Erectile dysfunction (ED) impacts an estimated 30 to 50 million men in the US, making it one of the most widespread health issues affecting men over 40.
Federal health guidance says ED is common and becomes more likely with age, but it is not considered a routine or harmless part of getting older. Research cited by the National Institute of Diabetes and Digestive and Kidney Diseases suggests about 40 percent of men are affected by age 40 and around 70 percent by age 70.
Doctors say it can be far more than a bedroom concern, warning that it may point to underlying problems elsewhere in the body and act as an early red flag for broader health issues.
In comments to the New York Post, Dr. Justin Houman, assistant professor of Urology at Cedars-Sinai Medical Center, said the situation is becoming increasingly serious.
“ED is what I call a canary in the coal mine for systemic vascular and metabolic disease,” describing it as “an early warning signal” from the vascular system.
An erection depends on several systems working together properly, including the brain, hormones, nerves and blood vessels.
Because of that, erectile dysfunction can sometimes be tied to more than mood or desire. It may be connected to hardened arteries, circulation problems, high blood pressure or high cholesterol.
“That’s why we say ED precedes cardiac events by an average of three to five years. It’s a window of opportunity, not just an inconvenience,” Dr Houman added.
According to Dr Houman, ED is associated with a number of other medical conditions, especially diabetes and cardiovascular disease.
He said men experiencing ED face nearly a 50 percent greater risk of developing heart disease than men who do not have it.
Recent cardiology guidance has strengthened that message. The 2024 Princeton IV consensus recommendations, highlighted by the American College of Cardiology, say erectile dysfunction should be treated as a cardiovascular risk marker and considered a risk-enhancing factor when doctors estimate a man’s future risk of atherosclerotic cardiovascular disease.
“An erection is fundamentally a vascular event,”
Healthy arterial blood flow, nitric oxide signalling and flexible blood vessels are all needed for that process to happen normally.
“The penile arteries are small, so when systemic vascular disease begins silently damaging blood vessels throughout the body, the penile arteries show symptoms first, often years before a man has a heart attack or stroke.”
NIDDK also lists heart and blood vessel disease, diabetes, obesity, low testosterone, thyroid imbalance, nerve disorders, certain medicines, smoking and heavy alcohol use among the factors that can contribute to ED.
He also stressed that ED should not be viewed simply as a sex-related issue, but as a warning sign that deserves attention.
“Whether or not you’re having sex with a partner is completely irrelevant to what your vascular system is trying to tell you,” he said.
“A man who develops ED at 45 and ignores it because he’s not in a relationship may be missing a three to five year window to intervene before a cardiac event or a diabetes diagnosis.”
The National Institutes of Health says erectile dysfunction is also more common in younger men than many people assume, with studies suggesting it affects between 14 percent and nearly 30 percent of men under 40.
Research has also found that roughly one in four men seeking treatment for newly developed ED is under the age of 40.
That figure comes from a frequently cited 2013 Journal of Sexual Medicine study, which found that 26 percent of men seeking first medical help for new-onset ED were 40 or younger. Researchers said the findings were concerning because almost half of those younger patients had severe ED.
Dr Houman said younger men should not brush off these symptoms, as they may be linked to cardiovascular danger, low testosterone, sleep apnea or psychological causes.
Mayo Clinic notes that when ED appears in a man younger than 50, it can be an especially important warning sign for heart disease risk, particularly when there is no obvious cause such as injury.
“In men in their 40s and 50s, ED is often the first clinical manifestation of cardiovascular or metabolic disease that hasn’t yet been diagnosed, and this is the group where acting early has the most impact on long-term outcomes,” he said.
“Older men sometimes accept ED as inevitable, but even at 60 or 70 it should prompt a health conversation, not just a prescription. No age group gets a pass,” Houman added.
Dr Houman said the best approach to reducing the risk of ED starts with taking the condition seriously and speaking to a healthcare professional early.
Health experts say that evaluation often goes beyond sexual function alone and may include checking blood pressure, blood sugar, cholesterol, hormone levels, sleep issues, mental health and medication side effects. Lifestyle measures that improve heart health, such as regular physical activity, weight management, quitting smoking and moderating alcohol, can also help lower ED risk.
Doctors also caution against self-treating with supplements bought online, since federal guidance says some products marketed for sexual performance may contain undisclosed ingredients or interact dangerously with prescription medicines. Anyone with chest pain, uncontrolled heart disease or nitrate use should speak to a clinician before using common ED drugs.