Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 3/20/2021
You expect certain changes as you age. But not being able to have a fulfilling sex life can be a surprise, especially in your 40s. That said, erectile dysfunction can affect men of any age. And while it’s more common in older age, your 40s aren’t “too young” to deal with impotence.
All men will eventually suffer from erectile dysfunction, unless, of course, they don’t live into old age. It’s known as aging related erectile dysfunction or aging related impotence. But a common misconception is that only old age leads to ED. When ED can be caused by numerous factors that begin as early as your 20s.
Men in their 40s have a lot going on -- they’ve officially reached middle age, which can be scary. But if you add to that a decline in sexual performance, being 40-something can feel pretty darned old.
But impotence in your 40s is not unheard of. On the contrary. One study, known as the Massachusetts Male Aging Study, found that about 40 percent of men in their 40s will experience some form of ED. This rate increases with age, but also didn’t jump to 40 percent out of the blue -- men in their 20s and 30s can also experience ED.
If 40 percent of men in their 40s deal with some form of ED, that means roughly two men in your friend’s group of five 40-somethings suffer from it, or have. In other words, you’re not alone, and there’s a good chance you know people who have dealt with it in their 40s as well.
Erectile dysfunction can be attributed to a lengthy list of potential causes. In fact, it is often a symptom of a larger health problem. Which means it could be a warning sign, so take heed.
ED can be a sign of pending heart trouble. It generally occurs two to five years before coronary artery disease, as a sort of red flag that your health is headed down the wrong path. According to research published in the journal American Family Physician, ED is as much of a predictor of heart disease as smoking is, and it’s most predictive of heart disease in men in their 40s. In other words, ED in your 40s is more likely to be a sign of cardiovascular disease than it is in your 50s or later.
ED can also be caused by metabolic syndrome, which is essentially a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.
These risk factors include high “bad” cholesterol, high blood sugar, and high blood pressure. Perhaps obviously, these signs are evidence that your diet and activity levels may be lacking.
Trouble getting or maintaining an erection in your 40s could also be caused by endocrine or hormone disorders such as low levels of the hormone testosterone. Testosterone levels decline with age, but “low T” is not unheard of in middle age.
Impotence can also be a side effect of depression. There is a strong association between mental health and sexual health, and both anxiety and depression can cause (or be caused by!) sexual performance issues. In other words, ED can create a vicious cycle with mental health conditions.
A related potential cause, antidepressant medication can also lead to sexual dysfunction. ED could be a side effect of both selective serotonin reuptake inhibitors (SSRIs) such as escitalopram or fluoxetine, or serotonin norepinephrine reuptake inhibitors (SNRIs) such as duloxetine.
There are other causes as well. Here are some of the more common causes of ED for men in their forties:
Mental health conditions
Drug or alcohol abuse
Physical disorders like venous leakage
The first step in treating erectile dysfunction is consulting with a medical professional. A healthcare provider can help you sort out what might be causing your impotence. And the cause will determine the appropriate course of treatment.
If your ED is caused by lifestyle issues such as being inactive, smoking or obesity, the power to reclaim your sexual health may lie in lifestyle changes. The research indicates steps like getting more exercise, losing weight, and controlling diabetes and high blood pressure can improve testosterone levels and lessen sexual dysfunction.
There are also medical treatments available, the most common and first-line choice of most physicians being oral medications known as PDE-5 inhibitors. This class of drugs includes medications such as sildenafil (Viagra, generic Viagra) and tadalafil (Cialis), among others. They are the first-line treatment largely because of their effectiveness and safety profiles.
Surgery and vacuum devices are also options for the treatment of ED in certain cases.
Talking with a healthcare provider about your struggles with impotence may not be the top thing on your to-do list — talking with anyone about sexual dysfunction can be uncomfortable. But your ED could be a sign of something more serious, and help is pretty easy to come by.
Erectile dysfunction becomes more common with age, but is not unheard of in men in their forties. In fact, some estimates suggest as many as 40 percent of 40-something men will deal with ED. ED in your 40s can be a sign of a serious health condition such as heart disease, or could simply be a side effect of a medication you’re taking. Talking with a healthcare provider will help you determine what’s causing your problem and how best to solve it.