Erectile Dysfunction After 50

Reviewed by Dr. Farhan Abdullah, DO

Board-Certified Internal Medicine · IFM Certified Functional Medicine Practitioner

Last clinically reviewed · May 2026

Why ED after 50 needs a real workup

New-onset or progressive ED after 50 is also a vascular health signal. Endothelial dysfunction in penile arteries often precedes coronary artery symptoms by years. Working up ED properly means working up the cardiovascular system at the same time — lipids, blood pressure, A1c, hsCRP, and often a more detailed cardiac risk assessment.

The four drivers, mapped to treatment

Vascular ED (the most common after 50): PDE-5 inhibitors (Cialis daily, Viagra as-needed), Softwave shockwave, the P-Shot, cardiovascular risk factor management.

Hormonal ED (low testosterone, high prolactin, thyroid dysfunction): hormone optimization, often via TRT.

Neurogenic ED (post-prostatectomy, diabetes complications, spinal causes): aggressive PDE-5 protocols, vacuum erection devices, intracavernosal injections, regenerative procedures.

Psychogenic ED (performance anxiety, depression, relationship stress): situational PDE-5 use to break the anxiety loop, therapy referral, mindfulness-based protocols.

What we'll work up beyond just the erection

Sleep apnea screening (huge ED driver, frequently missed). Medication review for ED-causing prescriptions you may not have connected to the symptom (antihypertensives, SSRIs, finasteride, certain antihistamines). Cardiovascular risk profile. Diabetes screening. Mental health screening. The first visit is free; the workup is comprehensive; the treatment is tailored to what we find.