Why waking up without an erection could be the first sign of a deadly heart problem

When billionaire health guru Bryan Johnson revealed on social media last year that he had started tracking the frequency of his erections while he slept, he became the focus of worldwide ridicule.

The California tech entrepreneur, who has nearly three million followers online, claims he intends to live for ever by making a series of extreme lifestyle changes. These include a regime of 100 vitamins a day and a daily 23-hour fast.

Johnson – who is 48 but claims to have the body of an 18-year-old – also subjects himself to countless daily blood tests and scans to spot any signs of ageing.

However, it is his latest testing regime that has perhaps gained the most attention so far. Because, along with measuring the number, duration and strength of his night-time erections, Johnson also announced he was measuring those of his 19-year-old son, Talmage, to compare with his own.

To do this, they were using a gadget known as a wearable penile ring sensor – the FirmTech Performance Ring – which tracks nocturnal erections by measuring changes in circumference and rigidity throughout the night.

‘Legitimately the most insane thing I’ve ever read,’ said one person on social media platform X. ‘For the love of God, why would you post this on the internet publicly?’ said another. ‘I feel bad for your son.’

But Johnson was unrepentant, arguing that all men who want to live a long and healthy life should be keeping track of their erections.

‘It really is one of the most important things for all of us to know about our bodies,’ Johnson insisted. ‘It’s just not talked about.’

The billionaire, who claims he intends to live for ever, urgued that all men who want to have a long and healthy life should be keeping track of their erections

And while experts say that Johnson’s methods are extreme, they argue he is correct that erections are an indicator of good health – and that erectile dysfunction could signal serious illness.

Large studies have shown that the issue often appears years before heart disease, diabetes or stroke, because the small blood vessels in the penis are among the first to be damaged by poor circulation, inflammation and metabolic disease.

Moreover, doctors warn that millions of men may be suffering from the stigmatising issue without realising it, because they are unaware of the early hidden signs – namely, less frequent and less rigid night-time erections.

Failure to tackle the problem at this stage, they argue, could ultimately lead to full-blown impotence or even life-threatening health problems being missed.

‘Healthy erections are testament to a good sleep routine, diet and regular exercise,’ says Mr Marcus Cumberbatch, consultant urological surgeon at Thornbury Hospital in Sheffield.

‘Poor erectile function, on the other hand, is often a sign of an underlying health problem. However, the signs of erectile dysfunction can be more subtle than men realise. So it’s important to learn them so that you can take action before it’s too late.’

Erectile dysfunction, or ED, is the inability to get or maintain an erection sufficient for satisfactory sexual performance.

As many as half of all men aged 40 to 70 will at some point experience erectile dysfunction, according to the British Association of Urological Surgeons.

The prevalence rises significantly with age – by 70, over two-thirds may be affected.

Reduced blood flow into the penis can be caused by a range of medical conditions, some more worrying than others.

Studies suggest that around a tenth of cases of erectile dysfunction are triggered by mental health problems such as anxiety or depression.

Experts say the problem can also develop as a result of strain in a relationship. In these cases, tablets called PDE5 inhibitors, which boost blood flow, can be game-changing. These include Viagra, or sildenafil, as well as Cialis, or tadalafil. In the UK, these tablets are available without prescription.

However, doctors warn that all patients who experience erectile dysfunction must see their GP because, in many cases, it is triggered by serious underlying health problems.

These include high cholesterol, which contributes to the build-up of fatty plaques in the arteries and restricts blood flow, and high blood pressure, which damages blood vessels and reduces their ability to dilate properly. Type 2 diabetes – a condition linked to obesity and physical inactivity – can also impair blood flow and damage the nerves involved in erections.

Research shows that up to three-quarters of men with diabetes will experience some degree of erectile dysfunction during their lifetime, often up to ten years earlier than men without the condition.

Doctors warn that all patients who experience erectile dysfunction must see their GP because, in many cases, it is triggered by serious underlying health problems

Obesity itself is also strongly linked to erectile dysfunction through its effects on hormones, inflammation and vascular health.

Left untreated, all these conditions significantly raise the risk of an early death.

One study by US scientists, published in The Journal of Sexual Medicine, found men with erectile dysfunction had a 70 per cent increased risk of an early death from any cause.

Another Dutch study found men with erectile dysfunction were up to 250 per cent more likely to develop cardiovascular disease, the leading cause of death globally.

However, concerningly, experts say that many men do not even realise they have the issue.

One Japanese study illustrates the gap: while around 40 per cent of men aged 40 to 69 reported erectile dysfunction – in line with many studies – clinical assessment by GPs found that as many as 92 per cent of men showed signs of the condition.

