What Bryan Johnson's Erection Tracking Reveals About Vascular Health

Bryan Johnson, the 48-year-old centimillionaire behind the Blueprint longevity protocol, has spent two years arguing that nighttime erections are a vital sign, on par with blood pressure or resting heart rate. "Men who do not have nighttime erections are 70% more likely to die prematurely," Johnson said in a 2024 interview. "It predicts death." The claim has drawn more than a million views. It also sits on a body of medical literature that Johnson rarely cites but that urologists and cardiologists have been assembling for two decades.

Penile arteries are much smaller than the arteries that supply the heart and brain, typically 1 to 2 millimeters in diameter against the 3 to 4 millimeters of a coronary artery. This means they show the first signs of atherosclerotic plaque buildup, often two to five years before a cardiac event, according to Dr. Ryan Welter, a regenerative medicine specialist and founder of Regeneris Medical. "Declines in penile health, particularly ED, have been established as an early predictor of cardiovascular disease," Welter told the New York Post in January.

What the research shows

A 2023 study in JACC: Advances drew on data from the National Health and Nutrition Examination Survey. It found that men with both erectile dysfunction and elevated cardiac biomarkers had the highest risk of all-cause mortality. A 2013 meta-analysis of cohort studies in Circulation: Cardiovascular Quality and Outcomes went further: erectile dysfunction independently predicted cardiovascular events and death from any cause, with a risk magnitude similar to smoking or a family history of coronary disease.

Johnson's protocol

Johnson takes 2.5 milligrams of tadalafil daily. That is a dose meant for benign prostatic hyperplasia, not erectile dysfunction. He calls it a longevity play. He also does low-intensity focused shockwave therapy. The acoustic pulses make tiny injuries in penile tissue. The body responds by growing new blood vessels. On top of that, he gets Botox shots into the penile smooth muscle to relax the tissue and let more blood through. He says these three things, layered onto his Blueprint diet and training, raised his nighttime erection quality by 34 percent. He got that number from an Adam Health sensor. It is a $249 ring worn during sleep that logs how often, how long, and how rigid his erections are.

Chris Bustamante is a nurse practitioner. He runs Lushful Aesthetics, a men's clinic in New York. He told the Post the shockwave therapy mechanism is real. "They trigger the growth of new blood vessels and increased blood circulation," he said. But the cheaper acoustic-wave gadgets sold to consumers probably do not fire deep enough to do much. Penile Botox wears off after three or four months. It works better with a drug like tadalafil behind it. Not great on its own.

What does not hold up

Penile stem cell shots are not FDA-approved. The safety and efficacy data is not there. Bustamante also said to stay away from salmon sperm injections. Those carry infection and allergy risks and the evidence is thin. He favors platelet-rich plasma instead. P-shots pull plasma from your own blood and inject it into the tissue to kick off repair. The studies behind this are modest. But they are growing.

The insight worth keeping from Johnson's project is not that you need a $249 erection tracker or a shockwave appointment. The experts land on something simpler: your metabolic health sets the ceiling on your erectile health. Welter put it bluntly: "The single most important treatment for longevity and health span, particularly for the penis, is diet and exercise." Bustamante tells patients to do 30 minutes of cardio a day, eat mostly plants and fiber, cut back on red meat and anything processed. Those foods drive up blood pressure and stiffen arteries. He had one more thing for cyclists: all that saddle time presses on the perineum and kills the nerves and vessels that supply the penis. A fancy seat won't save you.

Johnson's claim that nighttime erections predict mortality probably oversells the evidence. The 70 percent figure does not exist in that form in the peer-reviewed literature. His dataset is one guy. Himself. That is an anecdote. But the core idea is not controversial in cardiology. What happens in the smallest blood vessels happens everywhere. Erections need nitric oxide and healthy endothelial function. That is the same machinery that keeps your coronary arteries open and your blood pressure regulated. When it starts to go, the penis is often the first alarm.

References

1. Miner M, Esposito K, Guay A, et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation: Cardiovascular Quality and Outcomes 6(1):99-109. 2013. https://doi.org/10.1161/CIRCOUTCOMES.112.966903
2. Jani N, Zalawadiya S, Mehta A, et al. Elevated cardiac biomarkers, erectile dysfunction, and mortality in US men: NHANES 2001 to 2004. JACC: Advances 2(4):100380. 2023. https://doi.org/10.1016/j.jacadv.2023.100380