Persons most commonly affected: Males over 50 years of age.

Organ or part of body involved: Male sexual functions

Symptoms and indications: There are several normal changes that occur as a male becomes older. One is a decreased production of testosterone which stabilizes around age 60. The size and firmness of the testicles may be reduced because of this decrease. There is also a reduction in sperm which means a lesser chance of impregnating a female. Another change that occurs is the increase in the size of the prostate (prostatitis) is common and easily treatable with antibiotics and massaging the gland. If there are tumors, surgery may be required. This can cause problems such as a lack of erection because of the absence of hormones from the prostate gland. New surgical procedures can eliminate this threat.

The sexual response cycle also changes as the male becomes older. In the beginning of having sex (excitement phase), the erection may be delayed. Therefore, more direct stimulation of the penis is required. The erection may not be as firm when younger. The male may also experience a longer time before ejaculating (plateau phase) which can be an asset for the female because of the extra stimulation which can help her achieve an orgasm. The orgasm (orgasm phase) for the male is shorter than when younger. The urgency to ejaculate is reduced along with reduction in seminal fluid. The time right after orgasm (resolution phase) when the male returns to the nonexcited phase is of a shorter duration. The time that it takes a male to regroup (refractory period) can take anywhere from 12 to 24 hours or longer before he can achieve another orgasm. This period increases as the male becomes older.

According to some researchers, if a man remains sexually active in his youth and middle years, he can continue to be active in his later life. However, if a man stops having sex in his 50's and 60's, the chance of becoming impotent is greater. If he and his partner are able to use special techniques that rely heavily on genital stimulation, then he will be able to stay sexually active well into his advance years.

Causes and risk factors: The sexual functioning of the elderly can be negatively influenced by drugs prescribed for illness. Many older people (60%) are on drugs for cardiovascular conditions. Forty percent over age 80 are on diuretics which are known to contribute to erectile failure. Thiazides for the control of hypertension in unnecessary high doses also causes problems in erectile functioning.
Many elderly persons (85%) are taking benzodiazepines which can inhibit inhibit intimacy. Alcohol can produce impotency or a lack of sexual desire for both himself and his partner. This is because alcohol depresses the central nervous system which will lead to a reduction in sexual performance. Psychotropic medications may cause temporary impotence. Some other medications that can cause serious difficulties are antidepressants, tricyclics and monamine oxidase inhibitors, and some coronary care medications.

Prevention: In most cases, testosterone therapy clearly improves libido, muscle strength, sense of well-being, and mood. Cognitive performance is highly linked to bioavailable testosterone levels, and testosterone therapy has been shown to improve visual spatial memory in middle-aged men.