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Home / Erectile Dysfunction / What causes erectile dysfunction in your 30s, 40s, 50s and 60s
ED causes shift with age, from stress and lifestyle in your 30s to blood vessel and hormonal factors later on.
Short answer

The causes for ED (Erectile Dysfunction) change as you get older.

In your 30s, it's usually stress, anxiety, alcohol or lifestyle factors.

In your 40s, physical causes become more common, particularly blood pressure, blood sugar, cholesterol and the health of your blood vessels.

In your 50s and 60s, ED is often caused by a mix of several of these factors, plus medication side effects and, sometimes, a natural drop in testosterone.

At every age, ED is common, usually treatable, and worth mentioning to a doctor or prescriber, because it can be an early clue about other, bigger health concerns.

What's in this article

What this guide is about

If you've typed "why am I getting ED" into a Google search bar, you're not alone.

Most men experience ED (Erectile Dysfunction) at some point. If you’re reading this article, you’re one of them, and probably trying to understand why you’re experiencing ED.

This guide isn't a diagnosis, and it isn't a scare piece either.

It's a research-backed guide that outlines what causes ED at different ages, at different decades in your life, so you can work out what might apply to you and have a more useful conversation with a doctor or prescriber.

If you want to understand your treatment options rather than the causes, our guides on Viagra vs Sildenafil and Cialis daily vs-cialis-on-demand cover that in detail.

Before you begin: A little bit about OnlineClinic

OnlineClinic has been operating since 2011 and has treated more than 2.1 million patients.

The pharmacy is registered with the General Pharmaceutical Council (GPhC), our prescribers are registered with the General Medical Council (GMC), and the service is regulated by the Care Quality Commission (CQC).

As of August 2026, on Trustpilot, the service rating is 4.6 out of 5 based on 6,717 reviews.

What actually causes ED

Doctors generally group the causes of ED into a few overlapping categories:

  • Psychological. Stress, anxiety (including performance anxiety), depression, and relationship difficulties.
  • Vascular. Reduced blood flow to the penis, usually linked to the same processes that cause heart disease.
  • Hormonal. Low testosterone, though this is a less common cause than most people assume.
  • Medication-related. Certain blood pressure tablets, antidepressants and other common drugs can lead to erectile dysfunction.
  • Lifestyle. Smoking, heavy drinking, being significantly overweight, and lack of exercise.

You might find that for you, ED is caused by a mix of these factors. And that’s normal.

Most real-world ED cases are a mix of the above-mentioned factors, and they may even shift as you get older.

ED causes in your 30s

ED in your 30s is real, more common than people expect, and usually not a sign of anything serious.

A 2021 study involving 2,660 men found ED in around 11.3% of men aged 18-31.

Most common causes for ED in your 30s

  • Performance anxiety, especially with a new partner or after a bad experience
  • General stress, from work, money, or relationships
  • Depression or anxiety disorders
  • Heavy drinking or recreational drug use
  • Smoking, which affects blood vessels at any age
  • Poor sleep

What's different about the 30s is that psychological and situational causes do most of the heavy lifting.

One Japanese study proved this point: Younger men's ED is mostly driven by what's going on in their head and their life, while older men's ED is more often driven by what's going on in their body.

A 2024 Japanese cross-sectional study reflects the widely accepted clinical view that ED in men under 40 is more often driven by psychological factors, while in older men, biological and vascular factors tend to cause ED.

That said, it isn't always psychological.

One clinic-based study, involving 439 patients, found that around 26% men experiencing ED for the first time were under the age of 40, and nearly 48.8% men among those patients had severe ED.

So if it's persistent, it's still worth getting the basics checked (blood pressure, blood sugar, cholesterol) rather than assuming it's "just stress" and leaving it.

ED causes in your 40s

Something shifts in the 40s.

This is usually the decade where the first physical risk factors show up, even in men who feel otherwise healthy: Blood pressure starts to increase, weight becomes harder to shift, blood sugar edges towards prediabetes, and testosterone begins its slow, gradual decline.

The blood vessels that supply blood to the penis are also smaller than the ones that supply blood to the heart, so they tend to show damage first.

ED in your 40s isn't just about entering your 40s. It can be an early flag for your bigger health issues in your 50s and 60s.

Most common ED causes in your 40s

  • Early or undiagnosed high blood pressure
  • Weight gain, particularly around the waist
  • Prediabetes or early type 2 diabetes
  • The start of age-related testosterone decline
  • Ongoing psychological factors from the 30s (stress doesn't stop at 40)
  • Heavier alcohol use

The practical takeaway: If you get diagnosed with ED in your 40s, get your blood pressure, cholesterol and blood sugar checked, even if you feel fine otherwise.

ED causes in your 50s

By the time you enter your 50s, physical causes tend to overtake psychological ones as the main driver for ED, and this is the decade where the link between ED and heart health becomes hardest to ignore.

The mechanism is straightforward once it's explained.

An erection depends on healthy blood vessels being able to relax and supply blood to the penis.

