The Circulation Project Facebook ad: “35% of Diabetic Men Have Retrograde Ejaculation.”

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If you are a diabetic man and your ejaculate has disappeared, you have somewhere between three and five years before the same vascular failure could reach your heart. I am a urologist with 19 years of practice and I have spent the last decade watching this exact timeline unfold in diabetic patients while telling none of them what was actually coming. I am writing this letter to break that silence. 35 to 40 percent of long-term diabetic men experience retrograde ejaculation. Almost none of them are told that the same nerve and vascular damage causing it is happening simultaneously in their coronary arteries, their kidneys, and their eyes. They are told it is "just the diabetes." That phrase is one of the most expensive lies in modern medicine. I'm Dr. Daniel Westbrook. I'm a board-certified urologist who spent fifteen years writing eight-minute prescriptions to diabetic men without telling them what was about to happen to them next. When my own urinary and vascular symptoms started at 51, I knew something I had never explained to a single diabetic patient. The prostate isn't the disease. The erection isn't the disease. The retrograde ejaculation isn't the disease. They are all symptoms of one underlying problem — the systemic vascular and neurological destruction that decades of elevated blood sugar quietly produces. Almost every standard urological treatment for diabetic men masks the symptom while the underlying disease compounds toward a cardiac event. I have treated thousands of diabetic men in my career. I have seen what happens at year three after diagnosis. Year five. Year eight. Year twelve. And I have seen what almost no urologist documents properly because the appointments are too short and the prescriptions are too easy. The 58-year-old Type 2 diabetic, A1C 7.4 for the last four years, "well-controlled" by his endocrinologist's standards. Came to me for urinary symptoms. I noted in his chart that he had stopped ejaculating two years earlier. He had not told his endocrinologist. He had not told his GP. He had told no one. His blood pressure was 152 over 94. His LDL was 161. His feet had been tingling for the last eighteen months. He had four separate signs of progressive vascular and neurological failure across four different organ systems and not one of his doctors had connected them. The 54-year-old. Diagnosed Type 2 at 47. On metformin and lisinopril. Started noticing retrograde ejaculation around year four. His endocrinologist told him it was a known complication of diabetes and there was nothing to do about it. He came to me three years later because his erections had begun to fail. I added a Viagra prescription to his list. He thanked me. Two years after that he called me from a hospital bed after his first cardiac event. He was 56. His urinary symptoms had been the warning at year three. The retrograde ejaculation had been the warning at year four. The erectile dysfunction had been the warning at year six. The cardiac event was the warning his medical team finally listened to. The 62-year-old Type 2 diabetic, ten years post-diagnosis. Retrograde ejaculation for six years. Erectile dysfunction for four years. Diabetic neuropathy in his feet for two years. Eight medications. Three specialists. Zero conversations about the underlying disease that was producing all of them. I see these men in follow-up appointments. They do not complain. They are grateful I am "managing" their condition. But I know what they lost. They had years to address the endothelial damage their diabetes was producing. Years to restore their nitric oxide signaling. Years to save themselves from the cascade. Their symptoms had been screaming the warning the entire time. The prescriptions just turned down the volume one organ at a time. My own labs showed me what my diabetic patients' labs had been showing me for years. Fasting glucose creeping into pre-diabetic range. Hemoglobin A1C at 5.9. Urinary symptoms getting worse. Morning erections becoming less reliable. Blood pressure drifting up. The metabolic and vascular damage was already starting. And I was a urologist who knew exactly where it ended. What almost no doctor explains to a diabetic patient with retrograde ejaculation is this. Retrograde ejaculation in diabetic men is caused by autonomic neuropathy of the internal urinary sphincter. The sympathetic nerves that normally close the bladder neck during ejaculation have been damaged by years of elevated blood sugar. The sphincter stays open. The ejaculate takes the path of least resistance and goes backwards into the bladder instead of forwards. That same hyperglycemic damage to the sympathetic nervous system is also damaging the parasympathetic nerves that initiate erections. It is damaging the small vessels of the kidneys. It is damaging the small vessels of the eyes. It is damaging the linings of the coronary arteries. The retrograde ejaculation is not a side effect. It is a clinical sign that diabetic autonomic neuropathy and endothelial dysfunction have progressed to the point where they are visibly affecting one organ system. The other organ systems are progressing in parallel. They are just not symptomatic yet. A 2006 study in European Urology documented this timeline. Erectile dysfunction in diabetic men precedes the first cardiovascular event by an average of three to five years. The cardiovascular