How can I increase my libido and achieve morning erections again at my age?

Improving Sexual Desire and Morning Erections in a 50-Year-Old Male

The most effective approach to increase your libido and restore morning erections is to have your testosterone levels checked, as low testosterone is a common cause of decreased sexual desire and erectile function in men your age. 1

Initial Assessment

Medical Evaluation

• Check serum total testosterone levels (morning sample is preferred) 1
• Assess for underlying conditions that may contribute to sexual dysfunction:
  • Cardiovascular health (blood pressure, lipid profile)
  • Diabetes/metabolic status (glucose, HbA1c)
  • Psychological factors (depression, anxiety, stress)
  • Sleep quality (sleep apnea can reduce morning erections)

Lifestyle Assessment

• Your current metrics (VO2max of 44, resting HR of 49) suggest good cardiovascular fitness
• Body mass index (BMI) calculation: 26.2 (slightly overweight)

Treatment Algorithm

If Testosterone Deficiency is Confirmed (<300 ng/dL):

1. Testosterone replacement therapy is indicated 2
   • Available as gels, injections, or patches
   • Apply testosterone gel to shoulders and upper arms as directed
   • Monitor for side effects including increased red blood cell count, headache, and blood pressure changes

If Testosterone is Normal:

1. PDE-5 inhibitors (sildenafil, vardenafil, tadalafil) 1

   • High-quality evidence shows 69-88% improvement in erectile function
   • Can help restore confidence and sexual function
   • Contraindicated if taking nitrates

2. Lifestyle modifications:

   • Regular exercise (maintain your current fitness routine)
   • Weight management (aim for BMI <25)
   • Limit alcohol consumption
   • Smoking cessation if applicable
   • Stress reduction techniques

3. Sexual techniques:

   • Modify sexual positions or practices to increase arousal 1
   • Incorporate alternative sexual practices or scripts
   • Open communication with partner about needs and desires

Special Considerations

Medication Review

• Review current medications that may affect sexual function:
  • Antihypertensives (especially beta-blockers)
  • Antidepressants
  • Statins (though evidence suggests atorvastatin may actually improve rather than cause ED) 3

Psychological Factors

• Consider referral to a mental health professional with expertise in sexual health if psychological factors are contributing 1
• Performance anxiety can create a cycle that worsens erectile function

Common Pitfalls to Avoid

1. Ignoring the hormonal component: Many men with sexual dysfunction have undiagnosed testosterone deficiency that requires treatment 1

2. Over-focusing on ED medications: While effective, PDE-5 inhibitors treat symptoms but not underlying causes of decreased libido

3. Neglecting cardiovascular health: ED can be an early warning sign of cardiovascular disease; addressing this can improve both sexual function and overall health 1

4. Self-medicating: Avoid unregulated supplements marketed for sexual enhancement, as they may contain harmful ingredients or interact with medications

5. Delaying treatment: Sexual dysfunction tends to worsen over time if untreated and can negatively impact quality of life and relationships

At age 50 with your fitness level, you have excellent potential for improvement with appropriate intervention. Start with testosterone testing and proceed with targeted treatment based on those results.