Erectile dysfunction at 40: Why it happens and what actually helps
Erectile dysfunction (ED) at 40 is common, and it becomes more likely as men get older and other health conditions add up (Leslie & Sooriyamoorthy, 2024). It can start well before 40 too (Nguyen et al., 2017), and the cause can be physical, psychological, or both, so a doctor's check is the best first step.
Below, you'll find how common ED is at 40, what causes it, how testosterone and stress fit in, how to tell whether the cause is physical or psychological, and what helps.
How common is erectile dysfunction over 40?
In a large US study of men aged 40 to 70, 52% had some degree of ED, from mild to complete (Feldman et al., 1994). The same study found complete ED tripled between the ages of 40 and 70, from about 5% to about 15%. These men all lived near Boston and were studied in the late 1980s, so the figures may not match every group of men today.
ED can start earlier too. A review of research found that as many as 3 in 10 men under 40 have had erection difficulties at some point (Nguyen et al., 2017). For the full picture of erectile dysfunction, including how common it is at every age, see Mojo's main guide.
What causes erectile dysfunction over 40?
Physical and psychological causes can overlap, and the mix can shift as you get older.
The table below sorts the main causes into physical and psychological. For the full range of causes behind ED, including causes that go beyond the age-40 picture, see Mojo's dedicated guide.
| Cause | Type | What it involves |
|---|---|---|
| Hormone changes | Physical | Lower testosterone is mainly linked to sexual desire |
| Cardiovascular health | Physical | An erection depends on healthy blood flow |
| Blood sugar and weight | Physical | Diabetes is closely linked to ED |
| Stress and low mood | Psychological | Depression is linked to higher odds of ED |
| Performance anxiety | Psychological | Worry about how you'll perform, during sex or long before it |
| Relationship strain | Psychological | Strain with a partner |
Psychological factors are a common cause of ED in younger men (Nguyen et al., 2017). Around 40, physical causes start to play a bigger part as health conditions add up (Leslie & Sooriyamoorthy, 2024).
Diabetes is one of the conditions most closely linked to ED (Leslie & Sooriyamoorthy, 2024).
Performance anxiety means worrying about how you'll perform in bed. It can happen during sex, but the worry can also stick around the rest of the time, until the thoughts start to feel intrusive. Psychologists call stepping outside the moment during sex to judge your own performance spectatoring.
Testosterone and erectile dysfunction at 40
Low testosterone can contribute to ED (Leslie & Sooriyamoorthy, 2024).
Testosterone declines gradually, by roughly 1 to 2% a year, from your 30s or 40s onward, depending on which measure of testosterone is used (Institute of Medicine, 2004).
Testosterone is mainly linked to sexual interest and desire. Its role in the erection itself is less clear (Institute of Medicine, 2004).
A doctor's check for ED can include a morning testosterone blood test (Leslie & Sooriyamoorthy, 2024). Ask a doctor if you're worried about your levels.
Stress, midlife pressure, and erectile dysfunction
Feeling low and having erection problems are linked in both directions.
Large studies in the US and Europe found that, on average, people feel least happy in their mid-to-late 40s (Blanchflower & Oswald, 2008). So for many men, the years around 40 can already feel heavy.
ED is linked to nearly three times higher odds of depression (about 2.92 times), and depression is linked to somewhat higher odds of ED (Liu et al., 2018). To understand how depression and ED reinforce each other, Mojo has a full guide on that specific link.
When erectile dysfunction signals a bigger health problem
Sometimes ED is one of the earliest signs of heart disease or a blood vessel problem. The arteries that supply the penis are small, so ED can appear up to 5 years before heart disease or stroke (Leslie & Sooriyamoorthy, 2024).
A check for new ED often includes a heart and blood pressure exam, plus blood tests for blood sugar and cholesterol (Leslie & Sooriyamoorthy, 2024).
Mojo doesn't diagnose or monitor ED. See a doctor to rule out physical causes first. For what to expect when you talk to a doctor about ED, Mojo has a guide that walks through the appointment.
