High cholesterol, statins and ED: what the evidence shows
The short answer
High cholesterol is linked to ED, mainly because it helps build the artery plaque that can limit blood flow. Statins, the main cholesterol medicines, have not been shown to cause ED in large reviews, and small trials suggest a modest benefit. Do not stop a statin on your own; talk with your prescriber first.
In short: high cholesterol and erectile dysfunction (ED) share the same root problem more often than many men realize. Unhealthy cholesterol levels help build plaque inside arteries, and narrowed arteries are one of the most common reasons erections change. Statins, the medicines most often used to lower cholesterol, worry a lot of men, but the largest reviews have not found that they raise the risk of new ED, and small trials suggest a modest benefit instead. The evidence is not perfectly settled, so this guide walks through what the guideline, the NIH, the statin labels and the trial reviews say, and why stopping a statin on your own is the one step every source warns against.
Is high cholesterol linked to ED?
Yes. The American Urological Association (AUA) guideline lists dyslipidemia (unhealthy blood fat levels, including high cholesterol) among the independent risk factors that ED and heart disease share, along with age, smoking, diabetes, high blood pressure, obesity and inactivity. It reports that up to 42.4% of men with ED also have high blood fats, that higher total and LDL cholesterol are significantly linked to moderate to severe ED, and that men with poor erectile function had twice the odds of a raised total-to-HDL cholesterol ratio (AUA Erectile Dysfunction Guideline). These are links across groups of men, not a diagnosis for any one man, which our guide to what ED can signal about your health explains.
How does cholesterol affect erections?
It works mostly through the arteries. The NIH’s National Heart, Lung, and Blood Institute (NHLBI) names unhealthy cholesterol levels as a key risk factor that can trigger plaque buildup, and explains that as plaque grows the artery narrows and carries less oxygen-rich blood to the limbs and organs (NHLBI, Atherosclerosis Causes and Risk Factors). That plaque buildup, atherosclerosis, is on the NIH’s list of heart and blood vessel diseases that can lead to ED (NIDDK, Symptoms & Causes of ED). An erection depends on extra blood flowing into the penis, so arteries that cannot widen fully can show up there. The AUA guideline adds that the most common underlying mechanism of ED is vascular (AUA Erectile Dysfunction Guideline).
Do statins cause erectile dysfunction?
Status: FDA-approved for another condition, not for ED. Source: ZOCOR, LIPITOR and CRESTOR prescribing information, DailyMed, checked 2026-10-17.
On the best available evidence, statins do not appear to raise the risk of new ED, although the question is not fully closed. A 2018 review pooled 3 randomized trials and 3 observational studies covering 69,448 men with heart disease or heart risk factors, 24,661 of them on a statin, and found statin use was not associated with new-onset ED (risk ratio 0.96, a difference that was not statistically significant); the trial evidence was rated moderate quality and the observational evidence very low quality, and the authors asked for larger, high-quality trials (Elgendy et al., Am J Med 2018). A 2019 American Heart Association (AHA) scientific statement on statin safety concluded there is “no convincing evidence for a causal relationship” between statins and ED (Newman et al., Arterioscler Thromb Vasc Biol 2019).
Some research points the other way, which is why the worry persists. A 2026 genetic study (a Mendelian randomization analysis of UK Biobank and FinnGen data) linked genetically predicted statin use to a slightly higher ED risk, driven by atorvastatin and simvastatin, with no link for rosuvastatin (Wensong et al., Sex Med 2026). A news report on the study notes the authors caution that the especially strong atorvastatin estimate reflects lifelong genetic exposure rather than the real-world risk of taking the drug, that the design could not assess dose or treatment length, and that the study included only people of European ancestry (News-Medical, July 2026).
| Source | What kind of evidence | What it found |
|---|---|---|
| Elgendy et al. 2018 | Review of 3 trials and 3 observational studies, 69,448 men | No increase in new-onset ED with statins |
| AHA scientific statement 2019 | Expert review of trials and observational data | No convincing evidence that statins cause ED |
| Wensong et al. 2026 | Genetic (Mendelian randomization) study | Statin use, mainly atorvastatin and simvastatin, linked to higher ED risk; no link for rosuvastatin |
| Nurkalem et al. 2014 | 90 men with high cholesterol, followed 6 months | Erection scores fell on atorvastatin, unchanged on rosuvastatin |
Can statins help erectile dysfunction?
