ED in your 50s, 60s and beyond
The short answer
ED is common after 50 and becomes more common each decade: NIDDK says about 70% of men report it by age 70. It is still not a routine part of aging. Heart and blood vessel disease, diabetes, prostate problems and some medicines are among the common causes NIDDK lists, and sildenafil and tadalafil were tested in older men too.
In short: erectile dysfunction (ED) becomes more common after 50, and about 70% of men report it by age 70. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is clear that this does not make ED a routine part of aging (NIDDK, Definition & Facts). Much of what matters in these decades is the health picture around it: heart and blood vessel disease, diabetes, prostate problems and daily medicines are all among the causes NIDDK lists (NIDDK, Symptoms & Causes). This page covers what tends to change, which checks matter most, and what the drug labels say about men over 65. For the numbers decade by decade, see our guide to ED by age.
How common is ED after 50?
ED is common after 50, and new cases rise with each decade. In the Massachusetts Male Aging Study, which followed men for close to nine years, men in their 50s developed new ED at about 30 cases per 1,000 men each year, and men in their 60s at about 46, compared with about 12 in their 40s (Johannes et al., J Urol 2000). NIDDK says about 70% of men report ED by age 70 (NIDDK, Definition & Facts).
| Age group | What the studies found | Source |
|---|---|---|
| 50s | About 30 new cases per 1,000 men each year | Johannes et al., J Urol 2000 |
| 60s | About 46 new cases per 1,000 men each year | Johannes et al., J Urol 2000 |
| 53 to 90 | 33% reported ED in the past 3 months (age-standardized, men with prostate cancer excluded) | Bacon et al., Ann Intern Med 2003 |
| 70 | About 70% report ED | NIDDK, Definition & Facts |
| 75 and older | 77.5% affected in a US national survey | Saigal et al., Arch Intern Med 2006 |
Is ED normal at 60 or 70?
ED is common at 60 and 70, but common is not the same as inevitable or untreatable. NIDDK lists age as one factor that makes ED more likely, next to diseases such as diabetes and heart disease, medicines, stress and habits like smoking, and states that ED is not a routine part of aging (NIDDK, Definition & Facts). In a study of more than 31,000 men aged 53 to 90, those with no chronic medical conditions who kept up healthy habits had the lowest rates of ED (Bacon et al., Ann Intern Med 2003). So “it’s just your age” is not a full answer at 60 or at 70.
What changes with age?
Several things that affect erections can be present at once after 50. NIDDK lists the main groups of causes as conditions that affect blood vessels, nerves or hormones, certain medicines, mental or emotional issues, and lifestyle habits (NIDDK, Symptoms & Causes). In the Health Professionals Follow-up Study, desire, orgasm and overall sexual function all declined sharply by decade after 50 (Bacon et al., Ann Intern Med 2003). The table shows the changes most relevant to men in their 50s, 60s and older, and what a clinician usually looks at.
| What tends to change after 50 | What the sources say | What a clinician may check |
|---|---|---|
| Heart and blood vessel disease | Heart disease and high blood pressure were linked to a higher risk of new ED after adjusting for age (Johannes et al., J Urol 2000) | Blood pressure, cholesterol, heart symptoms |
| Diabetes | Diabetes was linked to higher ED risk in two large US studies (Johannes et al.; Saigal et al.) | Blood sugar tests |
| Testosterone | In a compilation of data on 7,000 men with ED cited by the Princeton III panel, testosterone below 300 ng/dL was found in 4% of men under 50 and 15% over 50 (Princeton III, Mayo Clin Proc 2012) | A morning testosterone blood test (AUA guideline) |
| Prostate | NIDDK lists enlarged prostate and nerve damage from pelvic surgery among causes of ED (NIDDK, Symptoms & Causes) | Urinary symptoms, past prostate treatment |
| More daily medicines | Blood pressure medicines, diuretics, antidepressants and others can cause ED as a side effect (NIDDK, Symptoms & Causes) | A review of everything you take |
| Weight and activity | Physical activity was linked to lower ED risk and obesity to higher risk in men over 50 (Bacon et al.) | Weight, waist, activity level |
These are associations from population studies. They show what tends to travel with ED, not which cause applies to a particular man, which is what an evaluation is for.
Why do heart and diabetes checks matter more?
