Many guys will experience some form of sexual dysfunction in their lives. But the risk of erectile dysfunction (ED) skyrockets around age 40—when 40 percent of men will develop the condition. And your risk increases by 10 percent for every decade of your life, according to the Cleveland Clinic.

“The underlying issues are what causes the ED, not the age itself. A 70-year-old is more likely than a 25-year-old to have more chronic illnesses and health issues that could impact his ability to achieve an erection,” Hone Health Medical Director Jim Staheli, D.O., wrote. “This is the reason that the ED percentages increase by 10 percent with each decade; your likelihood of having issues that affect your overall health increases, too.”

On a recent episode of The Drive podcast, host and longevity expert Peter Attia, M.D., and urologist Mohit Khera, M.D., discuss how to prevent a common culprit of age-related erectile dysfunction: penile atrophy.


What Is Penile Atrophy?

The penis is an organ, not a muscle. But atrophy of the cavernous smooth muscles that support erectile tissue in your shaft may cause a type of ED called venous leakage. When this occurs, the muscle tissue becomes too weak to regulate the flow of blood in and out of your penis. Thus, you’ll have a hard time keeping it up. 

“As we age, we get atrophy and fibrosis of the muscle. We are able to get the blood in. But we can’t keep the blood in,” Khera explains. “Aging causes venous leak. And we know that lower testosterone levels have been implicated in causing [this].”

Testosterone levels play a crucial role in maintaining blood flow to the muscles and connective tissues in your penis by promoting elasticity and circulation. And research shows that testosterone replacement therapy (TRT) may alleviate sexual dysfunction in men with venous leak (1). 

How to Prevent Penile Atrophy

Attia and Khera agree that maintaining healthy erections is a “use it, or lose it” situation. Having regular day- and nighttime erections and staying sexually active are the best ways to prevent atrophy, per Khera. 

“If you look at patients that are not using the penile muscle, like those who have a radical prostatectomy, [they] will start to atrophy,” says Khera. “Just like if I put your arm in a cast.”

While most men use erectile dysfunction drugs like Cialis and Viagra before sex to get an erection, Khera notes that PDE5 inhibitors may help promote hypertrophy—or an increase in size—of the cavernous smooth muscle (2).

“I look at daily Cialis as a preventative measure to keep the tissue healthy,” Khera says. “When you start to notice a mild degree of ED, that’s when I want you to start taking the daily Cialis.”