In this guide
- The question men ask quietly
- What normally changes
- What the big study found
- Is it testosterone?
- When it is not just age
- What actually helps
- Pills and other treatments
- Sex after 40 can be better
- My take
I am not a doctor. This is not medical advice. The facts in this article come from the NHS, Mayo Clinic and peer-reviewed studies on PubMed. The opinions are mine.
Some of the most interesting messages I get are not from young men. They are from men in their 40s and 50s who write something like: “Maximo, I used to be like a rock. Now it takes longer, it is not as hard, and I am scared it is the beginning of the end.”
It is not the end. But it is a moment to pay attention. After 14 years in an industry where erections are literally the job, I have learned that the penis is one of the most honest parts of the male body. When something changes, there is usually a reason.
The question men ask quietly
Men will talk about their knees, their back and their cholesterol with friends. They almost never talk about their erections. So every man thinks he is the only one.
He is not. The research is very clear that erection changes are common with age. The goal of this guide is to separate what is normal from what deserves a doctor’s visit, and to show what you can actually do.
What normally changes
With age, most men notice some of these changes, and many are completely normal:
- It takes longer to get hard. Thought alone may not be enough; you often need more direct touch.
- Erections may be slightly less firm, even if they are still good for sex.
- The refractory period gets longer. At 20 you might be ready again in minutes. At 50 it can be hours or longer. I explained this in my guide to the refractory period.
- Ejaculation may be less forceful and the amount of semen may decrease.
- Morning erections may be less frequent. If they disappear completely, read what morning erections mean.
None of these mean your sex life is over. They mean your body works a little differently and needs a little more time.
What the big study found
The most famous research on this is the Massachusetts Male Aging Study, which studied men aged 40 to 70 in the Boston area; about 1,300 of them answered its detailed sexual questionnaire. Published in 1994, it found that about 52% reported some degree of erectile dysfunction, from minimal to complete (Feldman et al., J Urol 1994).
Two more findings matter:
- Complete erectile dysfunction rose with age, from about 5% of men at 40 to about 15% at 70.
- Age was not the only factor. Heart disease, high blood pressure, diabetes, the medicines used to treat them, smoking, low “good” cholesterol, anger and depression were also linked to erection problems.
That second point is the one most men miss. Age raises the risk, but much of the risk comes from things that often travel with age, and many of them can be changed.
Getting older makes erection problems more likely. It does not make them inevitable.
Is it testosterone?
Many men immediately blame testosterone. Clinics advertise “low T” treatment everywhere.
Testosterone does fall slowly with age. Mayo Clinic explains that levels tend to decline gradually, on average about 1% a year after age 30 or 40 (Mayo Clinic: Male menopause). Very low levels can reduce sex drive and sometimes affect erections.
But for most men, weaker erections in middle age are not mainly a hormone problem. They are a blood flow problem. An erection is a hydraulic event: blood vessels in the penis have to open and fill quickly. Anything that damages blood vessels, such as high blood pressure, diabetes, smoking, high cholesterol and excess weight, makes that harder. I explained hormones in more detail in testosterone and sex drive.
If you suspect low testosterone, the right step is a blood test with a doctor, not supplements from a gym advert.
When it is not just age
Here is the part I want every man over 40 to read twice.
The NHS lists the common causes of erectile dysfunction: narrowing of the blood vessels, high blood pressure, high cholesterol, diabetes, being overweight, hormone problems, some medicines, stress, anxiety and depression, and drinking too much alcohol or smoking (NHS: Erection problems).
Erectile dysfunction can be one of the first visible signs of heart disease. The arteries in the penis are smaller than those around the heart, so they can show damage earlier. I wrote a full guide on erectile dysfunction and heart disease because so few men know this.
See a doctor if:
- erection problems last more than a few weeks
- they started suddenly
- you also have chest pain, breathlessness, or symptoms of diabetes such as thirst and frequent urination
- your penis has become curved or painful
- you have lost your sex drive completely
A sudden change in your 40s or 50s is not something to hide. It is information.
What actually helps
The good news is that the habits that protect your heart also protect your erections.
Lose excess weight. In a randomised trial published in JAMA, obese men with erectile dysfunction who lost weight and exercised more improved their erectile function, and about a third regained normal function after two years (Esposito et al., JAMA 2004).
Move. Regular aerobic exercise improves blood vessel health. My guide on exercise and erectile function covers what the studies recommend.
Stop smoking. Smoking damages the blood vessels the penis depends on.
Drink less. Alcohol may relax you, but too much makes erections weaker, at any age.
Sleep. Poor sleep and untreated sleep apnoea are linked to lower testosterone and tiredness.
Check your medicines. Some blood pressure tablets, antidepressants and other drugs can affect erections. Never stop a medicine on your own, but ask your doctor whether there is an alternative.
Train your pelvic floor. Pelvic floor exercises can help some men with erection and ejaculation control.
Pills and other treatments
If lifestyle is not enough, treatment works for most men. The NHS explains that PDE5 inhibitors such as sildenafil (Viagra) and tadalafil (Cialis) are usually the first option, and they need sexual stimulation to work. I explained the differences in Viagra vs Cialis.
They are not for everyone. Men who take nitrates for chest pain must not use them, and men with heart problems need a doctor’s check first. Do not buy them from random websites: fake pills are common.
If tablets do not work, doctors can offer other options, including vacuum pumps, injections and, in some cases, implants. Psychological therapy also helps when anxiety is part of the problem.
Sex after 40 can be better
This may sound strange from a man in my profession, but I believe many men have better sex after 40 than at 20.
At 20, many men are fast, anxious and focused only on themselves. With age, men can become more patient, more confident and more attentive. Slower arousal means more foreplay. A longer refractory period means you stop treating sex as a race to finish. Many women I know say the best lovers they have had were not the youngest.
What kills sex in middle age is not the change itself. It is shame, silence and avoidance. Men start avoiding intimacy because they are afraid of failing, and the anxiety makes the problem worse. I explained that cycle in sexual performance anxiety.
My take
If you are over 40 and your erections are changing, you are normal. Half the men your age are dealing with some version of the same thing, according to one of the most famous studies in sexual medicine.
But normal does not mean “do nothing”. I would treat your erection the way a good mechanic treats a warning light on a dashboard. It might be minor. It might be the first sign of something bigger, like blood pressure, diabetes or heart disease. Either way, you want to know.
Get your check-up. Lose the weight you know you need to lose. Stop smoking. Move every day. Talk to your partner instead of avoiding her. And if you need a pill, there is no shame in it. In my world, the men who last are not the ones who pretend nothing changes. They are the ones who look after the machine.
For the human stories behind this industry, read my columns on House of Maximo. Follow my work at maximogarciaworld.com, and for the 18+ side, fuckingpornstars.net.
Sources
- Feldman HA et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Journal of Urology, 1994.
- Esposito K et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA, 2004.
- NHS. Erection problems (erectile dysfunction).
- Mayo Clinic. Male menopause: Myth or reality?
- Mayo Clinic. Erectile dysfunction: symptoms and causes.
