Key takeaways

  • Erectile dysfunction is more common in older adults due to factors such as underlying health conditions, medications, and decreased testosterone levels.
  • Lifestyle changes, such as a healthy diet, regular exercise, and managing underlying conditions, can help treat or prevent erectile dysfunction.
  • Medical treatments for erectile dysfunction include PDE5 inhibitors, testosterone replacement therapy, and, in some cases, surgery.

Erectile dysfunction (ED), also known as impotence, is a condition that makes it difficult to get or maintain an erection. ED affects around 30 to 50 million people in the United States. It is more common as people age, with 70% reporting ED by the time they are 70 years old.

Treatment for ED can include lifestyle changes, medications, and, in some cases, surgery.

ED is the medical term for when a person has difficulty achieving or maintaining an erection.

Several factors may cause or contribute to ED. Aging is one such reason, as older males may be more likely to:

  • have medical conditions that can contribute to ED
  • take medications that may contribute to ED
  • experience decreased testosterone levels, which may reduce sexual arousal

Medical conditions

Older males may be more likely to have medical conditions contributing to ED. Examples of these health conditions include:

These conditions can affect blood flow or nerve sensations, both of which are necessary for an erection. Reduced blood flow, known as vascular insufficiency, is one of the most common causes of ED.

Medications

Older adults may be more likely to take medications to manage underlying medical conditions. While these medications can enhance overall health, some may worsen ED symptoms.

These medications can include:

A person who believes their medication may be contributing to their ED should discuss this with a healthcare professional. A healthcare professional may lower the dosage or suggest a suitable alternative.

A person should not stop taking a medication unless their healthcare professional has instructed them to do so.

Testosterone levels

Testosterone is a hormone with several important functions within the body. It helps with various aspects of sexual health in males, including:

  • regulating sex drive
  • maintaining the tissues that supply blood to the penis

Low levels of testosterone can lead to ED. Research shows that testosterone levels begin to gradually decrease around the age of 35 and then decrease more quickly as a person ages.

Choosing a treatment

Generally, healthcare professionals will try to treat the underlying cause of ED. However, that cause is not always known. If this is the case, the focus will typically be on improving sexual function.

Choosing an ED treatment is a personal decision. If a person has a partner, they may wish to talk about what may work as a couple.

A healthcare professional may recommend certain lifestyle changes to help manage ED symptoms. These may include:

A lack of sexual desire can also influence ED in older males. According to a 2020 review, an estimated 82.4% of males ages 80 and above report a lack of sexual desire. Seeking treatment from a sex therapist is one option that could improve sexual desire and reduce ED symptoms.

In addition to lifestyle measures, healthcare professionals may also prescribe medications for ED. Most are safe for older adults, though a medical professional will need to check that they are compatible with other medications that a person takes.

There are also over-the-counter medications available. Individuals can discuss all treatment options with their healthcare professional.

Did you know?

Medicare Part D and Medicare Advantage (Part C) plans will generally cover prescription medications. However, they may not cover medications that treat ED, such as Viagra. If a healthcare professional prescribes these medications for a different reason, then Medicare may cover them.

Medicare does, however, generally cover testosterone replacement therapy (TRT). Depending on whether a person receives this treatment in a doctor’s office or at home, it will either be covered under Part B or Part D.

Phosphodiesterase-5 inhibitors

One of the first-line treatments for ED in older people is a class of drugs called phosphodiesterase-5 (PDE 5) inhibitors. These medications relax and widen the blood vessels, improving blood flow to the penis.

PDE 5 inhibitors are generally safe in older people, including those with cardiovascular diseases. However, they are not suitable for people who take nitrates for heart conditions.

Some examples of PDE 5 inhibitors include:

»Learn more: PDE5 inhibitors

Testosterone replacement therapy

If an older person has low testosterone levels, a doctor may prescribe testosterone replacement therapy (TRT). This will involve regularly administering testosterone via injections, gel, or a skin patch.

However, TRT will not address some of the more common causes of ED in older adults, such as reduced blood flow or nerve damage.

TRT may not be suitable for everyone. The American Urological Association has set guidelines for this type of treatment. Individuals can discuss the options with their healthcare professional.

Intracavernosal injections

Alprostadil is an injectable medication or penile suppository that some people may use to achieve an erection. It quickly expands blood vessels in the penis, helping a person gain an erection within 10 minutes.

Injectable alprostadil medications include:

  • Caverject
  • Edex
  • Prostin VR

Alprostadil is one example of intracavernosal injection, but doctors may use a mixture of three drugs called Trimix, which includes alprostadil, phentolamine, and papaverine.

»Learn more: ED injections

Surgery is a possible treatment for people with refractory ED, where other treatments have not been effective.

Penile implant surgery has emerged as a safe and effective treatment for ED. It offers individuals a sustained, improved quality of life.

»Learn more: ED surgery

Healthy aging resources

To discover more evidence-based information and resources for healthy aging, visit our dedicated hub.

Older people may experience higher rates of ED. They may also be more likely to experience medical issues and take medications that increase the likelihood of the condition. An age-related decline in testosterone levels can also contribute to ED.

Anyone who has concerns about ED should speak with a healthcare professional. A health professional will work to diagnose the cause and provide appropriate treatment.

When treating ED in older people, a doctor may recommend a combination of lifestyle changes and medical treatments. A person can discuss the treatment options with their doctor to determine which approach will be best for them.