Erectile Dysfunction in Young Men: Symptoms, Causes, and Treatments

Erectile dysfunction (ED), the inability to have or maintain an erection firm enough for sex, can take younger men by surprise. Although erectile dysfunction is more common in older men, younger men can suffer from it, too. Because younger men expect to be ready to have an erection at the first sign of sexual stimulation, sexual dysfunction can be especially frustrating in this age group. 

How Common Is Erectile Dysfunction in Younger Men? 

Erectile dysfunction is a common problem. At least 30 to 50 million men in the United States suffer from the condition – at least 1 in every 5 men – which is probably an underestimate since many men are embarrassed to talk about their problem and younger men are less likely compared to older men to seek ED treatment from their healthcare practitioner.  By the year 2025, it’s estimated that 322 million men worldwide will likely develop erectile dysfunction, a 170 million increase from the mid-1990s. 

Statistics from studies like the Massachusetts Male Aging Study show that most men with erectile dysfunction are over the age of 40. Beginning at this age, men have an approximately 40% chance of having some form of mild, moderate, or severe ED. The risk of developing erectile dysfunction rises by 10% for every decade after.

If you think you won’t develop sexual dysfunction because you’re under 40, think again.  A study in the Journal of Sexual Medicine found that about 1 patient out of 4 with newly diagnosed erectile dysfunction (26%) was a younger man. According to the study, the younger men who pursued ED treatment had a similar rate of severe ED as the older men in the study. 

Other research suggests 8% of men in the 20 to 29 age range and 11% in the 30 to 39 range have erectile dysfunction.  

Risk Factors for Erectile Dysfunction in Young Men

The risk factors for erectile dysfunction in younger men are sometimes different compared to older men. The Journal of Sexual Medicine study found that patients 40 years old or under were less likely to have underlying conditions known to contribute to erectile dysfunction in older men such as high blood pressure and high cholesterol. The younger men with erectile dysfunction also were less likely to be obese or overweight and were less likely to have low total testosterone levels compared with the older patients who had erectile dysfunction. 

Younger men with erectile dysfunction also were more likely to engage in cigarette smoking and use illicit drugs such as cocaine or recreational drugs like marijuana compared with older men who had erectile dysfunction. 

In addition, the young men were more likely to suffer from premature ejaculation along with erectile dysfunction, while the older men with erectile dysfunction had a higher prevalence of Peyronie’s disease, a condition where the penis is curved, often leading to painful sexual intercourse.

Physical vs. Mental Causes of Erectile Dysfunction

What’s causing ED might be a physical (physiological) or psychological risk factor, or a combination of both. It was once thought that psychological causes were to blame for most cases of ED in younger men. However, studies now show that anywhere from 15% to 72% of ED in young men is caused by physical factors.   

Physical Risk Factors for Erectile Dysfunction in Young Men

Erectile dysfunction in young men can occur due to a number of physical causes. Here are some of the most common physical causes of ED in young men: 

Underlying Health Conditions Linked To Erectile Function

Although more common in older men, a number of health conditions can contribute to ED in younger men. High blood pressure and diabetes both are known to damage the blood vessels, which leads to reduced blood flow to many parts of the body including the penis. Healthy blood flow is critical for having an erection. 

Diabetes also impacts the nerves in and around the penis, and diabetes and high blood pressure both are linked to lower levels of testosterone, one of a number of sex hormones that’s critical to libido and sexual function. 

Other health conditions associated with erectile dysfunction in younger men include:

• Thyroid disease

• Epilepsy

• Multiple sclerosis

• Early coronary artery disease or vascular disease

• Peripheral artery disease

• Klinefelter syndrome, a common genetic disorder in males caused by a random accident that occurs in the sperm or the egg.

• Sleep apnea

Cigarette Smoking

Smoking can have several harmful effects on erectile function. It can lead to coronary artery disease, high blood pressure, and vascular disease, which is linked to ED symptoms. The nicotine in cigarettes also narrows blood vessels by affecting the body’s production of nitric oxide, a substance that widens blood vessels and improves blood flow.    

Illicit Drugs

Using drugs like cocaine, heroin, and methamphetamine can interfere with erectile function. The erectile dysfunction can persist for a while after substance abuse users quit using the drugs.   

Recreational Drugs

Marijuana (Cannabis sativa) is legal in many states and consequently its use as a recreational drug has become more popular in younger ED patients. However, marijuana use can affect sexual function. 

A review of studies published in medical journals compared the rate of erectile dysfunction in 1,035 men who smoked cannabis and 2,360 male nonusers. The review found that erectile dysfunction was twice as common in marijuana smokers compared to nonusers – 69.1% vs. 34.7%. The reviewers suggested that future research in this area look at whether the amount of marijuana a man smokes could contribute to a higher risk of erectile dysfunction. 

Alcohol Use

Drinking alcohol – especially more than three drinks per week – is linked to erectile dysfunction. This becomes an even bigger risk factor in men who drink more than three drinks per week and smoke cigarettes. 

