clearer effect was on keeping function from getting worse. In the Look AHEAD trial, 306 overweight or obese men with type 2 diabetes were followed for a year. The lifestyle group lost 9.9% of body weight against 0.6% in the comparison group, and fewer of them saw erectile function worsen (8% against 20%), but a similar share improved (22% against 23%). The authors concluded the program was “mildly helpful in maintaining” erectile function (Wing et al., J Sex Med 2010). Our guide to ED and diabetes covers glucose control and the other trials in this area.
Can changing a medicine improve ED?
It can when that medicine is part of the cause, and the change has to come from a clinician. The NIH lists many common medicines that can have ED as a side effect, including antidepressants, blood pressure medicines and diuretics, antihistamines, some pain relievers and sedatives (NIDDK, Symptoms & Causes of ED). It says a health care professional may review your medicines and suggest a different dose or a different medicine, and it is direct about the rest: “Do not stop taking any medicines on your own” (NIDDK, Treatment for ED). A medicine that controls blood pressure or mood is often protecting your health in other ways, so the swap is a shared decision. Our list of medications that can affect erections goes class by class.
Can ED caused by stress or anxiety improve?
It can be worked on, and counseling is the NIH’s suggested route. The NIH says anxiety, depression, stress, loneliness and low self-esteem can cause ED or make it worse (NIDDK, Symptoms & Causes of ED), and that health care professionals may suggest counseling when mental health or emotional issues are affecting ED. Counselors can help lower anxiety and stress about sex, and a partner may be invited to sessions (NIDDK, Treatment for ED). The AUA says referral to a mental health professional should be considered for men being treated for ED, to help with sticking to treatment, reduce performance anxiety and fit treatment into a relationship (AUA, Erectile Dysfunction Guideline). Neither source gives a success rate, and a psychological cause can sit alongside a physical one.
Does treating low testosterone help ED?
It can help when testosterone is actually low, mostly by making ED pills work better. The AUA recommends measuring a morning total testosterone level in men with ED. Statement 12 says men with ED and testosterone deficiency who are considering ED pills should be told the pills “may be more effective if combined with testosterone therapy.” In the AUA’s meta-analysis of four trials, the combination raised erectile function scores by 2.69 points more than the pills alone (AUA, Erectile Dysfunction Guideline). The NIH likewise says that if you have ED and low testosterone, testosterone may be prescribed together with ED pills (NIDDK, Treatment for ED). Whether testosterone is low, and whether treating it makes sense, is a question for blood tests and a prescriber.
Can ED improve after prostate surgery?
It can, slowly and often only partly, and it depends on whether the nerves were spared. The AUA guideline says that when the nerves beside the prostate are spared during radical prostatectomy, a gradual recovery is possible, commonly 12 to 24 months after surgery and possibly as late as 36 months. It also says “relatively few men recover baseline erectile function, particularly those over age 60 years at the time of surgery,” and that when the nerves are not spared, “the expected effect is an unrecoverable loss of erectile function.” A meta-analysis it cites, of studies with more than 12 months of follow-up, found erectile function recovery rates of about 60% with nerve sparing on both sides and 47% with one side (AUA, Erectile Dysfunction Guideline).
After radiation the pattern differs: ED may start later, 24 to 36 months after treatment, and may worsen over time. AUA Statement 11 adds that early use of ED pills after prostate cancer treatment “may not improve spontaneous, unassisted erectile function” (AUA, Erectile Dysfunction Guideline). Men whose function does not come back still have treatment options, which your surgical team can talk through.
Do ED pills or other treatments fix the problem?
They treat the symptom rather than the cause. The NIH describes PDE5 inhibitor pills as medicines that improve blood flow to the penis and “may help you get and keep an erection,” and it describes injections, suppositories, vacuum devices and implant surgery as ways to produce or support an erection (NIDDK, Treatment for ED). None of them is described as removing the underlying cause. That is also why the AUA asks men to address underlying medical issues even when they choose a treatment, since ED can be a marker of heart and blood vessel disease (AUA, Erectile Dysfunction Guideline). For the full list and how each works, see our overview of ED treatment options.