That relies on the same lining of the blood vessels (the endothelium) that, when damaged, leads to blocked arteries and heart disease.

Because the arteries in the penis are narrower than the arteries around the heart, they tend to show trouble first.

Some doctors describe ED as an early warning sign for larger health problems related to the heart.

Most common ED causes in your 50s

  • Cardiovascular disease, or the early stages of it
  • Type 2 diabetes
  • Medication side effects (blood pressure tablets and antidepressants are the two most common medicines with ED as a side effect)
  • Continued decline in testosterone levels
  • Prostate problems and their treatment

This is also the decade where medication becomes a bigger part of the picture, simply because more men are being treated for blood pressure, cholesterol, or mood by this age.

We cover which specific drugs are most often responsible further down.

ED causes in your 60s

By the 60s, ED is common.

Nearly 50% men in their 60s experience some degree of erectile dysfunction.

Most common causes of ED in the 60s

  • More advanced cardiovascular issues
  • Diabetes
  • Lower testosterone levels
  • After-effects of prostate treatment

Prostate surgery in particular has a large effect on erectile function, at least in the short-to-medium term, depending on the type of surgery and how much nerve tissue could be preserved, though many improve over the following months as nerves recover.

Radiotherapy and hormone treatment for prostate cancer can also affect erections, in different ways and to different degrees.

Taking multiple medications (common by this age, for blood pressure, cholesterol, mood or other chronic conditions) adds another layer, because several common drugs can each make ED a little more likely.

Here's the good part

Having more than one contributing cause doesn't make ED harder to treat, and it doesn't mean nothing can be done.

Most men in their 60s respond well to standard treatment, and addressing the underlying causes (blood pressure, diabetes control, reviewing medication) alongside it often helps.

Why ED can be an indicator of bigger health concerns

Across every decade, the same message holds: ED is common, it's rarely dangerous in itself, and it's genuinely useful information for your prescriber or GP, because it can point to another underlying health condition.

The clearest evidence for this comes from a major analysis that pooled data from over 92,757 men across multiple long-term studies.

It found that men with ED had 44% increased risk of total cardiovascular events (heart attacks, strokes, and related problems) from any cause over the following years, compared with men without ED.

A separate study following over 1,914 men found a similar pattern: ED was linked to around double the rate of heart attacks, strokes and cardiovascular deaths, even after accounting for traditional risk factors like age, smoking and cholesterol.

In 2024, a major update to the Princeton IV Consensus Recommendation formally recommended that doctors treat men presenting with newly diagnosed ED as being at higher cardiovascular risk until proven otherwise, particularly in men under 60 with no obvious explanation.

None of this means ED equals heart disease. Most men with ED do not go on to have a heart attack.

But it's a good enough reason to get your blood pressure, cholesterol, and blood sugar checked if you haven't recently, rather than treating ED as a separate, unrelated problem.

Is ED a result of low testosterone

Low testosterone gets blamed for ED a lot, often more than the evidence supports.

Testosterone does decline gradually with age, and low levels can contribute to reduced libido and, in some men, ED.

Genuinely low, symptomatic testosterone (not just a slightly lower number, but low levels alongside real symptoms) is less common than people assume: Most large population studies put it at somewhere between 1 in 20 and 1 in 8 men over 40, rising somewhat with age.

Guidance from endocrine specialists is clear that testosterone should only be treated when a man has both low levels on a morning blood test and genuine symptoms, not simply because he's over a certain age.

If you're being assessed for ED, a morning testosterone test (taken between 8am and 11am, when levels are highest) is a standard, sensible part of the picture, alongside blood pressure, cholesterol and blood sugar.

We go into this in more depth in Testosterone and ED: when low-T is the cause.

Can your medication cause ED

Certain common medications can cause or worsen ED as a side effect.

This becomes more relevant with age simply because more men are taking these medications by their 50s and 60s.

Medications most often linked to ED:

  • Beta-blockers, a common blood pressure medication
  • Thiazide diuretics, another blood pressure medication
  • SSRIs and other antidepressants
  • Finasteride, in a minority of users
  • Opioid painkillers, particularly with long-term use

By contrast, other common blood pressure medications, including ACE inhibitors, ARBs and calcium-channel blockers, do not affect erectile function severely, and are sometimes an alternative worth discussing with a prescriber.

Don't stop any prescribed medication on your own.

If you suspect a drug is contributing to erectile dysfunction, talk about it with your prescriber, who can weigh up whether switching is appropriate for your overall health, not just this one side effect.

Licensed ED treatment options in the UK

Whatever the underlying cause for ED, the first-line treatment for most men is the same class of medication, PDE5 inhibitors, which work by improving blood flow to the penis.

In the UK, four treatment options are licensed for ED: Viagra (sildenafil), Cialis (tadalafil), vardenafil, and Spedra (avanafil).

