Healthy Lifestyle for Men

A guy mentioned in chat today that his biggest 2 concerns about ageing are
1. Balding
2. Needing a supply of the “blue pills”

Erectile dysfunction is common, and it deserves plain speaking rather than whispers. Medically speaking, it is the persistent difficulty in getting or keeping an erection firm enough for sexual activity. Physiologically, an erection is a vascular event as much as a neurological one, it needs intact nerves, healthy blood vessels, a responsive hormonal environment, and a brain that allows the body to relax into arousal. Many of the classic medical causes are familiar, heart disease, high blood pressure, diabetes, high cholesterol, obesity, and neurological conditions, because each of these interferes with blood flow, nerve signalling, or hormone balance. Erectile dysfunction also frequently signals more than a local problem, it can be an early warning of systemic vascular disease, which is why clinicians pay attention to it as a red flag.

How common is it The best large scale community studies show that erectile difficulty increases with age, but it is not an inevitable part of ageing. Population work such as Laumann and colleagues in 1999 found a substantial prevalence of sexual dysfunction in men, with erectile problems rising in frequency through middle age and beyond, while also being associated with broader physical and emotional health. The practical point is that many men will experience some degree of erectile difficulty at some time, and that makes prevention and early assessment sensible.

We can divide the reasons erectile dysfunction happens into roughly three overlapping buckets, each of which points to different prevention strategies. The first bucket is vascular and metabolic disease. The small arteries and endothelial cells in the penis are especially sensitive to damage from high blood pressure, raised cholesterol, and chronic high blood sugar, which is why diabetes is a particularly strong risk factor. When vessels stiffen or clog, the penis cannot fill with blood the way it needs to. Importantly, research shows erectile dysfunction often precedes cardiovascular events, because the penile arteries are narrower and may show symptoms before the coronary arteries do. That is helpful, albeit worrying, because it gives a window to intervene.

The second bucket is lifestyle factors that accelerate vascular damage or directly affect sexual function. Smoking is a clear example, there is a dose related association between quantity and duration of smoking and the risk of erectile dysfunction, meaning the more you smoke, and the longer you have smoked, the greater the risk. Excess alcohol use has a biphasic effect, brief low doses can lower anxiety, but regular heavy drinking impairs nerve function and hormone levels, and can lead to erectile problems. Obesity and physical inactivity worsen metabolic syndrome and endothelial health, and they also reduce testosterone modestly, which can reduce libido and erectile responsiveness. On the encouraging side, trials show lifestyle changes can improve erectile function, weight loss combined with exercise led to meaningful improvement in about a third of obese men with erectile dysfunction in a landmark study, which demonstrates that prevention is not only theoretical but achievable.

The third bucket is psychological, and perhaps the most underestimated. Anxiety, depression, relationship stress, past sexual trauma, and pervasive performance worry can all interfere with the brain’s ability to permit arousal. The physiology of performance anxiety is simple enough, when the sympathetic nervous system floods the body with stress hormones, blood vessels constrict, and sexual response is suppressed. Psychological erectile dysfunction can begin at any age, and it often sits on top of a physical vulnerability to create a reinforcing loop. Modern psychosocial research emphasises that erectile dysfunction is rarely purely physical or purely psychological, more often it is a complex interaction between the two, which means prevention and treatment need both medical and psychological attention.

So what practical steps reduce the likelihood of erectile dysfunction, and what should someone actually do The anchor is cardiovascular health. Keep blood pressure, cholesterol, and blood sugar under control, not only because it lowers heart disease risk, but because it protects sexual function. Smoking cessation is one of the single best moves, because that reduces vascular damage and improves circulation. Moderate alcohol, or avoiding habitual heavy drinking, is sensible. Maintain a healthy weight, and do regular aerobic exercise, which benefits blood vessels, mood, and body composition. Recent systematic reviews and trials show aerobic training improves erectile function, particularly in men with metabolic risk factors, so the exercise advice is evidence based rather than cheerleading.

Regular medical review matters, especially if you have risk factors. Erectile dysfunction can be the first sign of otherwise silent cardiovascular disease, so it is sensible to discuss any new, persistent problem with a clinician who can check heart risk, ask about medicines that might be contributing, and arrange relevant blood tests. Some commonly prescribed medications can reduce erectile function, and a doctor can sometimes change therapy or suggest workarounds safely. Guidelines from major urology bodies recommend a combined approach of assessing physical health factors, considering psychological contributors, and personalising treatment.

Do psychological approaches help in prevention Yes, they do. Learning to manage stress through practical techniques, sitting down with a partner to lower pressure around sexual performance, and seeking therapy for anxiety or depression are all effective preventive measures. Couples therapy or sex therapy can also be preventative, because improving communication, reducing blame, and creating non sexual closeness reduces the pressure that often turns one bad experience into a repeating nightmare. Where anxiety is the dominant factor, brief behavioural approaches, sensate focus exercises, and cognitive restructuring are useful, and early access to a trained therapist is better than waiting until the problem grows into a crisis.

A few realistic tips you can start today without dramatic upheaval Walk briskly for at least 30 minutes on most days (I know it’s nt easy when it’s dark and cold outside…), cut back on processed food in favour of vegetables, fruit, whole grains, and lean protein, and if you smoke, make a plan to stop with medical support if needed, because nicotine replacement or medication doubles the chance of quitting successfully. Check your medications with your doctor, especially if sexual problems began after a new prescription. Prioritise sleep and find a way to offload chronic stress, whether that is via mindfulness, short daily walks, or just catching up with the guys after work. Have a frank but kind conversation with your partner about pressure and expectations, because often the relief of shared understanding is itself curative. Finally, if symptoms arrive, treat them as an invitation to check your overall health, not as a judgment on character. Early assessment can identify treatable causes and prevent downstream health problems.

A short note on medical treatments, and why prevention still matters Even though effective medical therapies exist, prevention is preferable. Pharmaceutical treatments, such as phosphodiesterase type 5 inhibitors, work well for many men, but they treat the symptom rather than the underlying risk, they have contraindications for some people, and they do not remove vascular or metabolic damage. Addressing the root causes, with lifestyle change and medical management of long term conditions, reduces the chance of recurrent problems and improves overall health, which is the real goal. Clinical guidelines recommend a combination of risk modification, investigation, psychosocial support, and targeted therapies when needed.

If you need one line of encouragement, here it is: protect your heart and your mind, and you will do more than reduce the risk of erectile dysfunction, you will improve your life. And above all, please don’t hide this from your partner and Aqua – keep up with the swimming and healthy lifestyle and I am sure all will be well !

Further Reading:

1. Laumann, 1999 – “Epidemiology of Erectile Dysfunction in the United States: Prevalence and Correlates”

2. Esposito, 2004 – “Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial”

3. Mostafaei, 2021 – “Psychological and Physiological Factors in Male Sexual Dysfunction: A Systematic Review”

4. Cao, 2014 – “Impact of Cardiovascular Risk Factors on Erectile Function: Clinical Evidence”

5. Dewitte, 2021 – “Performance Anxiety and Erectile Dysfunction: A Psychological Perspective”

6. Khera, 2023 – “Lifestyle Modification for Prevention and Management of Erectile Dysfunction”

7. Burnett (AUA Guideline), 2018 – “American Urological Association Guideline on Erectile Dysfunction”

8. EAU Guideline, 2023 – “European Association of Urology Guidelines on Male Sexual Dysfunction”