The Forgotten Foundation: Pelvic Health, Sexual Function, and Longevity

Why pelvic health belongs in every longevity conversation

When people talk about longevity, they usually think about heart disease, metabolism, muscle mass, or brain health. Pelvic health rarely makes the list. That omission matters.

Your pelvic floor is a central hub where movement, circulation, nerve signaling, continence, sexual function, and core stability intersect. When it’s strong, coordinated, and responsive, sexual function improves, injuries decline, confidence rises, and quality of life extends well into later decades. When it’s neglected, subtle dysfunction often shows up years before more obvious decline.

At Torre Prime, pelvic health sits at the intersection of THE TEMPLE (physical power & performance) and THE FLAME (vitality, intimacy & purpose)—because longevity isn’t just about living longer. It’s about staying functional, connected, and alive in your body.

The pelvic floor: not just “Kegels”

The pelvic floor is a dynamic sling of muscles, fascia, nerves, and blood vessels that:

• Stabilizes the spine and hips

• Coordinates with breathing and core control

• Regulates bladder and bowel function

• Supports erections, ejaculation, orgasm, and vaginal tone

• Influences blood flow to genital tissues

Pelvic dysfunction often begins silently—through tightness, weakness, or poor coordination—long before pain, erectile dysfunction, or incontinence appear.

Longevity requires balance, not just strength. An over-tight pelvic floor can impair blood flow and nerve signaling just as much as a weak one.

Sexual function is a downstream signal

Sexual health is one of the earliest indicators of systemic decline—and one of the most sensitive to pelvic dysfunction.

Because sexual response depends on precise timing between muscle contraction, relaxation, blood inflow, and nerve signaling, it often reveals problems years before standard medical metrics do. From a Medicine 3.0 lens, this is early signal detection—not symptom chasing.

Pelvic health looks different for women, gay men, and straight men

Pelvic health is universal—but how dysfunction shows up, what people notice first, and what gets ignored varies by anatomy, sexual practices, cultural messaging, and medical blind spots. Longevity medicine has to name those differences directly.

For women: strength and safety

Women are often introduced to pelvic health only after something goes wrong—childbirth injury, urinary leakage, prolapse, or pain with sex. But dysfunction frequently starts years earlier, driven by factors such as pregnancy and delivery trauma (even decades later), chronic breath-holding or bracing, hormonal shifts across perimenopause and menopause, and high-impact training without pelvic coordination.

Early signals may include:

• Pain with penetration or tampon use

• Leaking with coughing, running, or lifting

• Pelvic pressure or heaviness

• Reduced orgasm intensity

These symptoms are often normalized as “just aging.” From a longevity perspective, they’re early warnings, not inevitabilities. Pelvic care here isn’t about “tightening”; it’s about control, relaxation, load tolerance, and nervous system safety.

For straight men: performance is not just blood flow

Straight men are commonly taught to view sexual function through erections and testosterone alone. The pelvic floor, however, directly affects erectile rigidity, ejaculatory control, orgasm quality, and urinary control.

Early pelvic-related signs can include:

• Erections that start strong but fade quickly

• Difficulty maintaining firmness during position changes

• Pelvic or perineal tension

• Low-back or hip tightness paired with sexual symptoms

Pursuing medications or supplements without addressing pelvic coordination may limit results and miss the root cause. From a longevity lens, many sexual changes are neuromuscular and movement problems first, vascular or hormonal problems second.

For gay men: a uniquely under-addressed system

Gay men often experience pelvic health stressors that are rarely screened for or openly discussed in medical settings.

These may include:

• Chronic pelvic floor tension related to receptive sex

• Pain, guarding, or altered sensation

• Difficulty with erection or orgasm despite intact libido

• Anxiety-driven muscle bracing and shame-based disconnection

Because receptive anal sex requires relaxation, coordination, and trust in the pelvic floor, dysfunction may appear earlier—but is more likely to remain hidden due to stigma or clinician discomfort. Effective care here is neuromuscular, psychological, and relational, aligning directly with THE FLAME: vitality, intimacy, confidence, and embodied presence.

