The Missing
Links
Three critical systems that control erectile function beyond the standard vascular model: Neurogenic Drive, Structural Integrity, and Hydrogen Sulfide.
1. The Neurogenic Spark
While eNOS maintains the erection, the initial "spark" is purely neurogenic. This process begins in the hypothalamus and is transmitted via the cavernous nerves to release neuronal Nitric Oxide (nNOS).
This initial burst "primes" the smooth muscle to stretch, activating the shear-stress-dependent maintenance pathways. Without this spark, the engine never starts.
Protocol: The Dopamine Drive
Mechanism: Increases dopaminergic tone, directly inhibiting pituitary prolactin secretion.
Mechanism: Provides direct precursors for dopamine synthesis in the MPOA.
2. Structural Integrity
The Silent Killer: Cavernosal Fibrosis
Even with perfect signaling, an erection cannot occur if the "hardware" is fibrotic. Chronic inflammation and hypoxia upregulate TGF-β1, converting smooth muscle into collagen (scar tissue).
The Anti-Erection Force: ROCK
The penis is kept flaccid by active contraction via the RhoA/Rho-Kinase (ROCK) pathway. In diabetes, ROCK is chronically overactive, acting as a "parking brake" that NO cannot overcome [?].
Protocol: Structural Rehab
- Pentoxifylline (Off-Label)
Dosage: 400mg 2-3x daily.
Target: TGF-β1 inhibition. Powerful anti-fibrotic used in Peyronie's. - Daily Tadalafil
Dosage: 5mg daily.
Target: Chronic oxygenation prevents collagen deposition. - Icariin (Horny Goat Weed)
Dosage: 500-1000mg (Standardized).
Target: Natural ROCK inhibition + PDE5i synergy.
3. The Third Gas: H₂S
Hydrogen Sulfide (H₂S) is the third critical gasotransmitter. Produced by CBS and CSE enzymes, it works in concert with NO and CO.
Garlic (Allicin)
Dosage: High-allicin extract (e.g., 5000mcg+).
Polysulfides in garlic are converted to H₂S by red blood cells, directly activating KATP channels .
Taurine + NAC
Dosage: 2g Taurine + 600mg NAC.
Taurine upregulates CSE enzyme, while NAC provides the cysteine substrate for endogenous H₂S synthesis.
Diabetic Deficiency
Loss of H₂S enzymes is a primary driver of diabetic impotence .