Isn't this just my age?

Age genuinely does raise the risk

There is no point pretending otherwise, and the numbers are consistent.

In the 2021 US National Survey of Sexual Wellbeing, 24.2% of men overall met the criteria — but 48.0% of men aged 65 to 74, and 52.2% of those over 75.¹ In the Massachusetts Male Aging Study, new cases rose from 12.4 per 1,000 man-years at ages 40–49 to 46.4 at ages 60–69.² A Finnish cohort followed for twelve years saw prevalence climb from 61.6% to 78.9%, and every man aged 75 or over had at least mild erectile dysfunction.³

So age is an independent risk factor. That is settled.

But age is not the explanation

Here is the study that answers the question in the title.

Across 17,250 men, prevalence in healthy men rose from 10% at age 40 to 79% at age 80. But hypertension, obesity and diabetes shifted the curve sharply upward — enough that men with several comorbidities resembled healthy men fifteen to twenty-five years older.⁴

Read that again, because it reframes the whole question. If you are sixty with poorly controlled diabetes and hypertension, your erectile function does not look like a sixty-year-old's. It looks like an eighty-year-old's. That gap is not age. It is the part that can be worked on.

The same pattern shows in a cohort of healthy ageing men, where erectile function declined progressively over time but no severe erectile dysfunction was diagnosed at all — and where metabolic markers tracked function more closely than testosterone or age itself in men over 45.⁵

Healthy ageing produces gradual change. Severe dysfunction usually has something else driving it.

What is actually driving it

Cardiometabolic disease, most consistently. Diabetes, hypertension, heart disease, high cholesterol and obesity are associated with ED across every age group studied.²⁶⁷⁸ In elderly Brazilian men the strongest independent correlates were hypertension, diabetes, urinary symptoms, depressive symptoms — and age.⁹

Urinary symptoms, more than most men realise. In the Cologne Male Survey, lower urinary tract symptoms were an independent risk factor rather than merely a fellow traveller of ageing: they were present in 72.2% of men with ED against 37.7% of men with normal erections.¹⁰ If you have both a weak stream and unreliable erections, those are related problems, not two separate consequences of getting older.

How fast you are ageing, rather than how long. Recent work on biological age acceleration found strong associations with ED, suggesting the pace of ageing may matter more than the birthday for some men.¹¹¹²

There is real biology behind the age effect too — endothelial dysfunction, reduced nitric oxide availability, smooth muscle loss, fibrosis, oxidative stress and nerve injury are all documented mechanisms of age-related ED.¹³¹⁴ That is why age remains an independent predictor even after the diseases are accounted for. But much of that biology is vascular, and vascular biology responds to the same things cardiovascular risk does.

What moves the needle

Physical activity. In highly active older American men, the relative risk of ED was 0.7;¹⁵ in a Brazilian study of nearly 21,000 men, active men had about 20% lower odds.¹⁶ Reviews find exercise and Mediterranean-style diets improve erectile function, most plausibly through better endothelial and metabolic health.¹⁷

The obvious risk factors, in the obvious direction. Smoking, high BMI and sedentary behaviour recur across large cohorts, including one of 108,477 Australian men.¹⁸⁷

Mood. Depression and anxiety both accompany ED and appear to worsen prognosis and reduce the chance of remission.³¹⁹⁸

And a point of honesty about ageing itself

Not every age-related sexual change is a disease, and not every man wants maximal restoration of intercourse.

A systematic review found many older men still consider sex important and remain sexually active — while help-seeking stays low.²⁰ Separate qualitative work argues that some older men interpret erectile change as part of a broader shift in intimacy, rather than as a problem requiring the fullest possible medical correction at any age.²¹

Both positions are legitimate. What I would object to is a man arriving at the second position without ever having been offered the first — deciding to accept something he was never told was treatable.

One caution about what is being sold

Emerging regenerative and "anti-ageing" treatments for erectile dysfunction remain experimental. The evidence is largely animal and preclinical rather than clinically validated.¹⁴²² Where a clinic offers you something framed as reversing vascular ageing, that is the question to ask: in humans, or in mice?

How strong is the evidence?

Very strong for the age gradient — replicated across large population, longitudinal and review studies.¹²⁶ Strong for the claim that comorbidity and lifestyle add major risk beyond age.⁴¹⁸ Strong for ED as a signal of cardiometabolic disease.²³¹⁷⁸ Moderate for the exercise and weight findings, which are consistent but largely observational.¹⁵¹⁶ Weak for anti-ageing therapies.¹⁴

Bottom line

Ageing increases susceptibility. Vascular health, metabolic disease, urinary symptoms, medication, mood and lifestyle largely determine who actually develops erectile dysfunction and how badly.

Treatable causes stay treatable at seventy. What changes with age is not whether something can be done but which option fits — and that is a conversation about your heart, your medicines and your priorities rather than your birthday.

Worth reading alongside: why ED can be a warning about your arteries, and what to do if the tablets seemed not to work.