Pelvic health and longevity are inseparable

Pelvic dysfunction doesn’t exist in isolation. It correlates with broader longevity risks:

• Falls & instability: poor pelvic control compromises gait and balance

• Chronic pain: common overlap with low-back, hip, and SI joint pain

• Sedentary avoidance: pain or embarrassment reduces training consistency

• Hormonal feedback loops: sexual inactivity can reinforce low libido, mood changes, and stress responses

From a longevity perspective, these are early signals—opportunities for prevention.

Training the pelvic floor the longevity way

Pelvic health should be trained like any other performance system: assessed, individualized, and integrated.

Longevity-aligned pelvic care emphasizes:

• Coordinated breathing and diaphragm–pelvic floor timing

• Load tolerance during squats, hinges, and carries

• Relaxation as much as contraction

• Sexual-function–specific motor control

• Postural alignment and hip mobility

Generic “do Kegels” advice could worsen symptoms if tightness or poor coordination is the real issue.

Where this fits in the Torre Prime framework

Pelvic health spans multiple Torre Prime phases:

• THE SENTINEL — early symptoms, sexual changes, continence clues

• THE COMPASS — translating signals into targeted direction

• THE TEMPLE — strength, stability, and movement integration

• THE FLAME — sexual vitality, confidence, and connection

This isn’t niche care. It’s foundational care.

The long view: aging with agency

Longevity isn’t just about avoiding disease—it’s about preserving agency: moving freely, enjoying intimacy, controlling your body, and feeling at home in yourself as decades pass.

Pelvic health protects that agency.

If you want to be strong at 80, sexually engaged at 70, and confident in your body at every age in between, the pelvic floor cannot be an afterthought.

The Most Common Regrets Gay Men Have About Their Health in Their 50s

When I meet gay men in their 50s—whether at my clinic, at community events, or in a telemedicine visit—there’s a pattern that appears so consistently it’s almost predictable.
A sense of “I wish I had started sooner.”

Not because they’ve done anything wrong, but because no one ever taught them how their body really works, what longevity actually means, or how gay men’s health differs from the general population.

Based on my clinical work, decades of lived community experience, longevity research, and many of the stories shared directly with me, here are the seven most common health regrets gay men express in their 50s—and more importantly, what you can do about them now.

1. “I wish I had taken my metabolism seriously earlier.”

Many gay men arrive in midlife feeling like their metabolism changed “overnight.”
It didn’t.
It was slowly drifting for decades.

The regret:
Not paying attention to abdominal fat, rising waist size, creeping blood sugar, or declining muscle mass until they suddenly mattered.

What this really reflects:

• Untreated insulin resistance

• Chronically elevated glucose swings

• Loss of metabolic flexibility

• Inconsistent protein intake

• Lack of intentional strength training

What to do now:
A metabolic reset is absolutely possible in your 50s.
The tools are:

• Continuous glucose monitoring (CGM)

• Strength training 3–4 days/week

• High-protein, low-sugar nutrition

• Tracking waist circumference, not just weight

2. “I should have protected my brain earlier.”

Gay men disproportionately face chronic minority stress, sleep disruption, burnout, and cortisol dysregulation.

By the 50s, this shows up as:

• Brain fog

• Forgetfulness

• Poor focus

• Emotional reactivity

• Decreased sleep quality

The regret:
Not treating the brain as a long-term investment.

The truth from modern longevity science:
Brain aging begins in our 40s.
APOE4 risk, sleep quality, metabolic health, and stress load all shape cognitive aging.

What to do now:

• Prioritize sleep as a biological training zone

• Reduce alcohol (and other things)

• Train VO2 max, not just muscles

• Optimize vitamin D, B12, Omega-3

• Address loneliness and social isolation (huge for gay men)

3. “I wish I had kept my strength.”

By 50, most men have lost over 30% of their peak muscle mass unless they actively trained strength.

For gay men specifically:

• Aesthetics often overshadow function in youth

• Cardio is overemphasized

• True strength training is often delayed until too late

The regret:
Not building the “muscle reserve” that determines how well you age after 60.

