Myth vs Fact

Erectile dysfunction becomes more common with age, but it is not something men simply have to accept, and it can be an early sign of other health problems.

Large studies show that erection problems become more common as men get older. That is a change in risk, not a rule. Many older men have satisfactory erections, and many causes of ED, such as narrowed blood vessels, diabetes, medicines and low mood, can be identified and treated.

Because the blood vessels of the penis are small, ED can appear before problems with the heart's arteries. A persistent change in erections is therefore a good reason for a health check, whatever your age.

Medical review: Prof. Dr. Ateş Kadıoğlu, awaiting sign-off.

1. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health.

Read more: Erections after 40: what changes · Erectile dysfunction: causes and treatment

Inflatable implants are filled with a small pump when an erection is wanted and emptied afterwards. Malleable implants stay firm but can be bent down.

A three-piece inflatable implant has cylinders in the penis, a small pump in the scrotum and a fluid reservoir in the lower abdomen. Pressing the pump fills the cylinders; pressing a release valve returns the fluid, and the penis becomes soft again.

A malleable (semi-rigid) implant is always firm, but it can be bent downwards so that it is discreet under clothing. Which type suits a man depends on his health, his hand dexterity and his preferences.

Medical review: Prof. Dr. Ateş Kadıoğlu, awaiting sign-off.

Read more: How a three-piece penile implant works · Inflatable vs malleable implants

Low testosterone can reduce desire and contribute to erection problems, but most erectile dysfunction is linked to blood flow, nerves, medicines or stress.

An erection happens when nerves signal the blood vessels in the penis to relax and fill with blood. Anything that affects those vessels or nerves, such as diabetes, high blood pressure, smoking or surgery in the pelvis, can affect erections.

Testosterone mainly supports sex drive. Guidelines recommend measuring it in men with erectile dysfunction, and treating a confirmed deficiency, but testosterone alone rarely fixes erection problems caused by blood vessel disease.

Medical review: Prof. Dr. Bülent Alıcı, awaiting sign-off.

1. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432.

Read more: What low testosterone feels like · Why morning erections matter

Surveys of partners rarely put size at the top of what matters. Communication, arousal, erection quality and emotional closeness count for more.

Most men who worry about their size are within the normal range. Studies that measure many men show a wide normal variation, and men tend to underestimate their own size when they compare themselves with pornography.

Sexual satisfaction for both partners is shaped by many things: desire, arousal, erection firmness, time, communication and how comfortable a couple feel together. If worry about size is affecting your confidence or relationships, a urologist can check whether there is a medical issue and talk through the realistic options.

Medical review: Prof. Dr. Zülfü Sertkaya, awaiting sign-off.

Read more: Penis size: what is normal?

Testosterone treatment usually suppresses sperm production, so it is not suitable for men trying to conceive. 'Automatically' and 'permanently' go too far, though.

Testosterone taken as a medicine signals the brain to reduce the hormones that drive the testicles. As a result, sperm production often falls sharply, sometimes to zero. This is why guidelines advise against testosterone treatment for men who want children in the near future.

The effect is not the same in every man, and in many men sperm production recovers after treatment stops, although this can take months and recovery is not certain for everyone. Men who may want children should discuss fertility-sparing alternatives with a specialist before starting.

Medical review: Prof. Dr. Bülent Alıcı, awaiting sign-off.

1. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432.

Read more: Does testosterone naturally decline after 40?

A penile implant restores rigidity so that intercourse is possible. It is not a lengthening operation.

An implant fills the erection chambers of the penis from the inside, so the erection it creates reflects the length of those chambers. It does not stretch them further. Some men feel the erect penis is shorter than it was in earlier years, often because erections had already weakened before surgery.

Surgeons discuss expectations about size carefully before an operation. Men with Peyronie's disease or significant shortening may have additional procedures considered alongside an implant, but outcomes vary and should be discussed individually.

Medical review: Prof. Dr. Ateş Kadıoğlu, awaiting sign-off.

1. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health.

Read more: Penile implants explained · How inflatable prostheses have changed

Anxiety and stress are common factors in younger men, but physical causes are found too, and ED at any age deserves a proper assessment.

Performance anxiety, stress and relationship factors are common contributors to erectile problems in younger men, and they are very treatable. But research from everyday clinical practice has shown that young men make up a substantial share of new ED patients, and that some have physical risk factors such as smoking, raised cholesterol, hormonal problems or the effects of medicines and recreational drugs.

Assuming the cause is 'all in the head' can mean something treatable is missed. A doctor can help work out what is going on, which often involves both body and mind.

Medical review: Prof. Dr. Ateş Kadıoğlu, awaiting sign-off.

1. Capogrosso P, Colicchia M, Ventimiglia E, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man: worrying picture from the everyday clinical practice. J Sex Med. 2013;10(7):1833–1841.

Read more: Erectile dysfunction: causes and treatment · Why ED can be an early health warning

Men do not go through a sudden menopause, but average testosterone falls gradually with age, and other hormones change too.

Long-term studies that measured the same men over many years found a slow, gradual fall in average testosterone levels with age, together with a rise in the protein that binds testosterone in the blood. The change is usually gradual and varies greatly between men.

Only a minority of older men have both clearly low testosterone and typical symptoms. Weight, long-term illness, sleep and medicines all influence hormone levels, and some of these can be changed.

Medical review: Prof. Dr. Bülent Alıcı, awaiting sign-off.

1. Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87(2):589–598.
2. Wu FCW, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–135.

Read more: Does testosterone naturally decline after 40?