Yes — ED becomes increasingly common with age. The Massachusetts Male Aging Study found that 52% of men aged 40–70 experience some degree of ED. At age 40, roughly 40% of men report some difficulty. This does not mean it is untreatable — FDA-approved medications are effective for the vast majority of men regardless of age.

The Real Reasons ED Happens (And What You Can Actually Do About It)

Q: What medications cause erectile dysfunction?

Several common medication classes are associated with ED as a side effect: antidepressants (particularly SSRIs like sertraline and fluoxetine), beta-blockers (atenolol, metoprolol), diuretics (hydrochlorothiazide), and antiandrogens used for prostate conditions. If you suspect a medication is contributing to ED, discuss alternatives with your prescribing provider before stopping any medication.

Q: Can ED go away on its own?

In some cases — particularly when ED is tied to a temporary stressor, a new medication, or a correctable lifestyle factor — improvement without treatment is possible. However, for most men with persistent ED, effective treatment requires addressing the underlying cause and/or using an FDA-approved medication. ED rarely resolves fully on its own without intervention.

ED is rarely just physical or just psychological. Understanding the contributing factors is the first step toward effective treatment.

Affinity Direct Clinical Team·March 14, 2025·7 min read

Quick answer: ED is caused by reduced blood flow to the penis (most common), psychological factors, hormonal imbalances, or medication side effects. In most men, multiple factors contribute simultaneously. Vascular or cardiovascular causes account for approximately 60% of ED cases in men over 50. The good news: FDA-approved treatments are effective for the vast majority of men regardless of cause.

The Massachusetts Male Aging Study — one of the largest epidemiological studies of male sexual health — found that 52% of men aged 40–70 experience some degree of erectile dysfunction. Despite how common it is, ED remains widely undertreated, largely because men do not know what is actually causing it or what their options are.

Understanding the cause matters because it shapes treatment. A man with anxiety-driven ED and a man with vascular-driven ED may both benefit from medication — but addressing the root cause improves long-term outcomes for both.

Vascular and Physical Causes

The mechanics of an erection depend entirely on blood flow. When the brain signals arousal, smooth muscle in the penile arteries relaxes, blood rushes in, and pressure builds to create and maintain an erection. Any condition that impairs blood vessel function or reduces circulation can disrupt this process.

The most common vascular contributors include:

Atherosclerosis — hardening and narrowing of the arteries reduces blood flow everywhere, including the penis
Hypertension — high blood pressure damages the endothelial lining of blood vessels over time
Diabetes — both type 1 and type 2 damage blood vessels and nerves; men with diabetes are 3x more likely to develop ED
High cholesterol — contributes to arterial plaque formation
Obesity — BMI above 30 doubles ED risk through multiple mechanisms including inflammation and reduced testosterone

The International Society for Sexual Medicine (ISSM) estimates vascular causes account for approximately 60% of ED cases in men over 50. This figure climbs higher in men with multiple cardiovascular risk factors.

Psychological Causes

The brain is the first organ involved in sexual arousal. Psychological factors are the primary cause of ED in younger men (under 40) and a contributing factor in men of all ages.

Performance anxiety — worry about sexual performance activates the sympathetic nervous system, which actively suppresses the parasympathetic response needed for erection
Depression — both the condition itself and many antidepressants are associated with sexual dysfunction
Stress and fatigue — chronic stress elevates cortisol, which suppresses testosterone and impairs vascular function
Relationship issues — communication problems, low intimacy, or unresolved conflict frequently present as sexual dysfunction

A key distinction: psychological ED often appears suddenly and may be situational (present with one partner but not another, or absent during masturbation). Physical ED tends to develop gradually and affects all sexual contexts.

Hormonal Causes

Testosterone plays a supporting role in sexual function — it does not directly cause erections, but low levels reduce libido and can impair the response to sexual stimulation. Testosterone naturally declines by about 1% per year after age 30.

Other hormonal contributors include elevated prolactin (which suppresses testosterone) and thyroid dysfunction (both hypothyroidism and hyperthyroidism have been linked to sexual dysfunction). Hormonal ED is less common than vascular or psychological causes, but worth investigating if other causes have been ruled out.

