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Many things can cause testosterone levels to be low, such as problems with the pituitary gland, which regulates the production of the sex hormone; thyroid abnormalities; liver problems; and abnormalities within the testes themselves. So if you're unable to get an adequate erection, it's possible that something is causing trouble with your body's testosterone production. looking for viagra ? buy viagra without prescription online Fig. 2: Cellular perspective of the erection pathway. The signal (nitric oxide) is released from nerve endings or from endothelial cells and activates a cascade reaction, which ultimately leads to an increased cellular concentration of cGMP (cyclic guanosine monophosphate). This second messenger molecule induces a series of events that lead to smooth-muscle relaxation through a reduction in the intracellular calcium ion concentration. The enzyme PDE-5 (phosphodiesterase type 5) reverses this effect by metabolizing the cGMP to GMP rapidly. The clinically important inhibitors of this enzyme (sildenafil, vardenafil and tadalafil) all act to promote smooth-muscle relaxation by their ability to allow cGMP to accumulate when nitric oxide is released, as is the case when sexual stimulation is present. Photo: Christine Kenney NMDA-induced erections were significantly blunted in diabetic rats compared with control rats