Over 65: Folic Acid for Erectile Dysfunction—When It’s Worth Trying

Erectile dysfunction (ED) affects up to 52% of men aged 60–69 and nearly 70% of those over 70.¹ While age-related hormonal changes, vascular disease and chronic health conditions all play a role, emerging research suggests a simple B vitamin—folic acid—may help boost blood flow and improve erections in some older men. Below, we explore when adding folic acid for erectile dysfunction makes sense, what the science shows and how to talk to your doctor about giving it a try.

Why consider folic acid?

Folic acid (vitamin B9) is best known for preventing neural-tube defects in pregnancy—but it also:

• Lowers homocysteine. High homocysteine levels damage blood vessels and impair nitric oxide (NO) production. NO is essential for the smooth-muscle relaxation that allows penile blood vessels to fill.²
• Supports endothelial function. A 2016 trial found men taking 5 mg of folic acid daily saw significant improvement in flow-mediated dilation, a key measure of vascular health.²
• May boost nitric oxide synthase. Folic acid supplies methyl groups needed for the enzyme that produces NO, enhancing blood-vessel dilation.

Because ED in older men often reflects underlying endothelial dysfunction, improving vessel health with folic acid could translate into firmer, more sustainable erections.

What the research says

1. Huang et al. (2016):

   • Randomized, double-blind study in adults with elevated homocysteine.
   • 5 mg folic acid daily for 8 weeks improved flow-mediated dilation by 60% vs. placebo.
   • Suggests enhanced endothelial responsiveness, a cornerstone of erectile function.²

2. Real-world data:

   • Small observational studies in men with mild to moderate ED report modest improvements in erection hardness and frequency when adding folic acid to standard care (PDE5 inhibitors).
   • Benefits appear after 4–12 weeks of consistent supplementation.

3. Broader vascular health links:

   • Endothelial dysfunction underpins both cardiovascular disease and ED.³
   • Trials in heart-disease patients show folic acid reduces surrogate markers of vascular risk, hinting at shared mechanisms.

While large, dedicated ED trials are still pending, the existing evidence and low risk profile make folic acid an appealing adjunct.

Who might benefit most?

Folic acid for erectile dysfunction isn’t a one-size-fits-all remedy. Consider it if you:

• Are over 65 with mild to moderate ED
• Have high homocysteine (≥10 µmol/L) or known MTHFR gene variants
• Show poor endothelial function (e.g., history of cardiovascular disease, hypertension, diabetes)
• Experience suboptimal results with PDE5 inhibitors alone

Men with severe neurogenic ED (post-prostatectomy or spinal cord injury) or those relying solely on psychological arousal may see limited gains from folic acid.

How to use folic acid safely

When adding folic acid for erectile dysfunction, follow these guidelines:

• Dosage
– 5 mg once daily is commonly studied. Lower doses (0.4–1 mg) may help but show smaller effects.
• Duration
– Allow 8–12 weeks to gauge benefits—endothelial remodeling takes time.
• Monitoring
– Check serum folate and homocysteine levels every 3–6 months.
– Evaluate B12 status before escalating folic acid to avoid masking B12 deficiency.
• Drug interactions
– Methotrexate and anticonvulsants can affect folate metabolism—consult your doctor.
• Side effects
– Rare at ≤5 mg/day. May include mild gastrointestinal discomfort or sleep disturbances.

Lifestyle and medical factors to address first

Folic acid should complement—not replace—established ED strategies:

• Optimize cardiovascular risk factors:
  • Quit smoking
  • Control blood pressure, cholesterol and blood sugar
  • Maintain a healthy weight
• Exercise regularly: aerobic and pelvic-floor workouts
• Review medications that may worsen ED (e.g., beta-blockers, certain antidepressants)
• Screen for low testosterone if you have fatigue, low libido or muscle loss

If cirrhosis or advanced liver disease is in your medical history, bear in mind that folate storage and processing occur in the liver.⁴ ⁵ Severe hepatic dysfunction can impair folate handling and contribute to ED through hormonal and metabolic disruptions.

When to try folic acid

You might start folic acid if:

1. You’ve made lifestyle changes and are on optimal ED medications but still have residual symptoms.
2. Lab tests show elevated homocysteine or low folate levels.
3. You’re interested in a low-risk supplement with potential vascular benefits.

Before beginning, discuss your full medical history with your doctor. Some rare genetic conditions or drug regimens require specialist guidance.

Checking your symptoms

Not sure what’s driving your ED? Consider a free, online symptom check for erectile dysfunction to help you and your physician pinpoint potential causes—cardiovascular, hormonal, neurological or psychological.

Talking to your doctor

Although folic acid is generally safe, any new supplement can interact with medications or mask important deficiencies. Be sure to:

• Share your full medication list
• Discuss past medical history, including liver or kidney disease
• Review lab results (homocysteine, folate, B12)
• Set clear expectations about the timeline and likely degree of improvement

If you experience chest pain, severe abdominal pain, sudden vision changes or any life-threatening symptom, stop supplementation and speak to a doctor immediately.

Bottom line

For men over 65 grappling with mild to moderate erectile dysfunction, adding folic acid may offer modest improvements by tackling endothelial dysfunction and high homocysteine. It works best as part of a comprehensive plan—lifestyle optimization, medical therapy and targeted supplementation. With its excellent safety profile and potential vascular benefits, folic acid is worth considering if you meet the criteria above.

Before starting any new supplement—especially if you have chronic health conditions—speak to a doctor to ensure it’s right for you.