As a male in my 40s, I’m part of a group that faces some common physical and mental health challenges, such as receding hairlines, bicep tendon tears, and erectile dysfunction (ED). Though many guys seem to think ED is just an issue related to low testosterone, the causes of erectile dysfunction are many.

In this article, I've outlined the majority of ED causes and many of the most common treatments. Although most men face a situation now and then when it's difficult to get it up or keep it up, this deserves your full attention if it's an ongoing issue. Erectile dysfunction may be a sign of something severe.

What is erectile dysfunction (ED)?

The definition of erectile dysfunction (ED), also known as impotence, is “the inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance.”

Your nervous, muscular, and vascular systems must work in concert to form and maintain a firm erection. Stimulated by thought, touch, or REM sleep, nitric oxide (NO), acetylcholine, and other chemical messengers signal the penis' smooth muscle to relax. As the muscles relax, your corpora cavernosa fills with blood. As it fills with blood, the veins leaving the penis get blocked, allowing it to fill with more blood until it's full. As long as the veins remain blocked, you'll maintain your erection.

Erections fall into two categories:

Reflex erections: Controlled by peripheral nerves and the spinal cord and triggered by physical touch

Psychogenic erection: Controlled by the limbic system of the brain and triggered by erotic or emotional stimuli (like seeing your naked wife) 

The Massachusetts Male Ageing Study (MMAS) found that 52% of men ages 40-70 years displayed mild to moderate ED signs. Interestingly, another report showed that one in four men seeking medical guidance for ED are less than 40 years old.

Though erectile dysfunction is not itself a lethal condition, it may indicate a physical health problem that could be deadly. On the other hand, it could also be a sign of a less threatening physical condition or a mental health condition.

Causes of ED

Though many men jump to the conclusion that they have low testosterone, their hormones might not have anything to do with their lack of sexual function. Then again, testosterone could play a role.

If you have erectile dysfunction, consider the following 14 causes before jumping to the conclusion on the cause of yours.

The first four causes are the most common.

1. Cardiovascular Disease

Erectile dysfunction is one of the first signs of cardiovascular disease. Because the vessels of the penis are much smaller than those of the heart, vascular damage affects penile function before cardiac signs show up.

About one in three men with hypertension develop erectile dysfunction. High blood pressure alone doesn't cause cardiovascular disease, though. Increased blood pressure may cause blood vessel damage, which is exacerbated by elevated and oxidized LDL cholesterol and high systemic inflammation levels.

The same factors that lead to heart disease, heart attacks, and strokes lead to erectile dysfunction. However, those warning signs show up in penile function long before they show up as symptoms in the heart.

ED may precede cardiovascular disease by a significant period that usually ranges from 2 to 5 years (3 years in average)

Wang JM et al.

While ED may be a serious warning sign, the good news is, you may be able to stall or even reverse some of the cardiovascular damage before it causes heart disease.

2. Sleep problems

Inadequate sleep wreaks havoc on your mental and physical health. Though some hardass men cling to the adage, "Sleep when you die," the reality is, without sufficient quality sleep, you'll be dead a lot younger than you should be. Don't buy into that nonsense.

Your first indicator of inadequate sleep's impact on sexual function is a reduction in morning erections.