For men, the decades after 40 can bring gradual changes in cardiovascular health, muscle mass, metabolism, sleep, urinary function and sexual health. Some are part of normal ageing, while others can signal conditions that benefit from investigation or treatment.

The difficulty is that many important health problems develop quietly. High blood pressure, raised cholesterol and elevated blood glucose can cause little or no noticeable symptoms. Maintaining health with age therefore depends not only on responding to illness, but also on monitoring risk factors and protecting the systems that support long term health.

1. Make cardiovascular health a priority

Cardiovascular disease becomes increasingly important with age. Risk is influenced by blood pressure, cholesterol, smoking, diabetes, physical activity, body composition and family history.

Because high blood pressure and raised cholesterol can remain silent, regular health checks are valuable. In England, eligible adults aged 40 to 74 are generally invited for an NHS Health Check every five years. This assesses cardiovascular risk and can include blood pressure, cholesterol and other factors relevant to diabetes, kidney disease and heart disease.

Waist measurement, fitness and activity levels also matter. Excess abdominal fat is associated with metabolic and cardiovascular risk, while regular movement supports blood vessel health throughout the body.

2. Preserve muscle and physical fitness

Ageing is associated with a gradual decline in muscle mass and strength. Over time, this can affect mobility, balance, metabolic health and independence.

Resistance exercise becomes increasingly important as a result. Weight training, resistance bands and challenging body weight exercises can all help maintain strength. NHS guidance recommends strengthening activities on at least two days each week alongside regular aerobic activity.

Walking, cycling and swimming can support cardiovascular fitness, but strength training provides a different benefit by directly challenging muscle. The most useful programme is one that can be performed consistently rather than an intense routine that is difficult to maintain.

Men returning to exercise after a long period of inactivity, particularly those with cardiovascular disease or another significant medical condition, should discuss appropriate activity with a healthcare professional.

3. Eat for long term metabolic health

A healthy diet does not require an extreme eating plan. For most men, the fundamentals are more important than dietary trends.

Meals should regularly include vegetables, fruit, wholegrain carbohydrates and appropriate protein sources such as fish, eggs, lean meat, dairy products, beans and lentils. Unsaturated fats, including those found in olive oil, nuts and oily fish, can generally be prioritised over excessive amounts of saturated fat.

Protein becomes particularly relevant with age because it supports the maintenance of muscle. Fibre is also important for digestive and cardiovascular health.

Diet should be considered as an overall pattern rather than judged meal by meal. A sustainable approach that provides sufficient nutrients and supports a healthy weight is more useful than a restrictive plan that cannot be maintained.

4. Treat sleep as part of preventive health

Persistent poor sleep can affect concentration, mood, cardiovascular health and daily functioning. Most healthy adults need around seven to nine hours each night, although individual requirements vary.

Sleep quality matters as well as duration. Loud snoring, pauses in breathing, morning headaches and pronounced daytime sleepiness can be associated with obstructive sleep apnoea and should not simply be accepted as part of getting older.

A reasonably consistent sleep schedule, regular activity during the day and limiting stimulants close to bedtime can support better sleep. Persistent fatigue or major changes in sleep should be discussed with a clinician.

5. Do not dismiss changes in erectile function

Occasional difficulty achieving or maintaining an erection can occur because of stress, tiredness or alcohol. Persistent erectile dysfunction is different and should not automatically be considered an unavoidable consequence of ageing.

Erections depend on healthy blood flow, nerve function, hormones and psychological wellbeing. Recurrent erectile dysfunction can therefore be associated with wider health issues including high blood pressure, raised cholesterol, diabetes, anxiety and depression.

A healthcare professional may review blood pressure, medication, lifestyle and relevant cardiovascular or metabolic risk factors before discussing treatment. Where clinically appropriate, PDE5 inhibitors may be considered. These include sildenafil, the active ingredient in Viagra, and tadalafil. Both increase blood flow to the penis in response to sexual stimulation, although their duration of action differs.

These medicines are not suitable for everyone. In particular, sildenafil and tadalafil should not be used with nitrate medicines for chest pain because the combination can cause a potentially dangerous fall in blood pressure.

Ana Carolina Goncalves, Superintendent Pharmacist at Pharmica, says:

“Persistent erectile dysfunction should not simply be written off as part of getting older. Erections depend on healthy circulation, nerve function, hormones and psychological wellbeing, so recurring difficulties can be a useful reason to review a man’s wider health. The priority should be identifying possible contributing factors and then considering treatment that is both clinically appropriate and safe for the individual.”

For men experiencing repeated erectile difficulties, seeking professional advice can therefore address more than sexual function. It may also provide an opportunity to identify modifiable health risks.

6. Pay attention to prostate and urinary symptoms

The prostate commonly enlarges with age and this can cause urinary symptoms without being cancerous. However, changes in urinary function should still be assessed rather than assumed to be harmless.

Symptoms worth discussing include difficulty starting urination, a weaker flow, needing to urinate more frequently or urgently and repeatedly getting up during the night.

Prostate cancer may cause no symptoms during its early stages. A PSA blood test can help investigate prostate problems, but it is not a definitive cancer test. PSA can rise for several reasons and a normal result does not rule out every possibility.

Men concerned about prostate cancer should discuss their individual risk and the advantages and limitations of PSA testing with a clinician. Family history is relevant, particularly where close relatives have developed prostate cancer or certain related cancers.

7. Review alcohol and smoking habits

The effects of smoking and alcohol accumulate over time.

Smoking damages blood vessels and substantially increases the risk of cardiovascular disease, respiratory disease and several cancers. Because erections also depend on healthy blood flow, smoking can affect sexual health as well as wider health.

For people who drink regularly, UK guidance advises no more than 14 units of alcohol per week, spread across three or more days. This is described as lower risk drinking rather than a completely safe level.

Alcohol can also interfere with sleep, contribute additional energy intake and make erectile difficulties more likely in some situations. Reducing intake can involve smaller servings, lower strength drinks and regular alcohol free days.

8. Take mental health and medication reviews seriously

Mental and physical health become increasingly connected with age. Chronic stress can affect sleep, exercise, relationships, alcohol intake and sexual function, while depression can present as irritability, fatigue, loss of motivation or withdrawal rather than sadness alone.

Persistent changes in mood that affect everyday life deserve professional support.

Medication needs can also change over time. Men taking several medicines should review them periodically with a doctor or pharmacist, particularly when new symptoms appear after treatment has been started or changed. The same caution applies to supplements marketed for testosterone, sexual performance, muscle growth or longevity. Availability without prescription does not automatically mean that a product is necessary or appropriate.

Focus on healthspan, not simply lifespan

Healthy ageing is not about trying to prevent every physical change. A more useful objective is maintaining cardiovascular fitness, strength, cognitive function, independence, sexual wellbeing and quality of life for as long as possible.

For many men, the most effective strategy remains relatively conventional: stay active, preserve muscle, eat a balanced diet, sleep adequately, avoid smoking, keep alcohol within lower risk limits and attend appropriate health assessments.

Most importantly, do not assume that every new symptom is simply part of getting older. Many conditions that become more common with age can be prevented, identified earlier or managed effectively when changes are taken seriously.