IGF-1 levels, like testosterone, decline in an age-dependent manner. This progressive decline leads to various symptoms including erectile dysfunction (ED). Interestingly, IGF-1 is known to mediate endothelial nitric oxide production. Nitric oxide is considered to be a principal mediator of penile erection by causing relaxation of vascular smooth muscle which leads to engorgement of the penis with blood, thereby developing an erection.  The relationship of IGF-1 and penile erection has been described in otherwise healthy male subjects, and recent in vitro studies suggest that IGF-1 increases nitric oxide and may help maintain erectile function. [107-112] In one study, Pastuszak et al. reported that IGF-1 levels correlate significantly with sexual function scores in 65 men who completed the Sexual Health Inventory for Men (SHIM) and Expanded Prostate Cancer Index Composite (EPIC) questionnaires.  Other studies even reported that restoring IGF-1 levels through IGF-1 supplementation may help treat erectile dysfunction and increase libido. 
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