Stock photoBook a visit if the change is new or getting worse, or if you also have diabetes, high blood pressure, high cholesterol or a history of smoking. Call 911 for chest pain, shortness of breath or fainting. Seek urgent care for an erection that lasts more than four hours.
What counts as ED
The National Institutes of Health describes it three ways: getting an erection only some of the time, having one that doesn't last long enough for sex, or not being able to get one at all. An occasional off night, when you're tired, stressed or have had a few drinks, isn't the same thing. A pattern is what's worth a conversation.
Why your heart comes into it
Mayo Clinic explains that ED can be an early warning sign of current or future heart problems. The arteries that supply the penis are much smaller than the ones feeding the heart, so narrowing from atherosclerosis can show up there first. That's why a good doctor may check your blood pressure, cholesterol and blood sugar when you mention it. A pill or powder can't do that part, which is the main reason to see someone before you shop.
Common causes after 50
| Blood vessels | Atherosclerosis, high blood pressure and stroke can all limit blood flow. |
|---|---|
| Blood sugar and other conditions | Diabetes, chronic kidney disease and obesity are all on the NIH list. |
| Hormones | Low testosterone and thyroid problems. A simple blood test can check. |
| Medicines | Some antidepressants, blood pressure medicines and diuretics, antihistamines, pain relievers, sedatives and ulcer medicines. Never stop one on your own; ask whether there's an alternative. |
| Prostate and nerves | Prostate enlargement, pelvic surgery and nerve damage can play a part. |
| Mood and stress | Anxiety, depression, stress and loneliness can cause or worsen it, and worrying about it can keep it going. |
| Habits | Too little physical activity, heavy drinking, smoking and recreational drugs. |
Five things to do before you buy anything
- Tell your doctor, in one sentence"I've noticed a change in erections and I'd like to know if it's connected to anything else." They hear it every week. A primary care doctor is a fine place to start.
- Bring a full list of what you takeInclude over-the-counter products and supplements. Your list may turn out to be the explanation.
- Ask for the basic numbersBlood pressure, cholesterol, blood sugar and, if your doctor thinks it's useful, testosterone.
- Move moreWalking counts. Too little activity is one of the listed contributors, and what's good for your arteries is good for all of them.
- Cut back on smoking and heavy drinkingBoth are on the list, and free help to quit smoking is available at 1-800-QUIT-NOW.
What a doctor can offer
The options are better than many men assume: treating the underlying condition, adjusting a medication, prescription pills, counseling on its own or with a partner, vacuum devices, and for some men other medical or surgical treatments. Prescription pills have much stronger evidence than any supplement, but they are not safe for everyone, and they must not be combined with nitrates. That is exactly the kind of thing to settle in the office.
A warning about "natural" enhancement products
The FDA keeps a long list of sexual enhancement products found to contain undeclared prescription drugs, often the same active ingredients as Viagra and Cialis, sometimes in products labeled all natural. For a man on nitrates that can drop blood pressure to dangerous levels. Be especially careful with gas station pills, single-dose packets and anything without a full label. Before you buy any supplement, check that it prints its ingredients and amounts, look it up on the FDA's notification list, and read the refund terms.
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WellCraft 50 may earn a commission if you buy through links in that review. A supplement does not replace medical care and is not a treatment for ED.
Free printable guide
The men's health checkup checklist after 50
Get our free printable checklist: the screenings to ask about by age, 12 plain questions for the conversations men put off, and what to check before buying a men's supplement.
The bottom line
ED is common, it's often treatable, and it can be a useful early warning. One awkward sentence to your doctor can get you a real answer and, possibly, a heads-up about your heart that you'd want to have anyway.
This article is for general education and is not medical advice. Talk to your doctor about any new or changing symptoms.