Medicine 3.0 reality:
Muscle is the most important organ of longevity.

What to do now:

• Heavy strength training 2–3×/week

• Grip, carry, squat, hinge, and pull

• Track your centenarian decathlon movements

• Protein target: 1g per lb of ideal body weight

4. “I wish I had protected my sexual vitality.”

Many gay men in their 50s tell me:
“I thought erectile changes were just part of aging.”

They’re not.

The regret:
Waiting until their 50s to address:

• Erections

• Testosterone changes

• Performance anxiety

• Dopamine-driven exhaustion

• Porn desensitization

• Partner misalignment

• Shame-based avoidance of sexual healthcare

Gay sexual health is both physical and emotional.
Men often suffer silently, believing something is “wrong” with them.

What to do now:

• Assess hormones (don’t guess)

• Address metabolic health (huge for erections)

• Manage performance anxiety and sleep

• Consider Trimix, PDE5 inhibitors, or combination protocols

• Treat sex as part of overall vitality—not a separate topic

5. “I wish I had addressed sleep decades ago.”

Gay men have higher rates of insomnia, inconsistent schedules, nightlife habits, and cortisol shifts related to chronic stress.

By your 50s, poor sleep accelerates:

• Weight gain

• Brain aging

• Hypertension

• Mood instability

• Erectile dysfunction

The regret:
Not understanding that sleep is the most powerful longevity drug we have.

What to do now:

• A consistent bedtime (10 PM is ideal)

• Reduce blue light 2 hours before bed

• Target 90 minutes of slow-wave sleep

• Reduce alcohol and late-night eating

• Prioritize parasympathetic recovery (Downstate)

6. “I wish I had gotten my screenings earlier.”

This one is huge.

Gay men often avoid—or are not guided toward—early screening for:

• Colorectal cancer

• Prostate cancer

• Coronary calcium scores

• ApoB and advanced lipid panels

• Sleep apnea

• Liver health

• STI screening

• HIV PrEP management

• Bone density

The regret:
Assuming that “normal labs” mean optimal health.

What to do now:
Medicine 3.0 means testing early, testing deeply, and acting proactively—not reactively.

7. “I wish I hadn’t waited to build a support system.”

By age 50, many gay men discover an unexpected truth:

Longevity requires other people.

Yet:

• Many lived portions of life in secrecy or shame

• Many avoided forming deep community

• Many lost friends to HIV

• Many struggle with midlife dating or partnership

• Many fear being alone as they age

The regret:
Not investing in emotional well-being and community sooner.

The truth:
Loneliness is as dangerous as smoking 15 cigarettes a day.

What to do now:

• Rebuild chosen family

• Create routine contact—weekly dinners, group chats, meet-ups

• Practice vulnerability

• Build friendships around shared health goals

• Work with a longevity physician trained in mental and emotional health

Why These Regrets Matter—And Why They’re Not Fixed Destiny

Here’s the message I give every man who walks into Torre Prime:

Regret is information.
Not punishment.
Not fate.
Just information.

And when you use regret as data, not shame, you gain something incredibly rare in healthcare:

Control.

You can rewrite your 50s.
You can change your trajectory for your 60s.
And your 70s, 80s, and beyond can look radically different than your parents’ generation.

That’s the entire purpose of longevity medicine.

What Torre Prime Does for Gay Men in Their 40s and 50s

At Torre Prime, we treat gay men’s longevity as its own specialty.

Our framework includes:

• Deep-dive metabolic testing

• CGM-guided nutrition

• Hormone and sexual vitality medicine

• Sleep architecture optimization

• The Centenarian Decathlon

• Advanced labs (apoB, Lp(a), insulin, inflammatory markers)

• Early cancer screening

• Stress load analysis

• Cognitive preservation

• Emotional and relational health

• Community-building strategies

Because gay men deserve health care that gets us—not just “tolerates” us.

You don’t have to wait until you’re 60 to start over.

You can start today.