“Proposed framework for the action of androgens in erectile function. Testosterone is metabolized to 5α‐dihydrotestosterone (5α‐DHT), which possesses higher affinity for the androgen receptor (AR). 5α‐DHT and testosterone bind to the AR and elicit a host of biochemical signaling leading to several physiological responses. These include 1) increased expression of neural and endothelial nitric oxide synthases (nNOS and eNOS), 2) increased expression of phosphodiesterase type 5 (PDE 5), and 3) up‐regulation of α‐1 adrenergic receptors and down‐regulation of Rho A kinase. In addition, androgens maintain the structural integrity of the penile nerve fiber network and smooth muscle growth and function. The maintenance of the tissue structural integrity and biochemical signaling is critical for veno‐occlusive function and penile erecti” (M. Traish, Androgens Play a Pivotal Role in Maintaining Penile Tissue Architecture and Erection: A Review https://onlinelibrary.wiley.com/doi/full/10.2164/jandrol.108.006007
Or 5ar damaged? Do we have to find only a way to activate it?