MEN’S HEALTH

ERECTILE DYSFUNCTION IN MIDLIFE

Dr Shirin Lakhani on taking an integrated approach to treating symptoms and understanding the patient.

DR SHIRIN LAKHANI

Dr Shirin Lakhani is the founder of Elite Aesthetics and a highly experienced GP and aesthetic physician, specialising in Lichen Sclerosis and intimate rejuvenation treatments including the O Shot and P Shot. She graduated from Guy’s & St Thomas’ Hospitals in London in 1999 and has extensive NHS experience across multiple hospital specialities, including anaesthetics, where she developed advanced injection and procedural skills.

Erectile dysfunction (ED) is a common, yet frequently under-discussed, health concern affecting men in midlife. Its importance extends beyond sexual function. An erection depends upon vascular, neurological, hormonal and psychological pathways, meaning that a change in sexual function can provide an important window into a man’s wider health.

This integrated approach to male ageing will be among the themes explored at

MEN: Optimising Health, a new men’s health conference taking place in London on 19 November 2026.

For aesthetic and preventative medicine practitioners, the focus is shifting from looking younger to maintaining health and sexual function for longer.

ERECTILE FUNCTION AS A MARKER

ED becomes more prevalent with age, but it should not be dismissed as an inevitable part of getting older. Diabetes, hypertension, dyslipidaemia, obesity, smoking, cardiovascular disease, neurological disorders, pelvic surgery and certain medicines may all contribute. Anxiety, depression, relationship difficulties and performance anxiety may coexist with, or exacerbate, an organic cause.

Importantly, ED and cardiovascular disease share many vascular and endothelial risk factors. Erectile symptoms may precede clinically apparent cardiovascular disease in some men, making the consultation an opportunity to consider blood pressure, lipids, glucose control, weight, smoking and overall cardiovascular risk.

Assessment should therefore come before intervention. History should include the onset and severity of symptoms, morning or spontaneous erections, libido, ejaculation, medication and relevant psychological or relationship factors. The clinical picture can then guide examination and investigations.

WHAT ABOUT TESTOSTERONE?

Testosterone inevitably comes up in conversations about midlife male health. Androgens play an important role in libido and sexual function, and genuine hypogonadism can contribute to sexual symptoms. However, ED should not automatically be attributed to ‘low T’, nor should testosterone be prescribed as a general anti-ageing intervention.

Testosterone deficiency should be diagnosed only when compatible symptoms are accompanied by consistently low biochemical testosterone concentrations.

TREATMENTS THAT WORK

Lifestyle intervention continues to be fundamental. Regular exercise, weight management, smoking cessation, moderation of alcohol and proper management of diabetes, hypertension and dyslipidaemia can improve general health and may improve sexual function.

PDE5 inhibitors, including sildenafil and tadalafil, remain first-line pharmacological treatments for many patients. Where oral medication is unsuitable or unsuccessful, options include vacuum devices, intracavernosal therapies and, in selected cases, penile prosthesis surgery.

Psychosexual treatment also deserves recognition. Performance anxiety can prolong erectile difficulties, while depression, stress and relationship factors may contribute. Sometimes, multidisciplinary management is most effective.

REGENERATIVE MEDICINE

Of particular relevance to aesthetic medicine is the growing interest in regenerative treatments. Low-intensity shockwave therapy has attracted attention for vasculogenic ED, with research suggesting improvements in sexual function in selected patients. However, devices, protocols and patient selection vary considerably.

I have treated hundreds of men using platelet-rich plasma (PRP) for ED.

The P-Shot protocol uses a patient’s own PRP, injected into targeted areas of the penis. This is not appropriate for every patient. Grasping the underlying cause and assessing the wider health should always come first.

Evidence surrounding PRP for ED continues to develop, with studies reporting encouraging improvements in sexual function. My clinical experience has strengthened the importance of careful patient selection, realistic expectations and appropriate follow-up.

A WIDER DISCUSSION OF MEN’S HEALTH

A man presenting because his erections have changed may reveal untreated hypertension, metabolic disease, hormonal symptoms, psychological distress or cardiovascular risk. A sexual health consultation can therefore become an important entry point into preventative medicine.

For aesthetic medicine practitioners, this represents both an opportunity and a responsibility. As the speciality expands into wellness, longevity, and regenerative medicine, patients will increasingly ask questions beyond appearance. Our response must remain based in good medicine: assess first, identify risk, treat appropriately and be transparent about where evidence ends and innovation begins.

For ED, treating the symptom can matter enormously to quality of life, but understanding why it has occurred may matter even more.