Heart and diabetes checks matter because ED and heart disease share many of the same modifiable risk factors (Gupta et al., Arch Intern Med 2011). The American Urological Association (AUA) says men should be told that ED is a risk marker for underlying cardiovascular disease and other health conditions that may need evaluation and treatment (AUA guideline). The Princeton III expert consensus describes a window of 2 to 5 years between the start of ED and a coronary artery event, and notes that ED often occurs alongside heart disease that has not yet caused symptoms (Princeton III, Mayo Clin Proc 2012).
The same panel cites Olmsted County data suggesting ED is far more predictive of heart disease in men aged 40 to 49 than in older men. That is a difference in how strongly ED predicts heart disease, not a reason to skip the check: the AUA advice above applies to men with ED in general. Heart health also matters for treatment: the sildenafil label says ED medicines should not generally be used in men for whom sexual activity is inadvisable because of their heart condition (VIAGRA label, 5.1). For diabetes, a US national survey of men 20 and older found the odds of ED were more than twice as high with diabetes (odds ratio 2.69) after accounting for other factors (Saigal et al., Arch Intern Med 2006). Our guides to ED and heart disease and ED and diabetes go further. Neither link is a diagnosis on its own; it is a reason to get checked.
Which common medicines matter?
Two kinds of medicine matter after 50: those that can contribute to ED, and those that change whether an ED pill is safe. NIDDK lists antidepressants, antihistamines, blood pressure medicines and diuretics, chemotherapy and hormone medicines, some pain relievers, sedatives and ulcer medicines among medicines that can cause ED (NIDDK, Symptoms & Causes). A clinician may suggest a different medicine, but NIDDK is explicit: do not stop taking any medicine on your own (NIDDK, Treatment). Our guide to medicines that affect erections covers each group.
On the other side, the sildenafil label lists organic nitrates (such as nitroglycerin for chest pain) and riociguat as contraindicated, because the combination can drop blood pressure dangerously. It also advises caution with alpha-blockers, which many older men take for the prostate or blood pressure, since the two together can cause dizziness, lightheadedness or fainting, and notes an added blood pressure drop with other blood pressure medicines (VIAGRA label, sections 4 and 5). The tadalafil label says men should be stable on an alpha-blocker before starting an ED pill (CIALIS label, section 5). Bring a full list, including eye drops, supplements and anything taken only now and then.
Do ED pills work later in life?
They can: the trials behind sildenafil and tadalafil included many older men, and both labels report no overall difference in safety or effectiveness between men 65 and older and younger men. The sildenafil trials included more than 3,000 men aged 19 to 87, and 18% of all sildenafil study participants were 65 or older (VIAGRA label, 8.5 and 14). About 19% of men in the tadalafil ED trials were 65 or older (CIALIS label, 8.5). A pooled analysis of five placebo-controlled trials found sildenafil improved erectile function in men 65 and older, including those who also had diabetes; the most common side effects were mild to moderate headache, flushing and indigestion (Wagner et al., J Gerontol 2001).
Age does change some details, which is why the choice stays with the prescriber. Healthy men 65 and older had about 84% higher overall sildenafil exposure in the blood than healthy young men, and the label asks prescribers to consider a lower starting dose for that reason (VIAGRA label, 8.5). The tadalafil label says no dose adjustment is warranted on age alone, asks prescribers to keep in mind greater sensitivity to medicines in some older men, and notes diarrhea was reported more often in men 65 and older (CIALIS label, 8.5). Tadalafil is also FDA-approved to treat the signs and symptoms of an enlarged prostate (BPH), alone or together with ED (CIALIS label, section 1). Our guide to the safest ED medicine compares all four labels by health condition.
What about ED after prostate treatment?
Surgery or radiation for prostate cancer can affect erections, and NIDDK lists nerve damage from pelvic surgery among the causes of ED (NIDDK, Symptoms & Causes). The AUA guideline says men who want to preserve erectile function after radical prostatectomy or radiotherapy should be told that early use of ED pills after treatment may not improve unassisted erections (AUA guideline). In the sildenafil trials, 43% of men who had a radical prostatectomy reported improved erections on the drug, compared with 15% on placebo (VIAGRA label, 14). Our guide to ED after prostate treatment covers the options in more depth.
Can ED be reversed in older men?
