Erectile dysfunction at 60 is extremely common and, in most cases, treatable. A Finnish study of men aged 50 to 75 found that roughly three out of four had some degree of ED, with prevalence rising sharply after 60. But “common” doesn’t mean “inevitable” or “untreatable.” The majority of men at this age have options ranging from simple lifestyle changes to medications to procedures, and many regain satisfying sexual function.
Why ED Gets More Common After 60
Erections depend on blood flow. When you become aroused, the lining of your blood vessels releases a signaling molecule that relaxes the smooth muscle tissue inside the penis, allowing blood to rush in and create firmness. With age, the blood vessels stiffen and accumulate plaque (the same process behind heart disease), which damages that vessel lining and reduces its ability to produce the relaxation signal. Less signal means less blood flow, weaker erections, or none at all.
Over time, the erectile tissue itself can become less flexible as collagen builds up and replaces the smooth muscle that normally stretches to hold blood in place. This is why ED in older men tends to worsen gradually rather than appearing overnight. The underlying vascular damage also explains why ED often shows up two to five years before a heart attack or stroke, according to a meta-analysis published by the American Heart Association. That timeline matters: treating the blood vessel problems behind your ED can also protect your heart.
Other contributors at 60 include low testosterone, medications for blood pressure or depression, diabetes-related nerve damage, and psychological factors like performance anxiety or relationship stress. Most men have more than one factor at play.
Exercise as a First Step
Aerobic exercise is one of the most effective non-drug interventions for ED caused by vascular problems, and it’s the one most men underestimate. A systematic review of intervention studies found that 40 minutes of moderate-to-vigorous aerobic exercise, four times per week, for six months significantly improved erectile function in men with ED linked to inactivity, obesity, high blood pressure, or cardiovascular disease. That works out to about 160 minutes per week: brisk walking, cycling, swimming, or any activity that gets your heart rate up.
The key details: moderate intensity with occasional bursts of vigorous effort produced the best results. Supervised training outperformed unsupervised programs, likely because someone was holding participants accountable and ensuring proper intensity. If you’ve been sedentary, starting with 20-minute walks and building up over several weeks is a reasonable approach. The improvements in these studies took months, not days, so consistency matters more than intensity early on.
Pelvic Floor Exercises
The pelvic floor muscles play a direct role in trapping blood inside the penis during an erection. Strengthening them can make a measurable difference. In a randomized controlled trial published in the British Journal of General Practice, 40% of men who did pelvic floor exercises regained normal erectile function, and another 34.5% showed meaningful improvement. Only about a quarter saw no benefit.
The exercises involve contracting the muscles you’d use to stop urinating midstream or lift your testicles. You hold each contraction for up to 10 seconds, rest for 10 seconds, and repeat. The men in the study did these daily for six months, with weekly guided sessions for the first five weeks to make sure they were activating the right muscles. A physiotherapist who specializes in pelvic health can confirm you’re doing them correctly, which is worth the visit since many men unknowingly squeeze the wrong muscle group.
Oral Medications
PDE5 inhibitors remain the most widely prescribed treatment for ED. They work by amplifying the same relaxation signal your blood vessels produce naturally, making it easier for blood to flow into the penis when you’re aroused. They don’t create arousal on their own.
For men over 65, prescribing guidelines recommend starting at a lower dose because the body clears the drug more slowly with age, which means higher blood levels and a greater chance of side effects like headache, flushing, or nasal congestion. Men with severe kidney impairment also start at the lower dose for the same reason. Your prescriber will adjust upward if the starting dose isn’t effective.
There is one critical safety rule: these medications cannot be combined with nitrate-based heart drugs, including nitroglycerin, isosorbide mononitrate, or recreational “poppers” (amyl nitrite). The combination can cause a dangerous drop in blood pressure. Alpha-blockers prescribed for an enlarged prostate, such as tamsulosin or alfuzosin, also interact and require careful timing or dose adjustments. If you take any heart or prostate medication, your prescriber needs the full list before writing a prescription for ED.
Checking Your Testosterone
Low testosterone alone doesn’t always cause ED, but it can be a contributing factor, especially when combined with low desire or fatigue. The American Urological Association defines low testosterone as a total level below 300 ng/dL, measured with a morning blood draw (testosterone peaks in the early morning and drops throughout the day). A diagnosis requires both a low number and symptoms: reduced sex drive, difficulty with erections, fatigue, or loss of muscle mass.
If your levels are genuinely low and you have symptoms, testosterone replacement can improve desire and sometimes erectile function. It works best as part of a broader plan rather than a standalone fix. Men whose ED is primarily vascular often need a PDE5 inhibitor even after testosterone levels normalize.
Vacuum Devices
A vacuum erection device is a plastic cylinder that fits over the penis and uses a hand pump to create suction, drawing blood into the shaft. Once the erection forms, you slide a soft constriction ring off the base of the cylinder and onto the base of your penis to hold the blood in place. The ring should stay on for no more than 30 minutes to avoid tissue damage.
These devices work mechanically, so they don’t depend on blood vessel health, nerve function, or medication. Many men find them effective but less spontaneous than they’d prefer. They’re often used as a bridge while other treatments take effect, or as a long-term solution for men who can’t take oral medications.
Shockwave Therapy
Low-intensity shockwave therapy uses sound waves directed at penile tissue to stimulate new blood vessel growth. A typical protocol involves 12 sessions spread over several weeks. In one study tracking outcomes at 18 months, about 64% of men who had stopped responding to oral medications were able to achieve erections sufficient for sex after shockwave therapy (though most still needed oral medication alongside it).
The catch for men at 60: the best responders in that study averaged 46 years old and had shorter ED duration. Older men with severe, long-standing ED responded less reliably. The average non-responder was 62. This doesn’t mean it can’t work at 60, but expectations should be realistic, and the treatment is still considered somewhat experimental by major urology organizations.
Penile Implants
When other treatments fail or aren’t tolerable, an inflatable penile implant is the most definitive solution. A surgeon places a fluid-filled system inside the penis with a small pump in the scrotum. Squeezing the pump transfers fluid into the cylinders, producing a rigid erection. Releasing a valve deflates it. Most men learn to operate the device about six weeks after surgery.
Mechanical reliability is strong: 93% of implants are still functioning at five years and about 77% at ten years. Age, diabetes, obesity, and high blood pressure don’t significantly affect those numbers. When a device does fail, it can typically be replaced. Satisfaction rates for implants are consistently among the highest of any ED treatment, partly because the result is predictable and doesn’t require planning around a pill.
The Cardiovascular Connection
ED at 60 is worth taking seriously not just for sexual health but because it often signals the same blood vessel damage that leads to heart attacks and strokes. Research shows ED typically appears two to five years before a major cardiac event, giving you a window to act. If you haven’t had a cardiovascular workup recently, an ED diagnosis is a strong reason to get one. Managing blood pressure, cholesterol, blood sugar, and weight doesn’t just help your heart. It addresses the root cause of most ED at this age.
The overlap between vascular ED and cardiovascular disease also explains why the lifestyle interventions that help your erections (regular aerobic exercise, weight loss, quitting smoking, moderating alcohol) are the same ones cardiologists recommend. Fixing one problem often improves the other.