Medications That Can Cause ED

A number of commonly prescribed medications list ED as a potential side effect. The most significant include:

Antidepressants (SSRIs) — sertraline, fluoxetine, escitalopram. One of the most common medication-related causes of sexual dysfunction
Beta-blockers — atenolol, metoprolol. Used for hypertension and heart conditions; associated with reduced libido and erectile function
Diuretics — hydrochlorothiazide (HCTZ). Can reduce blood flow to erectile tissue
Antiandrogens — used for prostate conditions; directly suppress testosterone
H2 blockers and some antihistamines — less commonly associated, but worth noting

Do not stop any prescription medication without consulting your provider first. Many men benefit from switching to alternatives within the same drug class that have lower rates of sexual side effects.

Lifestyle Factors

Lifestyle choices have a measurable impact on erectile function — both positively and negatively:

Smoking — nicotine constricts blood vessels and damages endothelial function; smokers are nearly twice as likely to develop ED as non-smokers
Obesity — BMI above 30 is independently associated with doubled ED risk; abdominal fat is particularly linked to reduced testosterone and increased inflammation
Heavy alcohol use — drinking more than 14 drinks per week is linked to a 60% higher incidence of ED; while moderate alcohol does not harm erectile function, chronic heavy use does
Sedentary lifestyle — physical inactivity reduces cardiovascular health and is independently predictive of ED; men who exercise regularly have significantly lower rates of ED

When Is ED a Warning Sign?

ED and cardiovascular disease share the same underlying mechanism: endothelial dysfunction and impaired nitric oxide production. The penile arteries (1–2mm in diameter) are smaller than coronary arteries (3–4mm), which means arterial narrowing tends to produce ED symptoms before it produces chest pain or other cardiac symptoms.

Several studies — including a landmark analysis published in Circulation — have shown that men who develop ED are at significantly elevated risk of a major cardiac event within 3–5 years. New-onset ED in a man under 60, or ED accompanied by other cardiovascular risk factors (hypertension, high cholesterol, diabetes, family history), warrants evaluation by a physician — not just treatment for the ED itself.

This does not mean ED is always a cardiac emergency. It means it is worth taking seriously as a health signal, not just a quality-of-life issue.

The most effective approach for most men: treat the underlying cause and use medication together. FDA-approved PDE5 inhibitors (sildenafil, tadalafil) are effective regardless of the underlying cause — they work by amplifying the signal pathway that blood flow depends on. But addressing contributing lifestyle and health factors produces more durable improvements over time.

Common Questions

Is ED normal at 40?

Yes — ED becomes increasingly common with age. The Massachusetts Male Aging Study found that 52% of men aged 40–70 experience some degree of ED. This does not mean it is untreatable — FDA-approved medications are effective for the vast majority of men regardless of age.

Can anxiety cause ED?

Yes. Psychological factors — including performance anxiety, stress, and depression — are a significant cause of ED, particularly in younger men. The brain plays a critical role in triggering erections, and anxiety activates the sympathetic nervous system in ways that can prevent arousal. In many cases, psychological and physical causes co-exist.

What medications cause erectile dysfunction?

Several common medication classes are associated with ED: antidepressants (SSRIs), beta-blockers, diuretics, and antiandrogens. If you suspect a medication is contributing to ED, discuss alternatives with your prescribing provider before stopping any medication.

Can ED go away on its own?

In some cases — particularly when tied to a temporary stressor or correctable lifestyle factor — improvement without treatment is possible. However, for most men with persistent ED, effective treatment requires addressing the underlying cause and/or using an FDA-approved medication. ED rarely resolves fully on its own without some form of intervention.

Is ED a sign of heart disease?

It can be. ED and cardiovascular disease share the same root mechanism: endothelial dysfunction and reduced nitric oxide production. Studies show that men who develop ED are at significantly higher risk of a cardiac event within the following 3–5 years. New-onset ED — especially in men under 60 — warrants cardiovascular evaluation.

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This article is written and reviewed by the Affinity Direct clinical team for informational purposes. It does not constitute medical advice. All prescriptions require a provider evaluation. Last reviewed: March 2025.

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