Prescription Drugs

Certain prescription drugs cause erectile dysfunction. Researchers believe about one-quarter of all erectile dysfunction cases are caused by oral medications including:

• Antidepressants

• Antiepileptics

• Antipsychotics

• Opioids

If you’re on one of these medications and are experiencing erectile dysfunction, talk to your doctor to see if he or she can prescribe an alternative. 

Obesity

Obesity is a common problem in men in their 20s and 30s. It’s estimated that half of all men in the Western part of the world are obese and young men are no exception. Being excessively overweight leads to poor vascular health, which in turn reduces the flow of blood to the penis. One Danish study found that erectile dysfunction was more common in younger men aged 20 to 45 years old who had a high body mass index compared to obese older men. Other sexual dysfunctions such as premature ejaculation, delayed ejaculation, and sexual desire disorders were not related to being overweight or obese.  

Psychological Risk Factors for ED

In some cases, erectile dysfunction in young men is due to mental rather than physical factors. In this case, erectile dysfunction tends to appear more suddenly rather than the gradual onset that occurs due to physical causes. Mental health problems that can cause erectile dysfunction include the following:

• Depression

• Low Self-Esteem

• Performance Anxiety

• A traumatic psychological experience

• Relationship problems

• Watching porn

Difficulty Using A Condom

Even in healthy young men, erectile dysfunction can develop if you’re not comfortable using a condom. Younger men in particular might have difficulty using a condom since they’re not as experienced having sexual intercourse as older men. If you struggle to put a condom on the right way when you’re in the middle of sexual activity, it could cause you to go limp. There’s actually a name for this. It’s called condom-associated erection problem (CAEP).

If you’re nervous about putting the condom on wrong, CAEP can occur during sexual stimulation even before putting the condom on. During sex, if you don’t have the condom on right or if it feels too loose or too tight, it can interfere with erectile function. CAEP can ultimately lead to performance anxiety.

Nearly 14% of men aged 18 to 24 have CAEP while putting a condom on, while nearly 16% have CAEP during penis-in-vagina sexual intercourse, and roughly 32% have it both while putting the condom on and while having sex, according to a 2015 study. However, in this study, men reporting CAEP were significantly more likely than men reporting no CAEP to also have erectile problems during sexual activity even when not using condoms.  

How to Fix Erectile Dysfunction at a Young Age

If you have erectile dysfunction at a young age, seek professional medical advice to determine what’s causing ED, so that you’ll know how to fix the problem. Here are some possible ways to treat ED that you’ll want to talk about with your healthcare provider. Addressing these factors may significantly improve your sex life. 

Counseling 

If your doctor determines that the cause of your erectile dysfunction is psychological rather than physical, they will likely recommend you visit a therapist or attend sex therapy. If the cause of your sexual dysfunction is due to relationship problems, seeking help from a couples’ counselor may be the best course of action.

Healthy Lifestyle Changes

Often, all it takes to treat erectile dysfunction is to make a few healthy lifestyle changes. See what your doctor thinks about trying these strategies first before resorting to ED medications or other solutions. The good news is that the bodies of younger men may be more resilient and these lifestyle changes can work especially well in resolving sexual dysfunction. 

• Losing Weight

• Eating a Healthy Diet

• Exercising

• Quit Smoking

• Managing Stress

• Having Sex In the Morning When You Have More Energy

• Getting a good night’s sleep

• Avoiding Recreational Drugs

• Avoiding Illicit Drugs

• Reducing alcohol intake

• Avoid watching porn

Other Sexual Dysfunction Treatment Options for Young Men

Treating ED in younger men sometimes requires going beyond lifestyle changes. Here are some other ED treatment options you might discuss when you seek professional medical advice. After discussing your medical history and conducting an exam, your healthcare provider can help you find the best options to treat ED. 

Erectile Dysfunction Medication

To treat ED in younger men, doctors may prescribe medication for ED like Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), or Stendra (avanafil). An ED medication is usually the first treatment option employed in men whose erectile dysfunction is caused by poor blood flow to the penis. These drugs are known as phosphodiesterase type 5 (PDE5) inhibitors. An erectile dysfunction medication works by relaxing blood vessels to increase blood flow to the penis. 

They’re called PDE5 inhibitors because they block the PDE5 enzyme. When a man is sexually aroused, a molecule called nitric oxide is released. This in turn leads to the release of cyclic GMP, which relaxes the smooth muscle inside penile blood vessels, leading to increased blood flow. However, the PDE5 enzyme breaks down cyclic GMP and gets in the way of healthy erectile function. An ED medication that works as a PDE5 inhibitor stops the breakdown of cyclic GMP caused by PDE5, leading to increased blood flow and healthy erections. 

