What causes erectile dysfunction (ED) in men over 50?

If you have erectile dysfunction (ED) and are over 50, you are not alone. It's the most common sexual dysfunction for men. For some, it can be a sign of a more serious health problem. Read on to learn more about the causes of ED in men over 50 and what you can do about it. 

ED, sometimes referred to as impotence, happens when you can't get or keep an erection sufficient for satisfying sex. That might include erections that don't last as long as you want or aren't as firm as you'd like. These issues with erectile function may affect your sex drive in addition to your ability to have sex.

Erectile dysfunction is the most common sexual issue for men, affecting approximately 30 to 50 million adult men in the United States—that’s more than half of men aged 40 to 70 (Sooriyamoorthy, 2021).  

ED becomes more common with age. At age 40, about one-third of men have ED; this number climbs to 70% by age 70. But these statistics don’t mean that ED is inevitable or is necessarily a natural part of aging. ED can often result from a range of medical conditions that might come with age, like heart disease, high blood pressure, and diabetes (Sooriyamoorthy, 2021). 

The most common cause of erectile dysfunction in men over 50 is atherosclerosis, which is the build-up of plaque in the arteries or hardening of the arteries. This condition can affect any of the arteries in the body and commonly contributes to heart disease. But it can also affect the blood vessels in the penis responsible for erections. That's why almost half of men with diagnosed heart disease have significant ED (Sooriyamoorthy, 2021). 

As men age, the linings of arteries become less flexible. That means they don't expand as easily to let more blood flow through when you need it (like while getting an erection). Plaque buildup can also narrow arteries, meaning less blood can flow to the penis. This reduced blood flow can cause ED as well as heart attacks or strokes. 

Because the penile blood vessels are smaller than those in the heart, they can get affected by atherosclerosis long before you have signs or symptoms of heart disease (e.g., chest pain)—by as much as 10 years. ED can be an early indicator that your blood vessels are not doing well (Sooriyamoorthy, 2021). 

Studies show that young men with ED are 30% more likely to develop heart disease over the next 10 years (Pozzi, 2020). In fact, people with ED have over 60% more heart attacks, almost 40% more strokes, and a 25% increased risk of death than those without ED (Sooriyamoorthy, 2021). 

Erectile dysfunction and heart disease share a lot of the same risk factors and symptoms. If you have symptoms of ED, consider getting screened for cardiovascular risk factors like diabetes, high cholesterol, and high blood pressure.

ED isn't only due to cardiovascular issues. Other things can contribute to ED too, including (Sooriyamoorthy, 2021):

• Diabetes

• Obesity

• Anxiety and depression

• Relationship issues

• Sleep disorders

• Peyronie's disease

• ​Low testosterone levels

• Spinal cord injuries

Your erections will be best when you're healthy. Making simple lifestyle changes—like getting regular exercise, following a healthy diet, quitting smoking, getting enough sleep, and limiting your alcohol consumption—might help control the factors that can contribute to ED (Ostfeld, 2021). 

If a healthy lifestyle is not enough, your healthcare provider may recommend medications to treat your underlying conditions, or medications to help deal with the symptoms of ED.

Oral prescription medications for ED are highly effective at improving sexual function. The most commonly prescribed are phosphodiesterase-5 (PDE5) inhibitors like sildenafil (brand name Viagra), tadalafil (brand name Cialis), and vardenafil (brand name Levitra). PDE5 inhibitors work by widening your blood vessels and increasing blood flow to the penis. Some men have found natural remedies for ED to be effective at improving sexual performance (such as DHEA, ginseng, L-arginine, L-carnitine, and yohimbine), though the evidence is limited. 

If you're experiencing erectile dysfunction, know that there are a range of safe and effective treatment options available to improve your sex life and that of your partner or partners. Speak with a healthcare provider to learn which treatment might be right for you.

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Current version

April 14, 2022

Written by

Michael Martin

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.