ED is not something a single change reliably reverses, but some of its causes can improve when they are treated. A meta-analysis of randomized trials found that lifestyle changes and medicines for heart risk factors improved erectile function scores in men with ED (Gupta et al., Arch Intern Med 2011). In men over 50, several healthy habits were linked to keeping good erectile function even after other conditions were taken into account, and physical activity and leanness were the lifestyle factors most strongly linked to ED (Bacon et al., Ann Intern Med 2003). The AUA also advises that men with conditions that affect erections be told that diet changes and more physical activity improve overall health and may improve erectile function (AUA guideline). Beyond pills, the AUA says men should be informed about vacuum devices, urethral suppositories, injections and penile implants as treatment options (AUA guideline).
When to talk to a clinician
Talk to a clinician if erection problems keep happening, at any age. The AUA recommends a full medical, sexual and psychosocial history, a physical exam and selected lab tests, including a morning testosterone level (AUA guideline). That matters most if you also have heart disease, diabetes, high blood pressure or prostate symptoms, or take several daily medicines. Seek care right away for an erection lasting longer than 4 hours, or for vision or hearing loss after taking an ED pill (NIDDK, Treatment).
Sources
Every clinical statement on this page traces to one of these sources:
- NIDDK, Definition & Facts for Erectile Dysfunction, last reviewed October 2024. About 40% of men affected at 40 and 70% by 70; more likely with age but not a routine part of aging: niddk.nih.gov, ED definition and facts
- NIDDK, Symptoms & Causes of Erectile Dysfunction, last reviewed October 2024. Conditions, including enlarged prostate and pelvic surgery, and medicines that can cause ED: niddk.nih.gov, ED symptoms and causes
- NIDDK, Treatment for Erectile Dysfunction, last reviewed October 2024. Do not stop medicines on your own; seek care for priapism or vision or hearing loss: niddk.nih.gov, ED treatment
- Johannes CB, et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol 2000;163(2):460-3. New cases of 12.4, 29.8 and 46.4 per 1,000 man-years in men 40 to 49, 50 to 59 and 60 to 69; higher risk with diabetes, heart disease and hypertension: pubmed.ncbi.nlm.nih.gov/10647654
- Saigal CS, et al. Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med 2006;166(2):207-12. 77.5% of men 75 and older affected; diabetes odds ratio 2.69: pubmed.ncbi.nlm.nih.gov/16432090
- Bacon CG, et al. Sexual function in men older than 50 years of age: results from the Health Professionals Follow-up Study. Ann Intern Med 2003;139(3):161-8. 31,742 men aged 53 to 90; 33% age-standardized prevalence; physical activity and leanness linked to good erectile function: pubmed.ncbi.nlm.nih.gov/12899583
- Nehra A, et al. The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease. Mayo Clin Proc 2012;87(8):766. ED as a cardiovascular risk marker; 2 to 5 year window to a coronary event; cited Olmsted County data showing ED far more predictive of heart disease at 40 to 49 than in older men; cited compilation of 7,000 men with ED showing testosterone below 300 ng/dL in 4% under 50 and 15% over 50: pmc.ncbi.nlm.nih.gov/articles/PMC3498391
- American Urological Association, Erectile Dysfunction Guideline (2018). Evaluation, ED as a cardiovascular risk marker, morning testosterone, lifestyle counseling, treatment options and PDE5 inhibitors after prostate cancer treatment: auanet.org, ED guideline
- VIAGRA (sildenafil citrate) prescribing information, DailyMed. Contraindications, cardiovascular and alpha-blocker warnings, geriatric use (section 8.5) and clinical studies: dailymed.nlm.nih.gov, VIAGRA label
- CIALIS (tadalafil) prescribing information, DailyMed. BPH indication, alpha-blocker warning and geriatric use (section 8.5): dailymed.nlm.nih.gov, CIALIS label
- Wagner G, Montorsi F, Auerbach S, Collins M. Sildenafil citrate (VIAGRA) improves erectile function in elderly patients with erectile dysfunction: a subgroup analysis. J Gerontol A Biol Sci Med Sci 2001;56(2):M113-9. Five placebo-controlled trials; men 65 and older, including those with diabetes: pubmed.ncbi.nlm.nih.gov/11213274
- Gupta BP, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2011;171(20):1797-803. Six randomized trials, 740 men; improved erectile function scores: pubmed.ncbi.nlm.nih.gov/21911624
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