Of men aged 40–70 report some degree of ED
On average, men delay seeking help for sexual health concerns far longer than for any other symptom. Every one of these is common, and every one of them is treatable.
Difficulty achieving or maintaining an erection sufficient for satisfactory sex. Roughly half of men between 40 and 70 experience some degree of it, and prevalence rises with each decade.
Ejaculation sooner than desired, causing distress. The most common male sexual complaint overall, and among the most responsive to treatment.
Reduced sexual desire, distinct from erectile difficulty. Frequently hormonal, but also driven by sleep, stress, medication, and mood.
A self-reinforcing cycle where anxiety about performance causes the difficulty it fears. Common in younger men, and often present alongside a physical cause.
Peyronie’s disease — fibrous scar tissue causing curvature, shortening, or painful erections — is more common than most men realise and is frequently mistaken for something to live with. It has established treatment pathways, and early assessment matters because the condition has an active phase and a stable phase that are managed differently. If you have noticed a change in shape or new pain, raise it at your consultation.
This is the single most important thing on this page, and the reason we will not simply mail you a pill.
An erection is a vascular event. It depends on healthy blood vessels dilating and filling on demand. The arteries supplying the penis are considerably narrower than the coronary arteries supplying your heart — so when atherosclerosis begins narrowing arteries throughout the body, the effect becomes noticeable in the smaller vessels first.
The practical consequence is that erectile dysfunction can appear several years before a cardiac event, and it is recognised as an independent marker of cardiovascular risk. Treating the symptom with a tablet while ignoring what it is signalling is a genuine missed opportunity — sometimes a serious one.
This is why a proper ED workup includes blood pressure, lipids, glucose, and a cardiovascular history. Professional guidelines direct clinicians to stratify cardiac risk before initiating treatment, and to involve cardiology where a man’s risk is not low. New-onset ED in a man in his forties or fifties is a reason to look at the whole picture, not a reason to reach straight for a prescription.
Checked at every visit. Hypertension both contributes to ED and changes which treatments are appropriate.
Cholesterol and HbA1c identify the atherosclerosis and insulin resistance that drive vascular ED.
Testosterone, and where indicated prolactin and thyroid — low libido in particular is often hormonal.
Some blood pressure agents, antidepressants, and hair loss treatments cause or worsen ED.
Most cases have more than one contributor, and the mix determines which treatment will actually work.
The most common cause in men over 40. Atherosclerosis, hypertension, high cholesterol, and diabetes all reduce the blood flow an erection depends on.
Low testosterone, thyroid dysfunction, or elevated prolactin. More often responsible for reduced desire than for erectile failure itself — an important distinction.
Diabetes-related nerve damage, spinal injury, multiple sclerosis, or nerve injury following pelvic or prostate surgery.
SSRIs, beta blockers, thiazide diuretics, and 5-alpha reductase inhibitors used for hair loss are common culprits. Often reversible once identified.
Anxiety, depression, relationship strain, and performance anxiety. Rarely the sole cause in older men, but almost always a compounding factor once difficulty begins.
Smoking, heavy alcohol use, obesity, sedentary living, and untreated sleep apnea. The most modifiable category, and the one most often skipped.
A useful clue: if you still wake with morning erections but cannot achieve one with a partner, the plumbing is generally intact and the cause is more likely psychological or situational. If morning erections have disappeared entirely, a physical cause is more probable. Your provider will ask.
PDE5 inhibitors are the established first-line treatment and carry a strong professional recommendation. They differ mainly in how fast they work, how long they last, and whether food matters.
The long duration removes the need to time a dose around a specific occasion, which many couples find takes the pressure off. Also available as a low daily dose for men who prefer spontaneity over planning.
The original PDE5 inhibitor and the most studied. Effective and typically the least expensive, but absorption is slowed by a heavy or fatty meal, so timing around food matters.
A newer agent with a notably rapid onset, which suits men who want the shortest gap between taking a dose and it working. Duration sits between the other two.
PDE5 inhibitors taken together with nitrate medications — nitroglycerin for chest pain, isosorbide, and related drugs, including recreational “poppers” — can cause a sudden, dangerous drop in blood pressure. This combination is an absolute contraindication, not a caution. Tell your provider about every medication you take, including anything obtained without a prescription. Men taking alpha-blockers for blood pressure or prostate symptoms also need careful dose timing. This is precisely why buying these medications outside a clinical relationship is a genuinely bad idea.
These medications do not create desire and they do not work without arousal — they amplify the vascular response your body is already attempting. If a standard dose has not worked for you before, that often reflects dosing, timing, or expectation rather than failure of the drug, and it is worth revisiting with a provider before concluding it does not work.
Around a quarter to a third of men do not respond adequately to oral treatment. These are the next evidence-supported steps, and they work.
A very fine self-administered injection producing a reliable erection independent of arousal. Highly effective, including for men where oral medication has failed entirely. Training and a first dose are done in clinic.
