ED in your 40s and 50s: common causes and when to get checked

In the Massachusetts Male Aging Study, one of the largest early surveys of men's sexual health, about half of men aged 40 to 70 reported some degree of erectile dysfunction. The share went up with age, from roughly 40% of men in their 40s to nearly 70% of men in their 70s. Most of those cases were mild or moderate.

Usually, it starts in the blood vessels

An erection depends on blood flowing in quickly and staying there. The arteries that supply the penis are narrow, so the same changes that stiffen and narrow arteries elsewhere in the body tend to show up there first. High blood pressure, diabetes, high cholesterol, smoking, carrying extra weight and not moving much all make ED more likely, and most men with ED in midlife have at least one of them.

Why it can be an early warning

Because those small arteries are affected early, ED can appear before heart disease causes any other symptoms. In a 2006 Italian study of men with chronic coronary artery disease who also had ED, 93% had noticed the erection problems first, on average about two years before heart symptoms began. A Mayo Clinic study that followed 1,402 men for ten years found the link was strongest in younger men: men in their 40s with ED developed heart disease at about 50 times the rate of men the same age without it.

The American Urological Association treats ED as a marker for cardiovascular risk. If you're in your 40s or 50s and it's new, it's a good reason to get your blood pressure, blood sugar and cholesterol checked, even if you feel fine otherwise.

Other common causes

• Medicines. Some blood pressure drugs (including thiazide diuretics and certain beta blockers) and many antidepressants, SSRIs especially, can affect erections. Don't stop a prescription on your own; ask the doctor who prescribed it about alternatives.
• Diabetes, which damages both blood vessels and the nerves involved in an erection.
• Low testosterone, which more often lowers desire than causes ED by itself. The AUA recommends a morning testosterone test as part of an ED workup.
• Poor sleep, heavy drinking and stress. Worrying about whether it will work can also keep a problem going after the original cause has passed.

What helps besides medication

Lifestyle changes can improve erections on their own. In a 2004 randomized trial of 110 obese men with ED, aged 35 to 55, the group coached to lose weight and exercise more ended up with normal erectile function in 17 cases out of 55 after two years. In the control group, given general health advice, it was 3 out of 55. Stopping smoking, cutting back on alcohol and getting blood pressure and blood sugar under control work on the same underlying problem in the blood vessels.

When to get help

If erection problems happen more often than not for a few weeks, it's worth talking to someone. PDE5 inhibitors such as sildenafil and tadalafil work for many men, and an online assessment with a licensed provider is a fast way to get a prescription if it's appropriate. That provider will ask about your heart health and medicines, because some of them, nitrates in particular, can't be combined with ED drugs.

An online visit doesn't replace a physical exam or blood work. If your ED is new and you haven't had a checkup in a while, book one with your regular doctor too. If you ever have chest pain, shortness of breath or dizziness during sex, stop and get medical help.