The possible clinical causes of insufficient hardness, i.e. erectile dysfunction, in middle-aged men include mental factors, normal physiological changes, and disease factors. 1. Mental factors: due to work or other circumstances, some middle-aged men will experience increased mental stress or anxiety, depression and other emotions, the above negative emotions may cause the erection of the penis and erectile dysfunction. 2. Normal physiological changes: with age, the hormone level in the male body will gradually decline, which will also affect the erectile state of the penis and erectile dysfunction. 3. Disease factors: common clinical diseases include hypertension, diabetes, arteriosclerosis, etc. All of the above diseases will affect the blood congestion of the penis, thus causing erectile dysfunction. Erectile dysfunction may also be caused by other factors, if it is caused by disease factors, it is recommended that patients go to the regular hospital in time for treatment, and strive for early recovery.