Small trials, mostly in men who already have ED, suggest a modest benefit. A 2014 review of 11 randomized trials found erection scores on a standard 5-question survey (the IIEF-5, scored out of 25) rose by about 3.4 points with a statin compared with control, roughly one-third to one-half of the improvement reported for ED pills of the PDE5 inhibitor class and larger than the effect of lifestyle changes (Kostis and Dobrzynski, J Sex Med 2014). A second 2014 review of 7 trials (586 men, using atorvastatin or simvastatin) found a similar 3.27-point rise, but noted that this may fall short of a clinically important change for men with moderate or severe ED, and that the trials were short, lasting 6 weeks to 6 months (Cai et al., Asian J Androl 2014).
A third review found the clearest gain when a statin was added to sildenafil: statins alone did not differ significantly from placebo in its analysis, while statin plus sildenafil clearly beat placebo plus sildenafil (Cui et al., J Sex Med 2014). Statins are not approved to treat ED, and none of these reviews is a reason to start one for erections. Whether you need a statin is a heart-health decision for your clinician.
| Review | Trials and men | Main result |
|---|---|---|
| Kostis and Dobrzynski 2014 | 11 randomized trials | IIEF-5 up about 3.4 points with statins |
| Cai et al. 2014 | 7 trials, 586 men (5 pooled) | IIEF-5 up 3.27 points; may not be clinically important in moderate or severe ED |
| Cui et al. 2014 | 6 trials, 462 men | No significant difference for statins alone; clear gain when added to sildenafil |
Does it matter which statin you take?
Possibly, but the evidence is too thin to rank them. The 2014 review of 11 trials found the benefit grew as statins became less fat-soluble (less lipophilic), and that the amount of LDL lowering did not change the effect (Kostis and Dobrzynski, J Sex Med 2014). A small study of 90 men with high cholesterol and no other heart risk factors found erection scores fell over 6 months on atorvastatin but did not change on rosuvastatin (Nurkalem et al., Kardiol Pol 2014), and the 2026 genetic study pointed the same way (Wensong et al., Sex Med 2026). None of this is strong enough to justify switching on your own. If you think a change began with a new statin, that timing is useful to bring to your prescriber, who can weigh it against everything else the medicine is doing for you.
What do the statin labels say about ED?
The labels differ. The ZOCOR (simvastatin) label lists erectile dysfunction among reactions reported after approval, under reproductive system disorders, and explains that because such reports are voluntary and come from a population of uncertain size, it is not always possible to estimate how often they happen or confirm the drug caused them (ZOCOR prescribing information, section 6.2, DailyMed). The current LIPITOR (atorvastatin) and CRESTOR (rosuvastatin) labels we checked do not list ED among their adverse reactions (LIPITOR prescribing information, DailyMed; CRESTOR prescribing information, DailyMed). Statins also do not appear on NIDDK’s list of common medicines that can cause ED (NIDDK, Symptoms & Causes of ED), which our guide to medications that can affect erections covers in full.
Should you stop a statin because of ED?
No, not on your own. NIDDK says a health care professional may review your medicines and suggest a different dose or a different medicine, and adds: “Do not stop taking any medicines on your own. Talk with your health care professional first” (NIDDK, Treatment for ED). Statins are prescribed to lower the risk of heart attack and stroke, as their labels set out (LIPITOR prescribing information, section 1, DailyMed), and the AHA statement found that for patients in whom statins are recommended, “the benefits greatly outweigh the risks.” It also noted that about 10% of patients in US practice stop a statin because of subjective complaints, most often muscle symptoms (Newman et al., Arterioscler Thromb Vasc Biol 2019). Stopping leaves the cholesterol itself untreated, and that is linked to ED in its own right.
Can ED be an early sign of heart disease?
It can be a reason to get your heart and cholesterol checked. The AUA guideline says men should be counseled that ED is a risk marker for underlying heart and blood vessel disease, and that ED symptoms may come up to five years before a heart event (AUA Erectile Dysfunction Guideline). An AHA news report on a study of nearly 2,000 men with an average age of 69 and no history of heart disease or stroke found that, over nearly four years, men with ED had more than twice the rate of heart attacks, cardiac arrests, strokes and related deaths as men without it (6.3% versus 2.6%) (American Heart Association News, 2018). ED on its own does not mean you have heart disease. Our guides to heart disease and ED and high blood pressure and ED cover the wider picture.
When to talk to a clinician
Bring up ED with whoever manages your cholesterol, especially if it started or changed after a new statin or a dose change, and ask whether your heart risk has been checked recently. Bring a list of everything you take. Do not stop a statin on your own. Seek care right away for chest pain, fainting, or an erection lasting longer than 4 hours.