event arrives later because the coronary arteries are larger than the penile arteries. The disease has been there the whole time. You just feel the small vessels first. The retrograde ejaculation you have been quietly living with for the last two or three years is not the warning. The erectile changes that came before it were the warning. The urinary symptoms that came before that were the warning before the warning. Your body has been sending you the same message in increasingly urgent forms for the last decade. Men with diabetic ED have approximately 50 times the incidence of cardiovascular events compared to non-diabetic men without ED. Diabetic men with both urinary symptoms and ED carry an even higher cumulative risk because they have documented autonomic and vascular dysfunction in two organ systems simultaneously. Your prostate symptoms are not embarrassing. Your retrograde ejaculation is not just "part of having diabetes." They are your 10-year early warning system. And the standard medical cascade — metformin for the sugar, lisinopril for the blood pressure, atorvastatin for the lipids, tamsulosin for the prostate, Viagra for the erections — silences each individual alarm while the underlying endothelial and autonomic damage continues to compound. Endocrinologists do not order cardiac imaging. Urologists do not connect retrograde ejaculation to cardiovascular futures. Each specialist treats the organ in front of them. The patient gets six prescriptions. Nobody is treating the disease. I was not going to start that cascade on myself. And I needed to find a path that actually addressed the mechanism rather than masking the symptoms. I tried what diabetic patients try. Tightened glucose control. Helped my numbers but did not move the urinary symptoms. Did not restore the morning erections. Mediterranean diet. Exercise. Weight loss. Marginal improvements in markers. No improvement in the vascular symptoms. Standard supplements. Saw palmetto. Pumpkin seed oil. Beta-sitosterol. L-arginine. The standard list. Did not move the needle. My PSA was stable. My A1C was improving. But my nitric oxide markers stayed low. My flow rate stayed weak. My morning erections stayed gone. Nothing was reversing the endothelial dysfunction that decades of slightly elevated blood sugar had produced. But I kept thinking about something that made no sense in standard practice. Endothelial dysfunction in diabetics can reverse. Nitric oxide production can be restored. Autonomic nerve function can improve with sustained reduction in vascular inflammation. The cardiology research had been showing this for fifteen years. Almost no one in urology or endocrinology was applying it. So why wasn't I applying it to myself? November 14th. 10:23 PM. I was reviewing journals after a long clinic day. Couldn't sleep. The urinary symptoms were worse. The morning erections were almost completely gone. I was scrolling through endothelial dysfunction research with a specific focus on diabetic populations. Not looking for anything specific. Just exhausted. I found a 2024 paper on capsaicin and TRPV1 receptor activation in diabetic endothelial dysfunction. Capsaicin from chili peppers activates TRPV1 receptors in the lining of every blood vessel in the body. These receptors trigger sustained nitric oxide release. Nitric oxide causes the smooth muscle in arteries — and in the prostate, and in the corpora cavernosa, and at the bladder neck — to function correctly. In diabetic populations specifically, capsaicin had been shown to reduce inflammatory markers, improve endothelial function, and reduce post-prandial glucose excursions through TRPV1 activation in pancreatic beta cells. The mechanism didn't just support symptom relief. It supported repair of the exact vascular and autonomic damage that diabetes had been causing. I sat there at 10:23 PM staring at the diagram. Tamsulosin forces smooth muscle relaxation by blocking alpha-1 adrenoceptors. The relaxation lasts as long as the medication is in your bloodstream. Your underlying vascular dysfunction does not improve. In diabetic men, tamsulosin also worsens retrograde ejaculation by further relaxing the bladder neck sphincter that diabetic neuropathy has already partially disabled. Capsaicin activates your body's natural TRPV1 receptors. Continuous nitric oxide release. Natural sustained smooth muscle tone. Your endothelium heals instead of being chemically suppressed. The autonomic nerves that have been damaged by hyperglycemia have the inflammatory load reduced enough that some function can return. The vascular dysfunction that is causing your urinary symptoms, your retrograde ejaculation, your erectile dysfunction, and your elevated cardiovascular risk simultaneously — actually improves. I have been a urologist for 19 years. I have studied prostate disease for my entire career. And I had never connected therapeutic capsaicin to BPH symptoms in diabetic men. I had never been taught that the autonomic neuropathy causing retrograde ejaculation in my diabetic patients could potentially be slowed with TRPV1-mediated reduction in vascular inflammation. Because urologists don't study diabetic mechanisms in depth. Endocrinologists don't study urological outcomes. The shared mechanism — the underlying endothelial and autonomic root that explains why diabetic men cluster prostate symptoms, retrograde ejaculation, erectile dysfunction, and cardiovascular disease in the same individual — was never integrated into anyone's