What to Know About Erectile Dysfunction In Younger Men

Erectile dysfunction (ED) is a condition that is commonly associated with older age, but the inability to get or maintain an erection can also affect younger men—even teens.

ED is more common in men under the age of 40 than you might think, though the causes of ED in younger men are often different than in older men.

In most cases, ED is treatable, but the condition can be a sign of an underlying health condition, such as early heart disease. If you're experiencing ED at any age, but especially if you are in your teens or 20s, it's important to talk to your doctor.

Here's what you should know about ED in younger men, including the possible causes and ways to treat the condition.

ED in Younger Men Statistics

Erectile dysfunction (ED) is a condition that typically affects people with a penis who are over the age of 40. By the time a person is in their 40s, they will have a roughly 40% chance of having some form of ED—whether mild, moderate, or severe. For every decade thereafter, the risk increases by 10%.

While the risk of ED has been linked to older age, men under age 40 are also affected. A 2013 study that was published in the Journal of Sexual Medicine found that 26% of cases of ED—roughly one in four—occur in people ages 40 and under.

The study also noted that younger men who sought treatment were more likely to have severe ED than men over the age of 40 (48.8% vs. 40%).

While this could simply mean that younger men are more reluctant to seek treatment, the factors contributing to ED in this group of men were different. Overall, younger men with ED have a lower body mass index (BMI), higher testosterone count, and fewer comorbid medical conditions than their older counterparts. On the other hand, they had higher rates of smoking and illicit drug use, both of which are known risk factors for ED.

Other studies have suggested that around 8% of men between the ages of 20 and 29 and 11% of males ages 30–39 have some form of ED. The actual number might be even higher because men under the age of 40 are less likely to seek treatment than those over the age of 40.

Causes of ED in Younger Men

An erection is a complex physiological response involving the brain, hormones, nerves, muscles, and the circulatory system. Breakdown in any of these systems can lead to ED. In most cases, more than one factor is involved.

In addition to physiological (organic) causes, there are also psychological (psychogenic) causes—some of which play a central role in the onset of ED. Although ED in younger men was once thought to be almost exclusively psychogenic, more recent research suggests that 15%–72% of ED cases involve a wholly organic cause.

Organic Causes

Organic causes of ED include any condition that affects the physiological ability to achieve or sustain an erection.

In younger men, the causes can be broadly categorized as involving hormones (endocrinologic), involving the nervous system (neurologic), or involving blood vessels (ad vasculogenic). Medication side effects are also included because they can directly influence hormone levels.

In men under 40, organic causes of ED include:

• Endocrinologic disorders like diabetes, congenital hypogonadism, hyperthyroidism, hypothyroidism, hypogonadism (low testosterone), and Klinefelter's syndrome.
• Neurologic conditions like epilepsy, multiple sclerosis, and spinal cord trauma
• Vascular conditions like Peyronie's disease, peripheral artery disease (PAD), and early coronary artery disease (CAD)
• Medications, including antidepressants, antiepileptics, antipsychotics, opioids, and illicit drugs like cocaine, heroin, and methamphetamine

Psychogenic Causes

Emotions and moods also play an important role in the ability to achieve an erection because of how they relate to nerves, hormones, and the circulatory system. There are two aspects of an erection: the reflex erection, which is influenced by touch, and the psychogenic erection, which is influenced by emotions and erotic stimuli.

Some negative emotions and moods can diminish the ability to get or keep an erection. On rare occasions, they can even be the sole cause of ED. Even if the primary cause of ED is physical, the emotional stress that a person is experiencing can make the condition worse.

The psychogenic causes of ED can affect men of any age, but younger men might be more affected because they are often expected to be more "virile" and have greater "sexual prowess."

Common psychogenic causes of ED include:

• Depression
• Family or social pressures
• Low self-esteem
• Mental health problems like schizophrenia
• Performance anxiety
• Psychological trauma
• Relationship problems

How ED in Young Men Is Diagnosed

Erectile dysfunction is closely linked to aging, in part because older men often have conditions like hypertension, heart disease, and diabetes. Doctors will often take a more extensive approach when diagnosing ED in younger men.

In addition to a physical exam, a doctor will review your medical and family history to check for any risk factors that you may have. They will also ask you about any drugs that you take, including whether they are prescription, over-the-counter (OTC), or recreational.

The doctor will also ask specific questions about your condition, including when the problem started, how severe it is, and what is going on in your life. These questions will help them figure out whether the primary cause is likely to be organic or psychogenic.