The bottom line
High cholesterol is linked to ED because it feeds the artery plaque that can limit blood flow, and the AUA treats ED as a marker worth a heart check. Statins have not been shown to cause new ED in the largest reviews, and the AHA found no convincing evidence that they do, although one statin label lists ED from voluntary reports and some studies suggest the type of statin may matter. Small trials point to a modest benefit for erections rather than harm. If you suspect your statin, the answer is a conversation with your prescriber, not stopping it.
Sources
Every clinical statement on this page traces to a primary or guideline source:
- American Urological Association, Erectile Dysfunction Guideline: dyslipidemia as a shared independent risk factor for ED and heart disease; up to 42.4% of men with ED have high blood fats; total and LDL cholesterol linked to moderate to severe ED; twice the odds of a raised total-to-HDL ratio with poor erectile function; ED as a risk marker for heart disease, appearing up to five years before an event; vascular causes most common.
- NIH NIDDK, Symptoms & Causes of Erectile Dysfunction (last reviewed October 2024): atherosclerosis among the heart and blood vessel diseases that can lead to ED; list of medicines that can cause ED.
- NIH NIDDK, Treatment for Erectile Dysfunction (last reviewed October 2024): medicine review, a different dose or medicine, and “Do not stop taking any medicines on your own”; seeking care for an erection lasting longer than 4 hours.
- NIH NHLBI, Atherosclerosis Causes and Risk Factors (last updated October 28, 2024): unhealthy cholesterol levels as a key risk factor for plaque buildup; plaque narrowing arteries and reducing blood flow.
- Newman CB, et al. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association (Arterioscler Thromb Vasc Biol, 2019): no convincing evidence for a causal relationship between statins and ED; about 10% stop a statin because of subjective complaints; benefits greatly outweigh risks where statins are recommended.
- American Heart Association News, Erectile dysfunction may be warning sign for more serious health problems (July 11, 2018): nearly 2,000 men, average age 69, no prior heart disease or stroke; men with ED had more than twice the rate of heart attack, cardiac arrest, stroke and related death (6.3% versus 2.6%) over nearly four years.
- Kostis JB, Dobrzynski JM. The effect of statins on erectile dysfunction: a meta-analysis of randomized trials (J Sex Med, 2014): 11 randomized trials; IIEF-5 up 3.4 points; one-third to one-half of the PDE5 inhibitor effect; greater benefit with less lipophilic statins; LDL lowering did not change the effect.
- Cai X, et al. The role of statins in erectile dysfunction: a systematic review and meta-analysis (Asian J Androl, 2014): 7 trials, 586 men, atorvastatin and simvastatin; IIEF-5 up 3.27 points; may not be clinically important in moderate or severe ED; trials of 6 weeks to 6 months.
- Cui Y, et al. The effect of statins on erectile dysfunction: a systematic review and meta-analysis (J Sex Med, 2014): 6 publications, 462 men; no significant difference for statins alone versus placebo; improvement when a statin was added to sildenafil.
- Elgendy AY, et al. Statin Use in Men and New Onset of Erectile Dysfunction: A Systematic Review and Meta-Analysis (Am J Med, 2018): 3 trials and 3 observational studies, 69,448 men; statin use not associated with new-onset ED (risk ratio 0.96); trial evidence moderate quality, observational evidence very low quality.
- Wensong W, et al. Causal association between statin use and erectile dysfunction: a 2-sample Mendelian randomization study (Sex Med, 2026): genetically predicted statin use linked to higher ED risk, driven by atorvastatin and simvastatin; no link for rosuvastatin. Study limitations (atorvastatin estimate reflects lifelong genetic exposure; dose and duration not assessed; European ancestry only) as reported by News-Medical (July 6, 2026).
- Nurkalem Z, et al. The effect of rosuvastatin and atorvastatin on erectile dysfunction in hypercholesterolaemic patients (Kardiol Pol, 2014): 90 men followed 6 months; erection scores lower on atorvastatin, unchanged on rosuvastatin.
- ZOCOR (simvastatin) prescribing information, DailyMed: section 6.2 postmarketing reports include erectile dysfunction, with the limits of voluntary reports.
- LIPITOR (atorvastatin calcium) prescribing information, DailyMed: section 1 indications to reduce the risk of heart attack and stroke; ED not listed among adverse reactions.
- CRESTOR (rosuvastatin) prescribing information, DailyMed: ED not listed among adverse reactions.
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