training. At 11:11 PM I went looking for a properly formulated capsaicin supplement. What I learned during that search is something every diabetic man who tries capsaicin needs to know. Capsaicin is fat-soluble. When you swallow a powdered cayenne capsule, your stomach acid destroys most of the active compound before it reaches your bloodstream. You feel the heat. You don't get the arterial effect. For capsaicin to actually reach the endothelial cells where TRPV1 lives, it must be dissolved in an oleic-acid-rich oil before it enters your body. Cold-pressed avocado oil is the carrier the research uses. Absorption rates go from 10 percent to nearly 90 percent. Almost no supplement on the market does this. Most use the cheapest possible carrier oils — soybean oil, safflower oil, sunflower oil. The same family of refined seed oils documented to drive arterial inflammation. The carrier oil works against the active compound. For a diabetic patient with existing endothelial damage, the inflammatory load of those carrier oils makes the situation worse, not better. I found one brand that was different. Aurivita Capsaicin Power. 3mg of pharmaceutical-grade capsaicin per softgel — the dose used in the clinical research. Suspended in cold-pressed avocado oil rather than soybean or safflower. BioPerine added to slow the liver's breakdown of the compound. Hawthorn, beetroot, Korean ginseng, and vitamins D3 and K2 stacked alongside for additional vascular support. D3 deficiency is rampant in diabetic men. K2 directs calcium away from arterial walls — a particular concern given that diabetic vascular calcification accelerates the cardiovascular timeline. I ordered a bag that night. Three softgels in the morning with breakfast. I didn't expect miracles. The mechanism was sound. I started November 15th. November 22nd. One week in. Morning erections returning. Not consistent yet. But present for the first time in over a year. November 29th. Two weeks in. Did not wake up to urinate the previous night for the first time in two years. My fasting glucose was 8 points lower than usual. December 13th. Four weeks in. Morning erections every day. Full stream returning. My wife asked what I had changed. I had not told her I was taking anything. I wanted the physiology to prove the mechanism before I said anything. "Different approach," I told her. "Whatever it is, keep doing it." January 10th. Eight weeks in. Repeat bloodwork. Hemoglobin A1C had dropped from 5.9 to 5.6 with no change in diet beyond what I had already been doing. Blood pressure down from 144 over 88 to 126 over 78. My primary care doctor reduced one of my BP medications. Inflammatory markers down across the panel. LDL down 23 points. But the part that should make every diabetic man reading this letter pay attention came when I went back to my urologist colleague for a flow study and a digital exam. He looked at my flow rate. Looked at my prostate. Looked at his notes from six months ago. "Dan, what did you do? Your flow rate is back to where it was when you were 45. And your bladder neck tone has clearly changed on the scan." I explained the TRPV1 receptor activation. The continuous nitric oxide pathway. The capsaicin mechanism. The reduction in vascular inflammation and the modest improvement in autonomic function that came with it. He was quiet for a long moment. "I have hundreds of diabetic patients I have written tamsulosin and finasteride for over the years. If what you are describing is reproducible..." "The mechanism is real. The dose matters. The carrier oil matters. And the timeline matters." He started ordering it for his diabetic patients with retrograde ejaculation and weak flow. He has been telling me what he is seeing. I am not writing this letter because I am against tamsulosin or finasteride or metformin or statins or any of the standard medications you are on. These medications work. They relieve the symptoms they were designed to relieve. They have helped millions of diabetic men. But they do not fix your underlying endothelial dysfunction. They do not address the autonomic damage from years of elevated blood sugar. They do not lower your accumulated cardiovascular risk. They do not reverse the disease. They temporarily mask each individual symptom while the underlying damage compounds toward a cardiac event that no specialist on your team is currently tracking. And I see what happens five years later when the diabetic men who masked their urinary and sexual symptoms with prescriptions walk into a cardiologist's office with chest pain, an LDL of 180, and a coronary calcium score that nobody was tracking. Your prostate symptoms are not failing you. Your retrograde ejaculation is not failing you. They are warning you. The same endothelial dysfunction your diabetes has been producing for years is causing your urinary symptoms, your retrograde ejaculation, your erectile changes, and right now, building plaque in your coronary arteries. You have two choices. Mask each symptom with a separate prescription while your underlying disease accelerates toward the heart. Or address the vascular and autonomic root that is causing all of them simultaneously. I think about what I almost did. I almost started tamsulosin myself. I almost accepted further retrograde ejaculation and the deepening of my urinary dysfunction as the cost of treating my symptoms. I almost masked a cardiovascular warning with a prostate prescription. I almost became the diabetic patient I had been making for fifteen years — the man in his late fifties on six medications for six symptoms with no doctor connecting them to the underlying disease that diabetes had been quietly running in the background. Because once you are deep in the cascade, you are on medications for life. Once you have a cardiac event, the damage is permanent. Once you need bypass surgery, your life changes forever. And diabetic surgical recovery is meaningfully worse than non-diabetic recovery. Wound healing is slower. Infection rates are higher. Re-operation rates are higher. You do not get a second warning. Your prostate symptoms and your retrograde ejaculation are your first warning. Your only warning you can still act on while there is still time. I am sharing this because if you are a diabetic man who has noticed nothing comes out anymore, or whose stream has weakened, or whose morning erections have started failing, you deserve to know what I know. Not from a textbook. From 19 years of writing the prescriptions that ignored the underlying disease. Your prostate is not the problem. Your bladder neck is not the problem. Your erections are not the problem. Your diabetes is producing endothelial dysfunction system-wide. The penile arteries fail first because they are smallest. The bladder neck nerves fail next because they are most exposed to the vascular damage. The coronary arteries fail later because they are bigger. By the time the coronary arteries fail, you are not looking at retrograde ejaculation. You are looking at cardiac catheterization. Stents. Bypass. Lifelong medications layered on top of the diabetic medications you are already taking. Or worse. Eight weeks. That is how long it took my blood pressure to drop, my A1C to fall, my urinary symptoms to ease, my morning erections to return, and my flow rate to recover to where it had been at 45. Eight weeks of letting my endothelium do what it was designed to do. Heal. I am not saying don't take your diabetic medications. I am saying understand what you are masking when you add a urological prescription on top of them. Your retrograde ejaculation is your check engine light. Tamsulosin and finasteride are electrical tape over the warning indicator. Your endothelium is still failing. You just can't see the light anymore. But I see it every day in the diabetic men who come back to me three years later asking why their erections have stopped working, and six years later when their cardiologist calls me to ask what I prescribed. Every single one of them says the same thing. "I wish someone had told me my retrograde ejaculation was connected to my heart." I am telling you now. Your retrograde ejaculation is connected to your cardiovascular health. The same diabetic vascular damage is causing both. Fix the circulation, and you potentially save your remaining sexual function and your heart at the same time. Mask it, and risk everything. That is all I am asking you to consider. Give your circulation a chance to heal before you accept the cascade or risk a cardiac event. Because once retrograde ejaculation deepens, once erectile dysfunction follows, once cardiac damage occurs — every one of those becomes harder to reverse in a diabetic body than in a non-diabetic one. Your symptoms are giving you years of advance warning. Use them. Aurivita Capsaicin Power costs $54 for 60 days. Less than a dollar a day. Compare that to a lifetime of prescriptions that mask the warnings while the disease compounds. Compare that to the cost of a cardiac event in a diabetic patient — emergency catheterization, stenting, bypass, the cardiac rehab, the lost work, the changed life. It comes with a 120-day money-back guarantee. Use it for three full months. Two full bags. If your stream is not stronger, if your sleep is not better, if your morning erections are not returning, if your blood pressure and A1C are not moving, send back the bags, even empty, and get a full refund. No questions asked. I have never seen a pharmaceutical company offer that. I have never seen a cardiac procedure come with a money-back guarantee. And I have never seen a treatment that protects the diabetic prostate, the diabetic sexual function, and the diabetic cardiovascular system simultaneously. That is how confident I am in what TRPV1 activation actually does in a diabetic body. Address the circulation now, while you still can. https://aurivita.co/products/capsaicin-power-ed Dr. Daniel Westbrook, MD Board-Certified Urologist, 19 years Practicing physician P.S. Give it 60 to 90 days. See the difference for yourself. You have nothing to lose except $54 and 8 to 12 weeks. The upside is the version of yourself that doesn't end up in a cath lab in three years wishing someone had connected the dots earlier. P.P.S. You are not too late yet. You are still urinating, even with a weak stream. You are still getting some erections, even if they're weak. Your diabetes has not yet produced the cardiac event the timeline is building toward. That means your circulation has not completely failed. Please activate TRPV1 now, before any of it changes. Before your urologist writes the tamsulosin prescription, before your cardiologist gets your phone call, before the cascade your medical team is missing reaches the organ they finally pay attention to. Individual experiences vary. These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.

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35% of Diabetic Men Have Retrograde Ejaculation.

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