This phenomenon is not confined to older men. A US study published last year found that 19 per cent of men aged 18 to 34 believed they had erectile dysfunction, yet medical assessment suggested the true figure was closer to 26 per cent.

Experts say the issue is that many men have a misconception about what constitutes erectile dysfunction. Most, they say, believe the condition refers to a total failure to achieve an erection.

But experts say there are other signs, including changes to night-time erections.

Medically termed nocturnal penile tumescence, these are a normal part of male sexual function. During certain stages of sleep, parts of the nervous system that normally control the muscles governing blood flow to the penis switch off.

This, along with naturally fluctuating hormone levels, leads to erections at night and in the morning on waking.

Studies show that, for most men, it is normal to get between three and five erections a night, each of about ten to 30 minutes.

FirmTech – the company that manufactures penis monitors – analysed data from 150,000 men and found the number of night-time and morning erections remains relatively stable throughout life.

Instead, experts say one of the earliest signs of the problem is an erection that lacks rigidity. This means it might feel soft to the touch or be difficult to maintain during intercourse.

FirmTech says its research has shown that, between the ages of 20 and 60, rigidity reduces, on average, by about 15 per cent. And for those with underlying health issues, this change can be far more pronounced.

Father-of-four Keith Leech says his erectile dysfunction caused trouble in his 25-year relationship with his wife

‘A loss of rigidity in your erections is one of the common early signs of erectile dysfunction,’ says Mr Cumberbatch.

‘For the majority of people, erectile dysfunction is not sudden, and a loss of rigidity can happen over a number of years. This should signal it is time to act before function fully deteriorates. If you cannot get fully rigid, it is advisable to see a GP, as at that point there are often still steps that people can take.’

One of those affected by this issue is Keith Leech, 70, who says that his erectile dysfunction caused trouble in his 25-year relationship with his wife Heather.

The father-of-four, from Hastings, says that for the first few years he did not realise he had erectile dysfunction.

‘It was definitely gradual,’ he says. ‘The firmness of my erection decreased over time. Over a few years it was just getting to the point where sex wasn’t satisfying for either of us. It just didn’t feel right.’

He now believes his erectile dysfunction was caused by his blood pressure medication, beta blockers, as this is a known side effect.

But he ultimately decided to keep taking the tablets to protect himself from potentially fatal heart problems.

‘I figured I would rather be alive than take additional medications that may mess with that,’ says Keith, who is encouraging more men to speak about sex as part of a campaign with the online adult shop Lovehoney.

‘I do grieve what we once had, but we have learned to adapt as a couple.’

Thankfully, experts say most people can take effective steps to reverse the issue.

The first, they say, is to visit a GP, who can diagnose any possible underlying cause.

If the problem is triggered by high cholesterol or high blood pressure, for example, then a family doctor might prescribe tablets to bring these levels down. This should not only protect the body from deadly complications but also combat erectile dysfunction.

However, there are also lifestyle changes that can help with the issue.

Research shows that about 160 minutes a week of moderate exercise – such as brisk walking, running, cycling or swimming – for six months decreased erectile problems in men whose dysfunction was related to cardiovascular risk factors.

Meanwhile, a 2020 study of more than 20,000 men found that those who followed the Mediterranean diet – focused on wholegrains and lean protein – cut the risk of erectile dysfunction in men over 60 by a fifth.

‘As well as diet and exercising regularly, it is really important to have a good sleep schedule, getting eight hours a night,’ says Dr Jeff Foster, a GP specialising in men’s health. ‘This will help manage another important factor – stress.’

Experts say that for those who do not respond to lifestyle changes, tablets like Viagra and Cialis can be the answer.

The effects of Cialis tend to last for up to 36 hours, making it the more popular choice. However, some men find that Viagra, which lasts between four and six hours, has a stronger impact on their erections.

For those who fail to respond to any medication, there are vacuum erection devices – also known as penis pumps. These work by drawing blood into the penis, which is then kept there using a constriction ring placed around the base of the organ.

However, doctors say that the biggest challenge in tackling erectile dysfunction is that men do not seek help. On average, patients experience erectile dysfunction for three years before they see a doctor.

‘What is important is that if men experience more than one episode of erectile dysfunction, they see a GP,’ says Dr Foster.

‘Most men do not feel able to talk to their doctor and will do anything they can to avoid it.

‘This means that before they come to us, they have often tried to self-medicate with over-the-counter Viagra – and as we know, heart conditions are often the underlying cause. It means that men are delaying treatment for serious health conditions.’