Keeping Up With Erectile Dysfunction: Why Are There So Many Men Over 50 Asking for Help?

July 18, 2011

Bethsheba Johnson, G.N.P.-B.C., A.A.H.I.V.S.

Bethsheba Johnson, G.N.P.-B.C., A.A.H.I.V.S., is an associate medical director of St. Hope Foundation in Houston, Texas.

In my current practice, every day there is at least one man over the age of 50 asking for an erectile dysfunction (ED) medication. It seems to have become an epidemic. Or it is just more openly discussed. Or both.

So what are the causes of ED? And what can you do as a health care provider to help your patients understand ED medications and use them wisely to have a good quality of life?

Some of the causes of ED can include the following:

  • psychological conditions, including depression and poor self-esteem
  • substance use, including tobacco
  • comorbid conditions, such as diabetes, thyroid disorder, vascular disease and hypertension
  • HIV infection causing hypogonadism (low testosterone)
  • effects of aging
  • side effects of medications, such as antidepressants and beta blockers
  • abuse of hormones, such as growth hormone, testosterone and androgens, that at some point can shrink the genitalia (which means the patient can't use that excuse of just stepping out of cold water)
  • laboring under the misconception, which has been reinforced by the media and society, that all men have sex like rabbits

So what can we do as care providers?

  • Have an open dialogue with your patient.
  • If you are not the health care provider, then refer for a diagnostic workup that includes an evaluation for hormone levels and thyroid disorder.
  • Treat comorbidities, such as hypertension, diabetes mellitus and depression.
  • Discuss potential side effects of treating comorbidities, including contraindication of ED medications with heart disease.
  • Discuss drug-drug interactions between ED medications and antiretroviral medications for the treatment of HIV.
  • Discuss the role of substance use and tobacco.
  • Ascertain how the patient feels about himself.
  • Just be plain ol' supportive.

Thanks to Dr. Christopher Evans for the blog title!

Get email notifications every time HIV Care Today is updated.

Copyright © 2011-2016 Remedy Health Media, LLC. All rights reserved.

This article was provided by TheBodyPRO.

Reader Comments:

Comment by: Reed Gibson (Fresno, CA) Wed., May. 6, 2015 at 1:16 am UTC
I feel so relaxed and surely much updated after reading the articles that you keep updating on the website. It relieves me a lot and at the same time informs me because there according to me isn’t anything that is much informed as you are.

Reply to this comment

Comment by: Anonymous Wed., Aug. 24, 2011 at 2:48 am UTC
I do wish to stress the importance of psychological factors in ED. I have seen a number of clients who experience subclinical depression and subsequent ED. These clients may also be having some denialism in terms of accepting their status. Performance anxiety is one other important factor in these clients. They often lack confidence and this aggreviates
the condition. Supportive counseling as well as partner involvement are key steps to start with . It cannot be overemphasized to rule out general medical condition associated with ED.
Reply to this comment

Comment by: Bethsheba (Houston, TX) Fri., Jul. 29, 2011 at 2:44 pm UTC
How are other providers managing ED? I would love to hear from you.
Reply to this comment

Comment by: Rakesh B. (Amritsar,Punjab,India) Tue., Jul. 26, 2011 at 9:51 pm UTC
Nice and precise. An addition of tips for managing various types would have been like a cherry on the cake.
Not over 50 ,in this era of work-alcoholism,I see much younger patients exhausting too soon or finding no time for this basic need or doing it just like a duty.
Reply to this comment
Replies to this comment:
Comment by: Bethsheba (Houston, TX) Fri., Jul. 29, 2011 at 2:43 pm UTC
Thanks, Rakesh for your review. Your comments are so true. In terms of tips for managing patients it is important to look look for co-morbid conditions and treat those that are found. Also if it is a lack of adequate stimulation that is important to explore with your client. Inadequate sleep, being overextended, poor relationships, alcohol/drug use are morbid conditions that may require treatment.

Comment by: mario (NYC) Tue., Jul. 26, 2011 at 5:05 pm UTC
Why would this have anything to do with erections?
Testicular size has no effect on penile rigidity.

"abuse of hormones, such as growth hormone, testosterone and androgens, that at some point can shrink the genitalia (which means the patient can't use that excuse of just stepping out of cold water)"
Reply to this comment
Replies to this comment:
Comment by: Bethsheba Fri., Jul. 29, 2011 at 2:39 pm UTC
Hi Mario:
Good question. The atrophy of the testicles can in fact decrease the production of the necessary hormones such as testosterone, leutinizing hormone(LH)and follicular stimulating hormone (FSH)for adequate penile erection.
Thanks for your response.

Add Your Comment:
(Please note: Your name and comment will be public, and may even show up in
Internet search results. Be careful when providing personal information! Before
adding your comment, please read's Comment Policy.)

Your Name:

Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:


The content on this page is free of advertiser influence and was produced by our editorial team. See our content and advertising policies.