Is ED Common in 40 Year Olds? What the Surveys Actually Show

Yes, though how common depends on what is being measured. In a random-sample survey of more than 2,700 Turkish men that used the International Index of Erectile Function (IIEF), 17% of men aged 40 to 49 had ED, and most cases were mild.¹ The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) cites a higher figure, that about 40% of men are affected at age 40.² Both numbers appear online, and both can be true, for reasons covered below.

Why do the numbers differ so much?

A 2019 review of population studies found global ED prevalence ranging from 3% to 76.5%. The authors traced much of that spread to the screening tool: validated questionnaires such as the IIEF and the Massachusetts Male Aging Study (MMAS) questionnaire picked up more ED in young men than non-validated questions did.³ Three things drive the gap.

• The definition. Some surveys count any trouble with erections, including occasional trouble. Others count only persistent problems or a score under a set cutoff on a questionnaire.
• The severity counted. The MMAS, a community survey of men aged 40 to 70 near Boston, grouped minimal, moderate and complete impotence together and reached 52%. Complete impotence was far rarer, rising from 5% to 15% between ages 40 and 70.⁵
• The age band. Many studies report one figure for "men over 40." A 33% rate across all men 40 and older, as in the Turkish survey, hides a 17% rate in the 40s and 83% from age 70.¹

What do the studies say about men in their 40s?

The honest summary is a range. For men in their 40s, careful surveys put ED somewhere from roughly one in six to something nearer four in ten, with most cases at the mild end. These are older surveys of specific populations, so they describe groups, not any one man.

Is ED at 40 normal, or a sign of something else?

Common does not mean it can be ignored. In the Turkish survey, age, diabetes, hypertension, atherosclerosis and high cholesterol were each independent risk factors for ED.¹ In the MMAS, after adjusting for age, heart disease, hypertension, diabetes, related medications and measures of anger and depression were all linked to more impotence, and smoking added risk in men who already had heart disease or hypertension.⁵

That matters because ED can come first. A large analysis of men in a prevention trial found that men who developed ED had more cardiovascular events afterward, and the authors suggested ED be treated as a marker that calls for cardiovascular risk assessment.⁴ NIDDK likewise lists diabetes, heart disease, obesity, certain medications, smoking, heavy drinking, and anxiety and stress among the causes.² The 2019 review also found ED associated with cardiovascular disease and with higher all-cause mortality (odds ratio 1.26).³

A man in his 40s with new, persistent erection trouble is therefore worth a checkup that looks at blood pressure, blood sugar, cholesterol and current medications, not only at the symptom. Our guide to common ED myths covers why "it is just age" is a poor assumption.

What about ED in men under 40?

It happens, and the pattern differs. In an Italian clinic series of 439 men seeking help for new-onset ED as their main sexual problem, 114 (26%) were 40 or younger. Note what this does and does not say: it describes who showed up at one urology clinic, not how common ED is among all young men. Compared with older patients, the younger men had fewer other illnesses and higher testosterone, but were more likely to smoke or use illicit drugs. Severe ED was reported by 48.8% of the younger men and 40% of older men, a difference that was not statistically significant.⁶

The takeaway is that younger men with ED are not rare in clinics, and that lifestyle factors play a visible role. It also means a man in his 40s is not unusual for seeking an evaluation.

What usually contributes at this age?

• Cardiometabolic conditions. Blood pressure, diabetes and cholesterol problems damage blood vessels and nerves involved in erections.^2,1
• Medications. NIDDK names blood pressure medicines and antidepressants.² The trial evidence on blood pressure drugs is more nuanced than their reputation, so do not stop a prescribed medication without talking to the prescriber.
• Smoking and alcohol. Both appear in NIDDK's list of lifestyle contributors.² For alcohol, see our piece on alcohol and ED medication.
• Stress, anxiety and mood. NIDDK lists mental health and emotional issues, and the MMAS linked depression and anger scores with ED.^2,5
• Weight and inactivity. In a two-year randomized trial in obese men with ED, those assigned to weight loss and more exercise improved their erectile function scores; the control group did not.⁷ A meta-analysis of trials found that aerobic exercise improved erectile function as well.⁸

When should a man in his 40s see a clinician?

The American Urological Association guideline treats ED as a condition that deserves a medical and sexual history, an exam and tailored testing, and lists several treatment paths, from medication to devices and surgery.⁹ A reasonable trigger is trouble that has lasted a few months, keeps getting worse, or comes with other symptoms such as chest discomfort, numbness, low mood or reduced desire. Sudden chest pain is an emergency in its own right and not something to hold for an appointment.

Before any prescription, a clinician needs the full medication list. Sildenafil's label bars use with nitrates in any form, for example.¹⁰ Our guide to questions to settle before an online ED prescription lists what a good visit should cover.

Limits of the evidence

Prevalence figures come from surveys that differ in country, era, sampling and questionnaire. Some, such as the MMAS, are from the late 1980s. Self-reported erection problems are sensitive to how a question is worded. The clinic series cannot show how common ED is in the general population. None of these numbers can tell an individual man whether his own symptoms have a medical cause; that takes an evaluation.

Your questions

Is it normal to have erectile dysfunction at 40?

It is common, but it is not something to dismiss. In a Turkish survey using a validated questionnaire, 17% of men aged 40 to 49 had ED, mostly mild. Other studies report higher figures depending on how ED is defined. Persistent trouble is worth a medical evaluation because it can accompany heart disease, diabetes or high blood pressure.

What percentage of men have ED at 40?

Estimates range from about 17% in a validated-questionnaire survey of Turkish men to about 40% in the figure NIDDK cites. The spread reflects different definitions, severity thresholds and populations.

Can stress or anxiety cause ED in your 40s?

NIDDK lists anxiety, stress and other emotional issues among the risk factors for ED, and the Massachusetts Male Aging Study linked depression and anger scores to more impotence. Physical causes can also be present at the same time, so a clinician can sort out the mix.

Does ED at 40 mean heart problems?

Not necessarily, but it can be an early marker. A large analysis found men who developed ED had more cardiovascular events afterward, which is why clinicians often check blood pressure, blood sugar and cholesterol.

Can lifestyle changes help ED in men in their 40s?

In a two-year randomized trial in obese men with ED, weight loss and exercise improved erectile function scores compared with a control group. A meta-analysis also found improvements with aerobic exercise.

Read next

• Alcohol and ED Medication: What the Labels Actually Say
• 7 ED Myths, Checked Against the Research
• 9 Questions to Ask Before Getting ED Medication Online