Erectile Dysfunction at Age 40: Causes & Solutions

Turning 40 is a milestone. You have more wisdom than you did at 20, you’re probably more established in your career, and you might be rocking the salt and pepper look in your hair.

But for some guys, getting older means their body parts don’t work as well as they used to, including their penises.

Dealing with erectile dysfunction (ED) at 40 may seem young — weren’t the guys in those 90s Viagra® commercials... elderly? — but data suggests that by the time a man reaches his 40s, he has a 40 percent chance of developing erection problems. That number goes up 10 percent every decade — 50 percent in your 50s, 60 in your 60s, and so on.

Sure, ED may become more common as you age, but you don’t have to accept it as a done deal. We’ve come a long way since the 1990s, and so has our understanding of what causes ED — and what you can do about it. Keep reading to learn more.

It’s normal to have trouble performing from time to time. Stress, relationship conflicts, and fatigue can all play a role in your ability to get an erection. Experiencing these occasional bouts of erectile failure doesn’t necessarily mean you have ED.

But men who face erectile difficulties frequently may have a bigger problem going on, especially if they’re over 40. Studies show that, relative to men aged 18-29 years, the odds of being diagnosed with ED or prescribed treatment increase more than 15-fold in older men aged 40-49 years.

Why do extra birthday candles bring a higher risk of ED? Well, according to one 2023 study, middle-aged and elderly patients are simply more likely to have a combination of multiple risk factors for ED compared to younger men with ED. As you’ll see in the next section, your penis faces many threats as you get older, from vascular issues to hormonal imbalances. To counter these threats, treatment for ED often requires a multi-pronged approach.

A few things can impede sexual performance as you enter your 40s. We’ll outline the most common causes of ED below, but it’s important to talk with your healthcare provider if you’re having trouble getting or maintaining an erection to figure out the underlying cause — regardless of whether you have sudden ED or experience symptoms off and on.

Causes of erectile dysfunction in males in their 40s can be psychological or physical. Let’s take a closer look below.

Psychological Causes of ED

Psychological causes of ED at 40 include stress, performance anxiety, low self-esteem, depression, and relationship problems. They can impact sexual function and make it harder to get hard.

Pair that with the fact that life in your 40s tends to be filled with more stressors (work stress, relationship stress, and everyday stress). Plus, your risk for mental health conditions increases with age.

Moreover, if you have a chronic long-term disease like diabetes (another risk factor for ED), struggling to manage it over the years can exacerbate psychological distress, thereby compounding your risk factors for ED.

Physical Causes of Erectile Dysfunction at Age 40

The most common physical causes of ED in your 40s include:

• Vascular issues (the most common cause) relating to blood flow and blood vessels

• Neurological problems relating to the nervous system

• Hormonal imbalances like low testosterone

Let’s explain what might lead to vascular, neurological, and hormone-related ED.

Vascular Causes of ED

Cardiovascular issues are the main contributor when it comes to vascular-related ED.

Some types of heart disease — like hardened arteries (aka atherosclerosis), high cholesterol, and high blood pressure — can impact blood vessel health and restrict penile blood flow. Without proper blood flow to the penis, you can’t get or maintain an erection.

As you get older, you also have a higher risk for other medical conditions that can cause ED, like diabetes.

Since high blood glucose levels can damage nerves and blood vessels (yes, even the ones in your penis!), metabolic diseases like diabetes can mess with your ability to get hard.

As noted, you’re more likely to develop diabetes the older you get. According to the Centers for Disease Control and Prevention (CDC), people most often develop type 2 diabetes after age 45.

Neurological Causes of ED

Neurological ED stems from conditions like Parkinson’s disease or multiple sclerosis (MS). Neurological disorders can impair the nervous system, meaning your brain may be unable to send the signals needed to start or keep an erection.

As for what is a major risk factor for neurodegenerative diseases like these? Aging.

Hormonal Causes of ED

People often associate age-related hormone changes with female menopause. But men also go through hormonal changes as they get older.

That’s right, your ED may be the result of age-related hormonal changes like a dip in testosterone levels, which happens naturally as you get older. Low testosterone can hamper your ability to get and stay erect long enough for satisfying sexual activity.

Other Causes of ED at 40

The following causes may also lead to sexual dysfunctions like ED:

• Medications

• Lifestyle choices

• Prostate cancer

• Physical trauma

Medications

As you get older, you’re more likely to develop health problems that require you to take prescription drugs. ED is a side effect of some medications, including antidepressants and high blood pressure (aka hypertension) meds.

Some common culprits include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which are both used to treat depression and anxiety, as well as beta-blockers, which help treat hypertension.

Lifestyle Choices

Being inactive, smoking, drinking a lot, and having a bad diet can all raise your risk of ED. Why? These habits increase your chance of developing certain health conditions like the ones mentioned in the previous section. They can also increase your risk of obesity, another culprit behind ED.

Prostate Cancer

Prostate cancer treatments like surgery, chemotherapy and radiation may impact your ability to get and keep an erection. Or, you may find that your erections aren’t as hard as they used to be.