Physical or psychological: how to tell what's driving your ED
ED at 40 can have physical causes, psychological causes, or both. Physical causes tend to make up a bigger share of cases as men get older, and psychological causes tend to make up a bigger share in younger men.
| Pattern you're noticing | More often linked to | Why it fits | Next step |
|---|---|---|---|
| ED that's developed gradually as you've gotten older | Physical factors (hormone changes, cardiovascular health, metabolic health) | Physical causes play a bigger part as men get older | Book a check-up with your doctor |
| ED that started earlier in life | Psychological factors (stress, performance anxiety, relationship strain) | Psychological causes are common in younger men | Read the self-assessment guide linked below, and consider talking to a therapist |
| A mix of both, or you're not sure | Physical and psychological factors together | Physical and psychological causes can both be present | Start with a doctor, then look at psychological or relationship support |
For a full self-assessment for physical vs. psychological ED, Mojo's guide walks through how to place your own pattern. Use the table as a starting point for a conversation with your doctor.
What actually helps: treatment options for erectile dysfunction over 40
Start with a doctor to rule out physical causes. Once physical causes are ruled out, psychological and relationship-focused support can help with the rest.
The Erection Reset is Mojo's evidence-based program, built with clinical psychologist Dr. Shannon Chavez. It's a structured, expert-led way to work through spectatoring, performance anxiety, and communication with a partner.
AI-guided conversations help you apply what you learn to your own life. Results vary from person to person, and a doctor's check still comes first.
For the full range of ED treatment options, Mojo's guide covers what's available beyond this article.
FAQs
In a large US study of men aged 40 to 70, 52% had some degree of ED, from mild to complete (Feldman et al., 1994).
A mix of physical factors (hormone changes, cardiovascular health, metabolic health) and psychological factors (stress, performance anxiety, relationship strain). The two can overlap.
Yes. ED is common in men 40 and older, and it becomes more common with age (Leslie & Sooriyamoorthy, 2024). A doctor can check for physical causes.
Start with a doctor to rule out physical causes like blood pressure, blood sugar, and testosterone. Psychological or relationship-focused support, including an evidence-based program, can help with the rest, especially where stress, performance anxiety, or communication with a partner are involved. There's no guaranteed cure.
It can be a contributing factor, but vascular disease and diabetes are far more likely causes of ED (Leslie & Sooriyamoorthy, 2024). A doctor can test your levels.
Sources
- Nguyen, H. M. T., Gabrielson, A. T., & Hellstrom, W. J. G. (2017). Erectile dysfunction in young men: A review of the prevalence and risk factors. Sexual Medicine Reviews, 5(4), 508–520. https://doi.org/10.1016/j.sxmr.2017.05.004
- Institute of Medicine. (2004). Testosterone and aging: Clinical research directions. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK216175/
- Blanchflower, D. G., & Oswald, A. J. (2008). Is well-being U-shaped over the life cycle? Social Science & Medicine, 66(8), 1733–1749. https://www.nber.org/system/files/working_papers/w12935/w12935.pdf
- Liu, Q., Zhang, Y., Wang, J., Li, S., Cheng, Y., Guo, J., Tang, Y., Zeng, H., & Zhu, Z. (2018). Erectile dysfunction and depression: A systematic review and meta-analysis. Journal of Sexual Medicine, 15(8), 1073–1082. https://academic.oup.com/jsm/article/15/8/1073/6980541
- Leslie, S. W., & Sooriyamoorthy, T. (2024). Erectile dysfunction. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562253/
- Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54–61. https://pubmed.ncbi.nlm.nih.gov/8254833/
Mojo aims to provide useful wellbeing resources to its users; however, you should not solely rely on opinions or advice available on the Website or given by the Community. Always seek advice from a qualified medical doctor or other healthcare professional before acting.
About the experts
With 18 years as an accredited COSRT and BACP therapist, Amanda helps people navigate desire, intimacy, and the changes life brings.
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