By David Fenig, MD
Erectile dysfunction (ED) is not a normal part of the aging process for men. And while ED is more common in men as they grow older due to several factors, it’s not a condition you are destined to live with. The fact is, ED increases as men age likely due to obesity and other medical comorbidities such as diabetes, cardiovascular disease, neurological diseases and even sleep disorders – all which affect blood vessels and nerves.
Let’s take a look at ED by age group, what may be causing erectile dysfunction at certain life stages and what can be done to help:
Ages 20 – 45 years:
- In young men (between the ages of 20 – 45 years), erectile dysfunction is usually psychogenic (e.g. behavioral, situational, stress related, etc.), but may also be caused by low testosterone, especially when men are exhibiting other symptoms, or when obesity is an issue.
- When we talk about low testosterone or Low T, which is the hormone that controls sexual drive in men, it’s important to understand that Low T in and of itself is not a sole cause of ED, but rather a contributing factor. Testosterone declines as men age and younger men who have low normal values may become "unmasked" as they age - e.g. their testosterone can drop low enough to cause symptomatic hypogonadism requiring testosterone replacement.
- Sleep apnea and obesity can also be factors in ED. A healthy, low fat diet and exercise can help alleviate symptoms caused by being overweight.
Younger men who experience more than just occasional ED should discuss this with their doctor to determine what may be the underlying cause.
Ages 45 – 60 years:
As men age, chronic medical conditions can arise and play a leading role in the development of ED.
- Conditions such as diabetes, vascular disease, the development of high blood pressure, and high cholesterol affect the blood vessels and restrict blood flow to the penis.
- The development of neurological conditions such as Parkinson’s disease, multiple sclerosis and even stroke also affect the nerves and blood vessels, further restricting blood flow to the penis and leading to problems with ED.
- And, as a catch-22, medications used to treat high blood pressure can sometimes interfere with the blood flow to the penis.
- Sleep apnea and obesity can also be causes of ED as men age.
Men who are experiencing ED around middle age should talk to their doctor. ED can be a symptom of one of these underlying medical conditions and should be evaluated thoroughly so any medical conditions can be diagnosed early and kept under control to ensure overall good health.
- For men in this group, chronic medical conditions such as diabetes, cardiovascular disease and neurological disorders can worsen with age.
- Prostate cancer, which can also affect middle aged men, is not a direct cause of ED, but many treatments for prostate cancer can cause ED. These treatments include surgery, external beam radiation, brachytherapy, cryotherapy and hormone ablation.
- Prostate cancer patients should consider penile rehabilitation to help in the recovery of erections after treatment.
The bottom line for any man experiencing erectile dysfunction is this – don’t just live with it or think it’s something that happens as you age. Oftentimes, there is a medical reason for ED and the ED specialists at Chesapeake Urology are dedicated to helping men return to their normal sexual selves.