But also, cancer is a downer. It can take an emotional toll that trickles into your sex life, making it more difficult to get excited about sexual intercourse.

Physical Trauma

We’re sorry for bringing it up, but yes, injury to your pelvic area can cause ED. Injury might happen from direct trauma, like having a blood vessel or nerve nicked during prostate surgery. Or it could be an accident that causes a spinal cord injury.

And FYI: It’s possible for several causes to contribute to ED at once.

You’re 40, struggling to get hard, and worrying this might be the end of a satisfying sex life. You might even be asking yourself, Can ED be reversed?

Well, we’ve got good news: ED is treatable!

Just because you’re in your 40s and experiencing symptoms doesn’t mean you have to live with them forever.

There’s no one-size-fits-all solution for ED, but getting in touch with a healthcare professional who specializes in urology is a great first step in finding a treatment that works for you.

Let’s break down the different ED treatments a urologist might recommend.

ED Medications

The most effective treatments for erectile dysfunction in men aged 40 and up are ED meds known as PDE5 inhibitors. These drugs widen your blood vessels to improve blood flow to the penis, helping you get and stay hard.

Here’s an overview of current FDA-approved ED medications:

• Sildenafil (generic Viagra)

• Tadalafil (generic Cialis®)

• Stendra® (and the generic avanafil)

• Vardenafil (generic Levitra®)

Another option is our chewable hard mints, which contain varying dosages of sildenafil or tadalafil, the active ingredients in other FDA-approved erectile dysfunction meds. They come in a discreet case and have a fresh wintergreen flavor, so you can feel extra comfortable carrying them around.

Healthy Habits and Lifestyle Changes for ED

Day-to-day choices have a big impact on overall health — including erectile function.

Healthy lifestyle habits can help improve your overall well-being and make you less likely to develop medical conditions that can impact your equipment and make it tough to maintain an erection.

The following good habits may help prevent ED and improve existing erectile dysfunction symptoms:

• Talking to a therapist

• Following a healthy diet

• Quitting smoking

• Limiting alcohol intake and drug use

• Getting physically active

• Practicing stress-reduction strategies

Talking to a Therapist

Working with a psychotherapist or sex therapist can improve ED related to psychological causes. This professional can help you uncover the root cause of your symptoms and offer tips and tools to improve your sexual performance.

Following a Healthy Diet

Good nutrition can help manage conditions that can lead to ED, like cardiovascular disease, high blood pressure, and diabetes. Our blog has tips for maintaining an erection naturally, including ways to adjust your diet to improve sexual health.

Quitting Smoking

You probably already know it’s bad for you, but did you know smoking increases your risk of developing ED? Smoking can damage the blood vessels necessary for getting and maintaining an erection. So while you might think smoking looks cool, it definitely won’t make you feel cool — especially in bed.

Limiting Alcohol Intake and Drug Use

Both can be fun, but they can also make other types of fun less likely. Drinking too much and using recreational drugs are common risk factors for ED and can also be detrimental to your overall health over time.

Getting Physically Active

You don’t have to run a marathon tomorrow, but getting your heart rate up often is good for your cardiovascular health and can help improve conditions like high blood pressure. Regular exercise also helps you maintain a healthy weight, which is another win for your erections.

Practicing Stress-Reduction Strategies

Since stress can cause and exacerbate ED symptoms, finding ways to better cope with daily stressors — like doing yoga, meditating, or listening to soothing music — may help.

Studies have shown that mindfulness-based therapies can improve many areas of men’s sexual health, including sexual desire, sexual satisfaction, self-control, and erectile function.

Other Treatments for ED

If ED medications, therapy, and other lifestyle adjustments don’t work, your healthcare provider may recommend you try one of the following treatments:

• Penile injections, containing ingredients like alprostadil or phentolamine

• Vacuum devices (aka penis pumps) that manually increase penile blood flow

• Penile implants

• Testosterone replacement therapy (TRT) to address low testosterone

We live in a time when people can experience the best parts of their lives in their 40s and beyond. That means you have many years ahead of you to enjoy the things that make you feel good — sex included.

Sure, your risk of developing ED increases as you get older, but you’re not doomed to live without relief. Remember:

• Younger men experience ED more often than you’d think. Research shows that by the time a man reaches his 40s, he has a 40 percent chance of having erection problems.

• ED has many causes. From psychological causes like anxiety and stress to physical causes like vascular issues and hormonal imbalances, there are many reasons why you may have ED. Figuring out the underlying cause is key to getting the treatment you need.

• ED is highly treatable. With so many erectile dysfunction treatment options available, you’re bound to find one that works for your needs. Still, talking with a healthcare professional is crucial to figuring out what’s going on.

Ready to get help for your ED symptoms? Schedule a call with a healthcare provider today to start exploring solutions online without dipping into your gas money.

In addition to prescribing meds, our telehealth providers can recommend testing and physical exams to help diagnose any underlying conditions that may be contributing to your sexual function issues. You deserve a happy, healthy sex life, and we’re here to support you going after one.