The Biohacking Frontier: Men’s Pursuit of Sexual Longevity

In the evolving world of longevity science, an unexpected focal point has emerged: erectile health. At the forefront of this movement stands Bryan Johnson, the 48-year-old biohacker whose mantra “Don’t Die” has led him down some eyebrow-raising paths. Johnson’s regimen includes daily Cialis, penile Botox, and even low-intensity shockwave therapy to his genitals—all in pursuit of teenage-level sexual performance. His rationale? “Nighttime erections are a really important health marker,” Johnson claims, citing that men without them face a 70% higher risk of premature death. Johnson isn’t alone in this frontier; fitness expert Ben Greenfield, 44, has ventured into acoustic wave therapy and stem cell injections for similar purposes. These extreme measures raise important questions: Is penile health truly a predictor of longevity, or are these biohackers chasing an expensive fantasy?

The connection between erectile health and overall wellness runs deeper than many realize. Dr. Ryan Welter, founder of Regeneris Medical, explains that penile health encompasses multiple factors: erectile function, orgasmic ability, libido, and satisfaction with intercourse. Perhaps most significantly, erectile dysfunction (ED) often serves as an early warning system for cardiovascular disease, typically appearing two to five years before a heart attack. This connection exists because penile arteries are considerably smaller than those supplying the heart and brain, making them more susceptible to early plaque buildup. High cholesterol restricts the blood flow necessary for erections, while nerve damage—common with aging and conditions like diabetes or Parkinson’s—disrupts the critical brain-to-pelvis signaling pathway. Hormone imbalances, particularly low testosterone, further complicate matters by reducing both desire and physical capability. Beyond the physical aspects, Dr. Welter emphasizes a crucial point: “Happiness is one of the best predictors of longevity, and sexual dysfunction indicates unhappiness that must be addressed if longevity is the goal.”

The gradual decline in erectile function presents through several recognizable signs. Chris Bustamante, founder of NYC men’s clinic Lushful Aesthetics, notes that men typically experience softer erections, difficulty maintaining them, and changes in morning and nocturnal patterns. While ejaculation timing might vary—generally taking longer with age—sudden dramatic changes in any aspect of sexual function warrant immediate medical attention. Such abrupt shifts, especially when accompanied by symptoms like rapid weight gain or shortness of breath, could signal serious cardiovascular issues, hormone imbalances, or even tumors. This explains why Johnson meticulously tracks his nighttime erections using a $249 Adam Health sensor that generates an “erection health score” based on duration, frequency, and quality. Johnson also monitors sperm characteristics, penile blood flow, urination speed, and prostate size, though Bustamante considers erection quality a more reliable health indicator than semen volume, which naturally varies between individuals and decreases with age regardless of overall health.

When it comes to maintaining erectile health, the foundations remain remarkably simple despite the high-tech solutions flooding the market. “The single most important treatment for longevity and health span, particularly for the penis, is diet and exercise and maintaining good metabolic health,” Dr. Welter states emphatically. Bustamante recommends prioritizing fruits, vegetables, and fiber while limiting red meat and processed foods, whose saturated and trans fats damage blood vessels and elevate blood pressure—a direct cause of ED. For exercise, he advocates daily cardio and muscle-building activities, noting that “muscle is the organ of longevity.” Interestingly, he cautions against cycling, which places pressure on the perineum and can damage nerves and blood vessels essential for erectile function, regardless of specialized seating. Beyond these fundamentals, low-dose Cialis serves as a common pharmaceutical intervention, relaxing smooth muscles in the genital area to improve blood flow and facilitate erections.

The biohacking community has embraced various advanced interventions, some more credible than others. Bustamante explains that aging and sexual activity naturally desensitize penile tissue over time, leading men like Johnson to seek resensitization methods. Low-intensity focused shockwave therapy—not to be confused with the gentler, superficial acoustic wave therapy—creates micro-injuries in penile tissue that stimulate new blood vessel growth and improved circulation. This approach has shown promising results for enhancing sensitivity and function. Penile Botox injections temporarily relax muscles by blocking nerve signals, potentially enabling firmer, quicker erections for three to four months at a time. Bustamante notes that Botox can also enhance the effectiveness of medications like Cialis and Viagra. However, he strongly cautions against unproven treatments like penile stem cell injections (not FDA-approved) and the bizarre trend of injecting salmon sperm derivatives, which can cause infections and allergic reactions.

Among the more credible advanced interventions, Platelet-Rich Plasma (PRP) injections—commonly called “P-shots”—stand out as a promising option. This procedure involves extracting platelets from the patient’s own blood and injecting them into the penis to stimulate tissue repair and enhance blood flow. Unlike experimental stem cell treatments or questionable animal-derived injections, P-shots utilize the body’s natural healing mechanisms without introducing foreign substances. When combined with medically supervised shockwave therapy, these treatments can significantly improve erectile function and sexual satisfaction. For men experiencing age-related changes in sexual performance, these evidence-based approaches offer meaningful benefits without the extreme measures adopted by biohacking celebrities. Ultimately, while Johnson’s comprehensive tracking and innovative interventions generate headlines, the fundamentals of diet, exercise, and basic medical care remain the most reliable path to maintaining erectile health—and with it, a powerful indicator of overall longevity and well-being.