Addressing Erectile Dysfunction in Aging Men: Effectiveness and Safety of Current Medications

As men age, they are more likely to have ED. Most older adults, however, fail to seek medical attention because they see ED as a natural consequence of becoming older. Also, many think other diseases deserve more attention and care. It's a widespread misconception. Sexual health is very important and can influence different spheres of life. So in this article, we'll go through how medical specialists now treat ED in older men, what meds are used, and how effective and safe they are.

Erectile Dysfunction and Its Consequences

The inability to get or keep an erection good enough for sexual performance is what's known as erectile dysfunction (ED). The frequency and incidence of ED rise sharply with age, particularly among men aged 60 and above. Male erectile dysfunction is more prevalent in older men and occurs less often in men between the ages of 20 and 50. Men older than 70 have a 50-100 percent higher risk of developing this condition.


ED is not fatal but can have serious consequences. We talk about affecting the quality of life, decreasing job productivity, leading to withdrawal from sexual intimacy, and maybe causing unpleasant feelings like sadness, anxiety, or poor self-esteem. These aftereffects threaten both the patient's and their partner's well-being. As men age, they often reduce their standards for sex. But it doesn't imply older guys won't benefit from ED therapy. With appropriate medical care, even a little increase in erection strength may significantly impact a patient's mental and physical health.

Possible Reasons for ED in Elderly Men

As men age, penis loses some of its vascular supply. Also, the arterial bed of the penis is susceptible to atherosclerotic vascular abnormalities. As the second point, aging alters the relative percentage of -adrenergic receptor subtypes. The human erectile, bladder, and prostatic tissues - all show significant age-related alterations. ED is linked to low plasma nitric oxide levels because erections rely on NO generation.


Men with neurological or vascular issues are also at a much-increased risk of ED. Most cases of erectile dysfunction may be traced back to one of the following five causes:


●       chemical,

●       neurological,

●       vascular,

●       hormonal,

●       psychological.


Drug side effects are suspected in up to 20% of ED patients. Local injury to the pudendal nerve, often caused by persistent pressure from activities like long-distance bicycle riding, and diabetes mellitus are also potential causes of erectile dysfunction. Anxiety, stress, sadness, mental disease, and dementia are just some of the mental health issues that have been linked to erectile dysfunction.

 Additional Effects of PDE5 Inhibitors on Elderly Men

Many older men have polypharmacy due to the presence of many medical conditions. They are often afflicted with several ailments and use numerous medicines, many of which have the potential to impair sexual performance. This fact also calls for a thorough analysis of any possible drug interactions. One more serious reason worth mentioning is the following. It is generally agreed that atherosclerosis and other vascular diseases are the primary causes of ED.

PDE5 Medications

The modern pharmacy offers plenty of options to help people restore erectile function and enhance their erections. Due to their high effectiveness, convenience of use, and high safety profile, PDE5 inhibitors are regarded as the first line of treatment. Sildenafil (Viagra), Vardenafil (Levitra), Tadalafil (Cialis), and Avanafil (Stendra) are the four PDE5 inhibitors that have been granted regulatory approval on a global scale.


Although PDE5 inhibitors have lower response rates in senior men compared to younger patients, their convenience and minimal risk of side effects make them a good choice. They facilitate penile smooth muscle relaxation by inhibiting PDE5, an enzyme responsible for cGMP breakdown.

How Exactly Do PDE5 Inhibitors Improve Erections?

All PDE5 inhibitors accomplish the same goals. The primary objective of these medications is to restore normal blood flow. Vardenafil, Tadalafil, Sildenafil, and Avanafil - all cause an increase in blood flow to the penis. Sexual excitation triggers the release of nitric oxide (NO) in the cavernous body. This causes the smooth muscle fibers in the penis to relax and promotes an increase in blood flow. The drugs work at the precise arousal time to speed blood's entry into the cavernous bodies. This makes it possible for an erection to be achieved with less effort and time.


Pills only have an effect if a man is sexually aroused. If there is no stimulus, the medication will not function. It's a key feature of tablets. It's important to remember that if there's no attraction between you and your partner, the medication cannot work.

What PDE-5 Inhibitor Is Better?