A mechanical pump drawing blood into the penis, held with a constriction ring. Entirely drug-free, safe alongside almost any medical condition, and useful for men who cannot take PDE5 inhibitors.
Where low testosterone is contributing, addressing it improves desire and often the response to oral medication. Testosterone alone rarely resolves erectile difficulty, and we will not present it as though it does.
For performance anxiety or where the difficulty is situational, structured therapy has real evidence behind it — and works well alongside medication rather than instead of it.
Weight loss, exercise, smoking cessation, and treating sleep apnea produce measurable improvement in erectile function. Slower than a tablet, but they treat the cause.
For Peyronie’s disease, suspected venous leak, or where implant surgery becomes the appropriate option, we refer to urology rather than improvise.
These are heavily marketed by men’s clinics. Here is where the professional guidance currently sits — including where it is less favourable than the advertising suggests.
Acoustic wave therapy is proposed to stimulate new blood vessel growth in penile tissue. Some trials in men with vascular ED have shown benefit, but the American Urological Association guideline classifies low-intensity shockwave therapy as investigational — meaning the evidence is not yet sufficient to recommend it as routine care.
Marketed widely as the “P-Shot”, PRP involves injecting a concentrate of your own platelets. The AUA guideline classifies PRP for erectile dysfunction as experimental — an earlier stage of evidence than investigational, meaning it should be confined to research settings rather than sold as treatment.
Investigational does not mean useless, and research on shockwave in particular continues to develop. But these are among the most expensive things a men’s clinic can sell, and they are routinely presented as established treatment when the guidelines say otherwise. If you choose to pursue either, you deserve to do so knowing exactly where the evidence stands — not after being told it is proven. We would rather you started with the treatments that carry a strong recommendation and a fraction of the cost.
Premature ejaculation means ejaculating sooner than you or your partner would like, consistently enough to cause distress. It is defined by the distress it causes rather than by a stopwatch, though clinical definitions of the lifelong form reference ejaculation within roughly a minute of penetration.
It is the most common male sexual dysfunction, more common than erectile dysfunction, and it responds well to treatment. It can also be secondary to erectile difficulty — some men rush because they are anxious about losing an erection, in which case treating the ED resolves both.
Treatment is usually layered, starting with the least invasive option that works for you.
A direct conversation about what is actually happening, your history, your medications, and what you want to change. No euphemisms required.
Bloods covering hormones, glucose, lipids, and thyroid, plus blood pressure and a cardiovascular risk assessment.
Your provider talks you through what is driving it — vascular, hormonal, medication-related, psychological, or a combination — and what each option realistically offers.
Start with the least invasive effective option, review how it works in practice, and adjust. Most men need one or two adjustments to get it right.
A consultation that includes the workup, and treatment priced monthly with medication and follow-up included.
A full assessment of cause — including the cardiovascular and hormonal factors most clinics skip.
Ongoing physician-managed treatment with medication and adjustments included.
Sexual health treatment integrated with hormone optimization and cardiometabolic care.
We do not sell shockwave packages or PRP injections as first-line treatment. If the evidence-supported options do not work for you, we will refer you to urology rather than escalate to something the guidelines call experimental.
ED can be the first sign of vascular disease. We check blood pressure, lipids, and glucose as standard, because finding that early may matter more than the prescription.
Including when a treatment we could profitably sell you is classified investigational or experimental. You get the guideline position, not the sales pitch.
Private consultations, discreet delivery, and a provider who has had this conversation many times before. Men wait years to raise this — we try not to make it harder.
Prevalence rises with age — roughly half of men between 40 and 70 report some degree of it — but common is not the same as normal or inevitable. ED is usually caused by something identifiable: vascular disease, diabetes, low testosterone, a medication you are taking, sleep apnea, or anxiety. Treating it as an unavoidable feature of ageing means missing whatever is actually driving it, which in a meaningful number of men turns out to be cardiovascular.
Because the prescription treats the symptom and the bloods tell us why you have it. ED is recognised as an independent marker of cardiovascular risk and can precede a cardiac event by several years, so a workup that checks lipids, glucose, blood pressure, and hormones is standard care rather than an upsell. Professional guidelines also direct clinicians to assess cardiac risk before starting treatment, since some men need cardiology input first.
Often yes, but it depends, and it must be assessed properly. The absolute rule is that PDE5 inhibitors must never be combined with nitrate medications such as nitroglycerin — the combination can cause a dangerous drop in blood pressure. Beyond that, guidelines stratify men by cardiac risk: those at low risk can generally proceed, while others need cardiology consultation first. Bring a full list of your medications to your consultation.
The honest answer is that neither is established treatment. The American Urological Association classifies low-intensity shockwave therapy as investigational and platelet-rich plasma for ED as experimental — meaning the evidence is not sufficient to recommend either as routine care. Some shockwave trials in men with vascular ED have shown benefit and the research continues, but both are heavily marketed as proven when the guidelines say otherwise. We would rather you started with treatments that carry a strong recommendation.
