Men's Health After 50: Heart, Hormones and Sex in the Silver Years

I have looked after many men in their 50s and beyond. What I hear most often is, "I'm getting old, Doctor, I guess that's just how it is," whether it's tiring easily, a growing belly, poor sleep or erections that aren't what they used to be. It's true that the body changes, but many of these things are not something you simply have to accept, and some symptoms are warning signs that help us prevent serious disease in time.

Why men over 50 need whole-person care

Men of this age are often the head of the family, work hard and only see a doctor once they are seriously unwell. Conditions that become clearly more common in this period include high blood pressure, diabetes, high cholesterol, heart disease, an enlarged prostate, muscle wasting, thinning bones, depression and sexual problems. They are all connected, so care shouldn't be split into separate pieces.

Heart and blood vessels: priority number one

• Check blood pressure at least once a year, and blood sugar and cholesterol according to risk
• Keep your waist to no more than half your height
• Quit smoking, the modifiable risk factor with the biggest payoff
• Men aged 65–75 who have ever smoked should have a one-time ultrasound to check for an abdominal aortic aneurysm

Muscle, bones and falls

After 50, muscle declines by about 1% a year if you don't use it. Muscle wasting makes falls more likely, diabetes harder to control and recovery from illness slower.

1. Strength or resistance training 2–3 days a week, covering the major muscle groups
2. Aerobic exercise such as brisk walking, cycling or swimming, 150 minutes a week in total
3. Balance training, such as standing on one leg or tai chi
4. Protein of about 1.0–1.2 g per kg per day; see Nutrition after 50
5. An osteoporosis risk assessment; see Calcium, zinc and vitamin D

Prostate and urinary symptoms

Frequent urination, getting up at night to pee and a weak stream are usually caused by an enlarged prostate, which can be treated with medication or surgery. For PSA testing to screen for prostate cancer, men aged 55–69 are advised to discuss the pros and cons with their doctor first. Men whose father or brother had prostate cancer may start earlier.

Testosterone: understanding it properly

Testosterone levels fall slowly with age, by about 1% a year, but not every man becomes deficient. Testosterone deficiency is diagnosed when there are symptoms, such as lower sex drive, no morning erections, fatigue and low mood, together with low levels on morning blood tests on at least 2 occasions.

The most important recent evidence is the TRAVERSE study (NEJM 2023) in more than 5,000 men aged 45–80 with low testosterone and high cardiovascular risk. It found that testosterone gel did not increase major cardiovascular events compared with placebo, but slightly more atrial fibrillation (AF), acute kidney injury and pulmonary embolism were seen. So it should be used in men with a clear indication and monitored regularly. The details are in What is TRT and who is it for? and Depression or low testosterone: how to tell them apart.

Hormone supplements such as DHEA shouldn't be used on your own, because the evidence in men is weak and there are risks.

Sex life after 50

Sex at this age is still normal and important for happiness. What may change is that you need longer stimulation, erections may not be as full as before, and the recovery time after ejaculation gets longer.

• PDE5 inhibitors such as tadalafil or sildenafil work for most men, as assessed and prescribed by a doctor. They must never be combined with nitrate medicines for heart disease.
• Talking with your partner, adjusting the pace and adding intimacy that isn't focused on penetration help a lot. Try reading Sensate focus: a technique to rebuild intimacy.
• PRP or shockwave treatments for ED still have limited evidence; discuss the pros and cons with a doctor first.

Vaccines to get after 50

• Influenza, once a year
• Shingrix shingles vaccine, 2 doses from age 50
• Pneumococcal vaccine; US guidance in 2024 expanded it to all adults from age 50
• Tetanus–diphtheria every 10 years

Mind and brain

Men often don't talk about sadness or stress, yet suicide rates among middle-aged and older men are several times higher than among women. Retirement, loss or chronic illness are vulnerable times. If you feel hopeless, don't want to do anything or have thoughts of harming yourself, call 1323, Thailand's free 24-hour mental-health hotline (Thai language; ask for English support). Worsening hearing and eyesight are also linked with dementia risk and should be checked and corrected.

How Dr. Kris Clinic cares for men over 50

I work as a family physician, looking at the whole person: assessing heart, diabetes and bone risk, reviewing medicines and vaccines, testing hormones when there are symptoms, assessing and treating sexual problems, and talking about your relationship with your partner, without judgment and in confidence. English-speaking consultations are available.

Go to hospital immediately or call 1669 (Thailand's medical emergency number) if you have chest pain or tightness, breathlessness, weakness on one side of the body, a drooping face, slurred speech, or an erection lasting more than 4 hours.