Although all PDE5 inhibitors are about equally effective, there are notable variances in how well they are absorbed after oral administration and how long their effects last. Check out the table below for the most crucial data you should know.


Name of the drug

Active ingredient

Onset of action

Action duration



Around 60 minutes

4 hours



15-30 minutes

36 hours



Around 25 minutes

8-12 hours



15-30 minutes

3-6 hours


Since both Sildenafil and Vardenafil are extensively metabolized in the gut wall and liver, their oral bioactivity is rather low. This factor may affect the window of opportunity for sexual activity and should be carefully addressed when designing an ED therapy. It has been shown that the absorption rates of Sildenafil and Vardenafil are reduced by eating a high-fat meal.

 Common Side Effects and Warnings

The ultimate efficacy in each situation will rely on the unique physical traits of the individual. To make an informed decision, you must first understand the causes and severity of ED. You need to be checked out and find out if you have any chronic conditions.

Effectiveness and Safety Profile

The meds are usually effective for elderly patients. However, a reduced effectiveness rate was seen for PDE5Is in senior males, particularly in individuals older than 80. Adverse effects are the same as for patients of any age. In addition, supplementing with testosterone may improve the effectiveness of PDE5Is in males suffering from ED and late-onset hypogonadism. It is due to testosterone's dual roles in maintaining the health of erection-supporting tissue and nerves, and boosting PDE5Is effectiveness by increasing bioavailable NO in the cavernous smooth muscle.


Age-related androgenic insufficiency unquestionably reduces the efficacy of PDE5Is medications. In addition to the patient's increased weariness, sleeplessness, sadness, etc., testosterone deprivation significantly lowers libido. As previously discussed, drug action requires a preexisting desire and attraction to a partner. Physicians may prescribe advanced testosterone medication therapy for three months. Such treatment has the potential to boost the efficacy of the meds.

 Effectiveness and Safety Profile

Even among older adults, PDE5Is have a stellar safety record. Patients over 65 y.o. do not have a higher incidence of myocardial infarction. However, PDE5 inhibitors are obviously contraindicated in patients with unstable angina pectoris, recent myocardial infarction, certain arrhythmias, and poorly managed hypertension, just as they are in younger individuals.

Common Side Effects and Warnings

Common side effects of PDE5Is therapy include headache, facial and ocular hyperemia, nasal congestion, and back discomfort. Blurred vision is caused by cross-reactivity with PDE6 in the retina. Elderly individuals sometimes experience symptoms of flushing and dyspepsia.


The list of common adverse effects includes:


●       headache;

●       dizziness;

●       hot flashes to the face;

●       bloody nose;

●       heart palpitations;

●       heartburn, nausea, indigestion;

●       runny nose and/or nasal congestion;

●       sleep problems (insomnia);

●       muscle and back pain.


Do not exceed the specified dosage of medications in order to avoid side effects. Older people often take several drugs. That’s why when taking PDE5Is, one should be careful of potential pharmacokinetic interactions. Doctors should always check for medications that might exacerbate erectile function before beginning therapy for ED. Also, thorough counseling should always be provided.

Additional Effects of PDE5 Inhibitors on Elderly Men

PDE5Is therapy for ED has been shown to improve sexual pleasure and alleviate symptoms of benign prostatic hyperplasia, a condition often experienced by men as they age. Because of the benefits of treating both ED and lower urinary tract symptoms simultaneously, this result will likely encourage more mature men to seek ED therapy.


Furthermore, PDE5Is therapy may increase ejaculatory frequency, which is linked to a lower risk of prostate cancer. When it comes to increasing sexual activities and general quality of life, medical treatment of ED is essential.


After men reach the age of 60, there is a rise in the incidence of ED. Although older men tend to have a lower libido than younger men, they can still be active and satisfied with their sexual life. A thorough examination of all medications that might affect erectile function should be done before beginning therapy for erectile dysfunction, and men should always be counseled accurately.


PDE5 inhibitors are generally safe and useful in older patients. The optimal PDE5I drug for a man should be determined using information gathered during a standard diagnostic workup for ED. The effectiveness of PDE5I drugs remains the same at whatever age, provided that you have the requisite sexual drive. All age groups of individuals may benefit from this drug. Examining current health conditions and listening to body reactions allow men to make the right choice for their ED treatment.

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