Apart from the above-mentioned treatments, UK also has a Generic Impotence Trial Pack, which includes 4 tablets of tadalafil 10mg, 4 tablets of vardenafil 10mg, and 4 tablets of sildenafil 10mg. The prices for the same starts from -.

Two are available without a prescription, after a short pharmacist consultation: Viagra Connect (sildenafil) and Cialis Together (tadalafil).

Which one suits you often comes down to how long you want it to last and how you'd like to plan around it, rather than the underlying cause.

Medicine Active ingredient Works in Lasts upto Take before sex Price from* Good to know
Viagra (branded) / Sildenafil (generic) Sildenafil 30 - 60 minutes Around 4 hours 30 - 60 minutes Viagra from £28.99
Sildenafil from £8.99		 Works best on an empty stomach; a heavy or fatty meal can slow it down
Cialis (branded) / Tadalafil (generic) Tadalafil Around 30 minutes Upto 36 hours At least 30 minutes Cialis from £42.99 Nicknamed "the weekend pill" for its long window
Cialis Daily Tadalafil (low dose) Builds up over a few days of daily use Continuous, while you keep taking it Not timed to sex, taken at the same time every day From £72.99 Ideal for men having sex more than twice a week
Vardenafil Vardenafil 15 - 30 minutes Upto 5 hours 25 - 60 minutes Vardenafil from £29.99 A lower-dose option sometimes suggested alongside other health conditions
Spedra Avanafil 15 - 30 minutes (often the fastest) Up to 5 - 6 hours Around 30 minutes From £21.99 A newer option; some men get on with it with fewer side effects

PDE5 inhibitors should not be taken alongside nitrate medications (commonly prescribed for angina) or recreational nitrates ('poppers'), as the combination can cause a dangerous drop in blood pressure.

Tell your prescriber about all medications you're taking, including any for blood pressure or chest pain, before starting treatment.

Our guides on Viagra vs Sildenafil and Cialis daily vs on-demand walk through the practical differences.

Addressing an underlying cause, whether that's blood pressure, weight, alcohol, stress or a medication switch, often improves things further, alongside or instead of tablets.

We cover the lifestyle part of it in Lifestyle and ED: weight, alcohol, sleep and exercise, and the anxiety part of it in Anxiety-related ED: the psychological side.

What happens when you order from OnlineClinic

Our process is straightforward. From start to finish, this is what happens when you order with us:

  1. Fill in the medical questionnaire. It takes 5 to 10 minutes. The questions are thorough on purpose
  2. A GMC-registered prescriber reviews your answers. If they need more details, they will message you through your account
  3. If treatment is approved, it is dispensed and dispatched. Next-day delivery, with the full patient information leaflet included
  4. If it is not approved, the prescriber explains why. You are not charged for treatment that is not issued

Every price includes the prescription, the consultation, the packaging, and delivery. There are no hidden fees.

Operating since 2011

More than 2.1M patients treated

CQC · GPhC · GMC regulated

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Frequently asked questions

Is it normal to get ED in your 30s?

At what age does ED usually start?

Can ED be reversed?

Does ED mean I have heart disease?

Is my ED caused by low testosterone?

Could my blood pressure tablets be causing this?

Is OnlineClinic safe to use?

Trial evidence

  • Paolo Capogrosso et al. One Patient Out of Four with Newly Diagnosed Erectile Dysfunction is a Young Man—Worrisome Picture from the Everyday Clinical Practice. The Journal of Sexual Medicine, 2013. Read the trial
  • Calzo JP et al. Erectile Dysfunction in a Sample of Sexually Active Young Adult Men from a U.S. Cohort: Demographic, Metabolic and Mental Health Correlates. Journal of Urology 2021. Read the trial
  • Saito T et al. Age-related differences in the psychosocial and biological contributors to erectile dysfunction. JMIR Formative Research, 2024. Read the trial
  • Vlachopoulos C et al. Prediction of cardiovascular events with erectile dysfunction: a systematic review and meta-analysis. Circulation: Cardiovascular Quality and Outcomes, 2013. Read the trial
  • Zhao B et al. Erectile dysfunction predicts cardiovascular events: a systematic review and meta-analysis. Journal of Sexual Medicine, 2019. Read the trial
  • Uddin SMI et al. Erectile dysfunction as an independent predictor of future cardiovascular events (MESA). Circulation, 2018. Read the trial
  • Köhler TS, Kloner RA, Rosen RC et al. The Princeton IV Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clinic Proceedings, 2024. Read the proceedings

Product information and regulation

Medically reviewed by Dr. Anup Jethwa, Clinical Lead

GMC Reg. #7138282 · Last reviewed: 27-08-2026 · Next review: 23-06-2027

Disclaimer

Erectile dysfunction treatments are prescription-only or pharmacy medicines. Whether treatment is suitable for you is decided by a GMC-registered prescriber or pharmacist based on your individual medical history. The information here is general guidance and is not a substitute for professional medical advice. If you have chest pain, sudden severe symptoms, or think you may be having a heart attack, seek emergency medical help immediately.

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