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Physical causes Cardiovascular diseases such as atherosclerosis Diabetes, affecting nerve health and blood flow High blood pressure, damaging blood vessels over time High cholesterol, leading to reduced penile blood flow Obesity, which increases risk of diabetes and vascular disease Hormonal imbalances such as low testosterone Peyronies disease, causing scar tissue and painful curvature Neurological conditions like Parkinsons disease, multiple sclerosis, or spinal cord injury Medications including antidepressants, antihistamines, and certain blood pressure drugs Substance abuse of tobacco, alcohol, or illicit drugs Sleep disorders such as sleep apnea Psychological causes Everyday stress and performance anxiety Anxiety and depression affecting sexual desire Relationship problems reducing intimacy and arousal Other factors Aging, as older men more often have contributing health issues Injuries to nerves or arteries controlling erection What are the symptoms of erectile dysfunction

Without guardrails in place, consolidation has metastasized

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By 1954 Marlboro still had no more than 1% of the national market