Erectile Dysfunction Management in Men Over 60 in 2026

Understanding Erectile Dysfunction in Men Over 60

Erectile dysfunction refers to the consistent inability to achieve or maintain an erection adequate for sexual intercourse. While it becomes more prevalent with age, it is not an inevitable part of aging. Research indicates that approximately 50-60% of men over 60 in the U.S. experience some degree of ED, with prevalence increasing in older age groups.

Several physiological and psychological factors contribute to ED in older men. Common contributing health conditions include cardiovascular disease, diabetes mellitus, hypertension, obesity, and hormonal imbalances such as low testosterone. Mental health factors like depression, anxiety, and stress also play significant roles. Medications prescribed for chronic conditions may additionally affect erectile function.

Lifestyle Factors Affecting Erectile Function

Lifestyle plays an important role in erectile health. Modifiable behaviors and general health improvements have been associated with better erectile function.

Physical Activity

Regular aerobic exercise improves cardiovascular health and blood flow, which are critical for erectile function. Men engaging in moderate physical exercise, such as walking, swimming, or cycling, often report improved ED symptoms.

Diet and Nutrition

A diet low in saturated fats and rich in fruits, vegetables, whole grains, and lean proteins supports vascular health. The Mediterranean diet, in particular, has been associated with improved sexual function among older men.

Weight Management

Obesity correlates strongly with ED due to its effects on vascular health and hormone levels. Weight loss through diet and exercise may contribute to improvements in erectile capacity.

Smoking and Alcohol

Smoking negatively affects blood vessels and erectile function. Cessation of smoking is advised. Excessive alcohol consumption can also impair sexual function; moderation may alleviate related ED symptoms.

Psychological Well-being

Mental health issues such as stress, depression, and anxiety can contribute to ED. Psychological counseling or therapy may be beneficial in addressing these factors when appropriate.

Medical Evaluation and Diagnosis

Diagnosis of ED typically involves a detailed medical and sexual history, physical examination, and assessment of relevant laboratory tests including blood glucose, lipid profile, and hormone levels (e.g., testosterone). Screening for cardiovascular disease and psychological evaluation might be necessary to identify underlying causes to target.

Healthcare providers use validated questionnaires, such as the International Index of Erectile Function (IIEF), to assess the severity and impact of ED. This assessment helps tailor management strategies.

Prescription Medications for Erectile Dysfunction

Phosphodiesterase type 5 inhibitors (PDE5 inhibitors) remain the primary pharmacologic treatment for many men with ED. These medications facilitate blood flow to the penis by enhancing the nitric oxide–cyclic guanosine monophosphate pathway.

Common PDE5 Inhibitors

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)

Onset and Duration

• Sildenafil and Vardenafil usually take effect within 30-60 minutes and last for about 4-6 hours.
• Tadalafil may begin working within 30 minutes and can remain active for up to 36 hours.
• Avanafil typically has a rapid onset around 15-30 minutes with duration similar to sildenafil.

Safety and Considerations

Men with cardiovascular disease or using nitrates should consult healthcare professionals before using PDE5 inhibitors due to potential interactions and contraindications. Common side effects include headache, flushing, nasal congestion, and indigestion.

Regular monitoring and consultation with a healthcare provider are advised when initiating or continuing PDE5 inhibitor use.

Other Medical Treatments

Vacuum Erection Devices (VEDs)

VEDs create a vacuum around the penis that draws blood into the corpora cavernosa, causing an erection. A constriction ring may be applied to maintain the erection. These devices are non-invasive and can be used in various clinical situations.

Penile Injections

Medications such as alprostadil can be injected directly into the corpora cavernosa to induce an erection. This method is typically considered when oral therapies are ineffective or contraindicated.

Intraurethral Suppositories

Alprostadil can also be administered as a urethral suppository. This approach is less invasive than injections but generally less effective.

Hormone Therapy

Testosterone replacement therapy might be considered in men with documented low testosterone levels accompanying ED, although it is not a primary ED treatment. Hormone therapy requires evaluation of benefits and risks.

Non-Prescription Supplements

Various over-the-counter supplements marketed for sexual health contain ingredients such as L-arginine, ginseng, yohimbine, or ginkgo biloba. Some studies suggest these substances may have modest effects on vascular or erectile function; however, evidence is inconsistent and limited by study quality.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements with the same rigor as prescription drugs. Additionally, some supplements have been found to contain undeclared ingredients or contaminants. Individuals considering supplements should consult healthcare providers for safety and potential interactions.

Psychological and Behavioral Therapies

Psychological interventions such as cognitive-behavioral therapy (CBT), sex therapy, and couples counseling can address emotional or relational issues contributing to ED. These approaches may be used alone or in conjunction with medical treatments.

Impact of Telemedicine

Telemedicine has increasingly facilitated access to healthcare services related to sexual health in the U.S., providing remote consultations that might improve reach to specialists or primary care providers who can evaluate and manage ED. However, the quality of care depends on thorough clinical assessment and proper follow-up.

Typical Costs in United States (2026)

When considering management options for erectile dysfunction in the United States, typical cost ranges include:

• Basic option: Lifestyle counseling and initial evaluation by a primary care provider often covered by insurance, though co-pays may vary.
• Standard option: Prescription PDE5 inhibitors typically cost $10-$80 per pill without insurance, with generic versions often lower, or medication with partial insurance coverage may reduce out-of-pocket expenses.
• Premium option: Advanced treatments such as penile injections, vacuum devices, or testosterone therapy may range from several hundred to several thousand dollars annually, depending on insurance coverage and provider fees.

Costs for psychological therapies vary widely, with sessions averaging $100-$250 each, though some insurance plans provide partial coverage.

Summary

Erectile dysfunction in men over 60 has multifactorial causes, often related to vascular health, hormonal status, and psychological factors. Management involves a combination of lifestyle modifications, medical evaluation, pharmacologic and non-pharmacologic treatments, and addressing mental health aspects. Decisions should be guided by healthcare professionals based on individual health status and preferences.

Continued research is ongoing to better understand effective interventions and optimize treatment approaches tailored for aging men in the United States.