HONOLULU - With Hawaii being the healthiest state in the nation, it is no surprise to find men exercising, taking care of themselves and paying attention to their health.

"As you start getting older, you start realizing that health is very important," Kent Terada, a Kailua resident said. 
As men age, many find themselves slowing down.
"Not being able to get up and go," Mike Kamakea, an Oahu resident said.

Men may notice less energy, slower reflexes or diminishing muscle mass and share the aches and pains of aging with their guy friends. 

"It's kind of a main topic around friends my age, how are you keeping up, how is your diet etc," Terada said. 

But what about erectile dysfunction, which reportedly affects the amount of men correlated to their age... 40 percent of 40 year olds have it. 50 percent of 50 year olds have it and so on. 

"Wooo...that's a pretty touchy subject, I don't go there unless it is brought up, but that's on every guys mind. Absolutely," Terada said. 

It is also on the mind of Dr. Howard Jung, the Chief of Urology at Kaiser Permanente Hawaii, who said it is normal for men as they age and doesn't need to be treated unless it interferes with a relationship or quality of life.

"It is very common for guys to come in, in good relationships, desire is there, sensation is there, they are just having difficulty achieving rigidity in order to have intercourse," Jung said. 

So what causes erectile dysfunction or ED?

"The penis is basically a blood vessel covered in skin, when you have ED, it is the first sign of cardiovascular disease or lack of blood flow to the penis," Jung said. 

While cardiovascular issues may be the most common cause of ED, they are not the only ones.

Medications can also have an affect and so can a man's frame of mind.

"When people are stressed out, anxious or have performance issues, it feeds back on itself and they have more difficulties with erections," Jung said. 

Hormones can also play a part in ED. 

Women go through menopause when their hormone levels drop and something similar happens in men.

"That is where you have a loss of testosterone, and you need that man hormone to have an erection," Jung said. 

Men can be treated for low testosterone, which may increase energy levels and improve sexual performance.

But Dr. Jung adds too much testosterone can also make prostate problems worse and may increase the risk of blood clots.

"You can overshoot, your testosterone is too high and you feel great, you feel like superman, your masculinity has peak but there is an imbalance so you are getting toxic levels and if you are not being monitored, it could be very dangerous," Jung said. 

There are also pills, like Viagra, that may help men counteract their ED.

Along with more invasive measures, like pumps, injections and even surgical implantation.

The good news when it comes to men's health issues, sometimes the cure is right in front of you, at the dinner table or at the gym.

"You can regain, I have seen it where you regain your erections. You weren't exercising, eating right and all of a sudden you get your heart rate up, improving your heart health and your erections come back," Jung said.