Penis Pumps

Otherwise known as external vacuum devices, vacuum pumps, or vacuum erection devices, penis pumps are suction devices used to temporarily enhance blood flow to the penis, long enough to create and maintain an erection. They’re made of a plastic tube that covers the penis, a hand or battery-powered pump connected to the tube, and a constriction ring, which is a band placed around the base of the penis after it’s erect. The constriction ring holds the blood in the penis to maintain a longer erection. These can be used together with erectile dysfunction medications or other means of treating ED.

Li-ESWT

Urologists use a method known as low-intensity extracorporeal shockwave therapy (Li-ESWT) in men with erectile dysfunction. This method has been used safely and effectively in urology clinics for over a decade. 

Pelvic Floor Exercises

Kegel exercises are another treatment option for ED in younger men. They strengthen the pelvic area and the ischiocavernosus and bulbocavernosus muscles around the penis, which are involved in erectile function.

Testosterone Injections

These are used in men with erectile dysfunction who have hypogonadism (low testosterone). The injections can be used as a stand-alone ED treatment option or they can be used together with an ED medication. 

Penile Injections

A drug called alprostadil is an erectile dysfunction medication that’s injected into the penis 5 to 20 minutes before sex. The drug is a vasodilator, which widens blood vessels to increase blood flow and promote erections. It’s also available as an intraurethral suppository to treat erectile dysfunction.

Penile Implants

These are considered a last resort for men with erectile dysfunction, as they involve surgery. Penile implants—or penile prostheses as they’re sometimes called—are medical devices surgically inserted in the penis. This leads to erections and ejaculation in men with erectile dysfunction.

Natural Remedies

Research shows that certain natural remedies may show promise in supporting sexual function. In a review of the medical literature, panax ginseng, a combination of pycnogenol (Maritime pine), L-arginine, L-citrulline, and roburins (oak wood extract), and tribulus terrestris were all effective at supporting healthy erections and sexual satisfaction. 

Scientists believe L-arginine and L-citrulline may exert positive effects on sexual function by increasing levels of nitric oxide, which widens the blood vessels that feed erectile tissue. Some of the natural remedies also raise levels of sex hormones like testosterone.

Frequently Asked Questions About ED in Younger Men

If you’ve developed erectile dysfunction, the inability to have or maintain an erection firm enough for sex, in your younger years, perhaps you’re wondering if this is normal. Below are some answers to common questions about ED in young men, but always seek treatment from your healthcare provider if you’re concerned about sexual dysfunctions.  

Can you have erectile dysfunction in your 20s?

Sexual dysfunction in younger men is more common than you would think. A study in the Journal of Sexual Medicine found that about 1 patient out of 4 with newly diagnosed erectile dysfunction (26%) was a young man. According to the study, the younger men who pursued ED treatment had a similar rate of severe ED as the older men in the study.

Other research suggests 8% of men in the 20 to 29 age range and 11% in the 30 to 39 range have erectile dysfunction. This suggests that erectile dysfunction is having a significant effect on the sex life of many younger men.  

Why am I not getting hard at a young age?

There are many reasons why a young man can develop erectile dysfunction. Reasons that involve mental health include:

• Performance anxiety

• Depression

• Low self-esteem

• Psychological trauma

• Relationship problems

• Watching porn

There are also physical risk factors for erectile dysfunction in younger men. These include:

• Medical conditions such as high blood pressure, cardiovascular disease, thyroid disease, sleep apnea, and diabetes

• Being overweight or obese

• Cigarette smoking

• Drug abuse 

• Marijuana

• Drinking too much alcohol

• Some prescription drugs like antidepressants

Can erectile dysfunction be cured while young?

Erectile dysfunction can be cured in younger men. In fact, some of the underlying medical conditions associated with erectile dysfunction such as cardiovascular disease might resolve easier in younger men since there has been less time for damage from the disease to accumulate in the body compared to in older men. 

Quitting cigarette smoking and stopping the use of drugs linked to erectile dysfunction may also improve erectile function. If you have high blood pressure, seeing your doctor to get it treated may also help, although some high blood pressure medications can actually cause ED.

Seeking the help of a professional therapist can improve erectile dysfunction in cases where it’s caused by mental health problems.    

Is there a natural way to fix erectile dysfunction at a young age?

Talk to your doctor about lifestyle factors that may contribute to your erectile dysfunction. It may be that eating a healthy diet, losing weight, and addressing other lifestyle factors may be enough to improve your sexual health.

Some natural remedies such as panax ginseng, L-arginine, L-citrulline, roburins (oak wood extract), and tribulus terrestris may also support sexual health. Research has found some of these substances increase levels of nitric oxide, a molecule necessary for strong erections.

Other possible ED treatments that don’t involve surgery or oral medications include using a penis pump and pelvic floor exercises.   

You can also explore whether your erectile dysfunction is more about mental health problems such as depression, performance anxiety, or low-self esteem or something that’s going on in your relationship with your partner rather than a physical cause. If your erectile dysfunction has a mental rather than physical origin you can visit a therapist either alone or together with your partner to help resolve the problem.   

If none of these strategies work, your doctor may want to treat erectile dysfunction with ED medications.