One surgical option aims at the cause in a small group. AUA Statement 21 says penile arterial reconstruction “may be considered” for young men with a focal blockage in a pelvic or penile artery and no wider blood vessel disease, and it cautions that the long-term success of the procedure is not well established. The AUA does not recommend penile venous surgery (AUA, Erectile Dysfunction Guideline).
What about shockwave, stem cell or PRP treatments?
The AUA does not treat any of them as an established answer. Its guideline says low-intensity shockwave therapy and stem cell therapy “should be considered investigational” for men with ED, and platelet-rich plasma (PRP) “should be considered experimental” (AUA, Erectile Dysfunction Guideline). Clinics that advertise a “permanent” fix with these methods are going beyond what the guideline supports. Our page on experimental ED therapies explains what the studies have and have not shown.
When to talk to a clinician
Talk to a clinician if erection problems keep coming back, and sooner if they started with a new medicine, after surgery, or alongside diabetes, high blood pressure or heart disease. The AUA says men should be counseled that ED is a risk marker for heart disease and other conditions that may need evaluation, and it recommends a morning testosterone test (AUA, Erectile Dysfunction Guideline). Do not stop a prescribed medicine on your own. If you take an ED medicine and have an erection lasting more than 4 hours, or vision or hearing loss, the NIH says to call your health care professional right away (NIDDK, Treatment for ED).
Sources
Every clinical statement on this page traces to a primary or guideline source:
- NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases), Treatment for Erectile Dysfunction, last reviewed October 2024. Treating the underlying cause when possible, lifestyle changes, counseling, medicine review and not stopping medicines on your own, PDE5 inhibitors, testosterone with PDE5 inhibitors, other treatments, seeking care right away, and “changing a daily habit could help prevent or improve your ED”: niddk.nih.gov, ED treatment
- NIDDK, Symptoms & Causes of Erectile Dysfunction, last reviewed October 2024. Conditions, medicines, mental health issues and lifestyle behaviors that can lead to ED: niddk.nih.gov, ED symptoms and causes
- Burnett AL, et al. Erectile Dysfunction: AUA Guideline (J Urol 2018). Goals of restoring sexual function, addressing underlying medical issues, ED as a risk marker, morning testosterone, Statements 6, 7, 11, 12, 21 and 22 to 25, the lifestyle evidence review, the testosterone meta-analysis, and the natural history of erectile function after prostatectomy and radiation: auanet.org, ED guideline
- Khera M, et al. Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials (J Sex Med, 2023). 11 trials, 2.8-point mean gain, larger in more severe ED: pubmed.ncbi.nlm.nih.gov/37814532
- Esposito K, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial (JAMA, 2004). 110 men, 2 years, scores from 13.9 to 17, 17 against 3 men reaching 22 or higher: pubmed.ncbi.nlm.nih.gov/15213209
- Gupta BP, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis (Arch Intern Med, 2011). 6 trials, 740 men; 4 lifestyle trials, 597 men, 2.40-point gain: pubmed.ncbi.nlm.nih.gov/21911624
- Wing RR, et al. Effects of weight loss intervention on erectile function in older men with type 2 diabetes in the Look AHEAD trial (J Sex Med, 2010). 306 men, 1 year, worsening in 8% against 20%, improvement in 22% against 23%: pubmed.ncbi.nlm.nih.gov/19694925
- Martin SA, et al. Predictors of sexual dysfunction incidence and remission in men (J Sex Med, 2014). Florey Adelaide Male Ageing Study, 810 men over 5 years, ED remission in 29.0% and incidence in 31.7%, predictors of each: pubmed.ncbi.nlm.nih.gov/24548342
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