Nearly 1/2 of men have some degree of erectile dysfunction by age 50. This is due to four main reasons. Muscle Loss: Men lose up to 40% of their penis muscle tissue with age. Scar tissue: If during the process of getting an erection, the penis inflates unevenly or bends or twists to a side, this is scar tissue. 23% of men have visible twisting of the penis due to scar tissue on autopsy. Vascular issues: Just like the coronary arteries, the blood vessels of the penis can fill with calcium and plaque. Low testosterone: As men age, alpha reductase enzyme levels increase turning testosterone into estrogen. By dealing with these issues, we can support proper erectile function.