A board-certified cardiologist has identified what he calls the "endothelial reset" — a mechanism that restarts nitric oxide production inside damaged blood vessels. The discovery came after imaging the arteries of men over 50 whose ED had been progressively worsening despite normal testosterone and clean bloodwork. Every scan showed the same damage. Not blocked arteries. Not low hormones. A one-cell-thick lining inside the vessel wall had stopped functioning. The layer responsible for producing the molecule that makes erections possible had gone dormant. Current ED medications work by amplifying that molecule. But if the lining has stopped producing it, there's nothing to amplify. That's why the dose keeps going up. That's why it eventually stops working. The compound he identified doesn't amplify the signal. It reactivates the cells that produce it. His full clinical findings are available here.
Not enough history yet to show a trend.