LEUVEN, Belgium — Talking about problems in the bedroom is never an easy task for a man. Culturally, men are inundated from an early age with the idea that the ability to perform sexually at a moment’s notice is a trademark quality of a “real man.” According to a new study, however, erectile dysfunction may represent a much bigger problem than just embarrassment.

Researchers have concluded that men with erectile dysfunction face an overall higher risk of death, regardless of their testosterone levels.

“As both vascular disease and low testosterone levels can influence erectile function, sexual symptoms can be an early sign for increased cardiovascular risk and mortality,” comments lead researcher Dr. Leen Antonio, of KU Leuven-University Hospitals in Belgium, in a release by the Endocrine Society.

Lower than average testosterone levels have been linked to a higher death risk in the past among middle-aged and older men, but most of the research on that topic has yielded inconclusive results. Some studies have even found an association between broad sexual dysfunction in men and a higher mortality risk.

So, in an effort to clarify these vague prior findings, the research team this time around utilized data collected as part of a large observational European study that focused on age-related hormonal changes in older men and subsequent health developments. In all, information on 1,913 men were included in the study.

For each man, researchers investigated the relationship between their hormone levels and sexual functioning – both at the beginning of the observation period and once again just over 12 years later, assuming of course said participant was still alive.

During the entire follow-up period (12.4 years), a total of 483 participants (25%) passed away. Among those fatalities, researchers discovered that men with normal levels of testosterone yet still suffering from erectile dysfunction had a 51% higher risk of dying than men with no reported sexual problems.

Additionally, men with notably low testosterone levels and sexual dysfunction symptoms had an even higher risk of death than participants with normal testosterone and no sexual symptoms.

The results were broken down in even greater detail. For example, men who reported erectile dysfunction, weak morning erections, and low sexual drive had a higher death risk than men with normal sexual tendencies. More specifically, men suffering from all three of these complaints had a 1.8 times higher risk of dying than men with no symptoms. For men with just erectile dysfunction, that risk of dying was 1.4 times higher.

Overall, men who died tended to have lower levels of free testosterone, or the testosterone that is easily used by the body.

This research is set to be presented at ENDO 2020, the Endocrine Society’s annual meeting. It will also be published in the Journal of the Endocrine Society.