There are also some other tests and procedures that a doctor might use to diagnose ED, including:

• Blood and urine tests to check for signs of heart disease, diabetes, thyroid disease, and hormone problems (including low testosterone)
• Penile duplex ultrasonography, a test that can be done in a doctor's office that typically requires an injection to induce erection and can show arterial and venous blood flow to help identify a problem or provide reassurance of normal vascular function
• Penile angiography, a form of X-ray using an injected contrast dye to visualize blood circulation in the penis
• Combined intra-cavernous injection and stimulation (CIS) test, a simple in-office test using an injected drug and either manual or visual stimulation to assess the quality of an erection
• Nocturnal penile tumescence (NPT) stamp test, a simple at-home test in which four to six postage stamps are wrapped around the shaft of the penis to check if you get nighttime erections (evidenced by a tear or break in the stamps)
• RigiScan, a device similar to the NPT that uses a series of looped sensors to measure penile engorgement and rigidity during sleep

If the cause is thought to be psychogenic, your doctor might refer you to a psychologist. You can talk with this expert about any sexual, relationship, or mental health factors that might be contributing to your ED. Anxiety reduction using alternative measures or working with a therapist, psychologist, psychiatrist, or couple's counselor, may also be helpful.

How to Fix ED at a Younger Age

The ED treatments that are often used in older people can also be tried in younger people, but the treatment that will work best will vary from person to person. A combination of lifestyle changes, counseling, medications, and other therapeutic approaches is usually tried first.

Your doctor will also treat any underlying medical conditions or address current treatments for conditions that could be contributing. For example, you might be able to change a medication that is causing ED.

Lifestyle Modifications

Research has not shown that being overweight or obese is inherently linked to ED in younger men, partly because their stronger cardiovascular systems tend to compensate. However, obesity can reduce testosterone levels in some men and further complicate ED symptoms.

There are some simple lifestyle changes that may help improve the quality of your erections as well as improve your overall health and well-being, including:

• Eating a nutritious diet (limiting processed foods)
• Exercising regularly (which can improve your libido, stamina, and mood)
• Quitting smoking (as smoking reduces blood circulation and promotes ED)
• Maintaining a healthy weight
• Managing your stress
• Getting plenty of sleep
• Avoid recreational drugs

Medications

Viagra (sildenafil) is one of the best-known medications for treating ED, but it's not the only prescription drug that can be used to treat this condition.

There are several oral and injectable drugs that can either be used on demand or on an ongoing basis to treat ED, depending on what is causing it. Medications prescribed for ED include:

• Phosphodiesterase type 5 (PDE5) inhibitors include Cialis (tadalafil), Levitra (vardenafil), Stendra (avanafil), and Viagra
• Alprostadil is a vasodilator drug used five to 20 minutes before sex to induce an erection. It is available either as a penile injection (Caverject) or an intraurethral suppository (MUSE).
• Testosterone injections are used specifically for men diagnosed with hypogonadism (when the body doesn't produce enough testosterone). These drugs can augment erectile function and be used without ED medication or provide a more robust response with ED medication.

Psychotherapy

Counseling can help people address the social and psychological issues related to ED. This includes cognitive-behavioral therapy (CBT), mindfulness-based therapy (MBT), and sex therapy. Counseling may take place with couples or groups, or be conducted on a one-on-one basis.

Penile Pumps

A vacuum pump, which can be purchased online or in sex shops, can be an option for people who have not seen benefits from using medication to treat ED.

The device consists of a cylinder that is placed over the penis and a hand pump that extracts air from the cylinder. The resulting vacuum draws blood into the penis, causing engorgement.

An elastic band can then be placed around the base of the penis behind the scrotum to maintain the erection.

Surgery

If all other treatment options fail, surgery might be considered as a last resort. These procedures are especially beneficial for men with ED that's caused by diabetes, vascular disease, and spinal cord injury.

The two common surgical approaches used to treat ED are:

• Penile implant surgery is a procedure in which either a malleable implant (offering permanent firmness) or more commonly an inflatable implant (offering on-demand erections) is inserted within the two spongy tubes (corpora cavernosa) that make up the inner shaft of the penis.
• Microsurgical penile revascularization is a complicated surgery that is mostly used in men under 40 who have sustained a traumatic injury. It restores blood flow by connecting an artery in the abdomen to one on top of the penis.

Complementary and Alternative Therapies

Many natural remedies found online or in supplement stores claim to improve erections. While few offer substantive proof of their effectiveness, a 2020 review of research from the University of the Western Cape in South Africa and the Cleveland Clinic concluded that five natural remedies showed promising results in treating ED.

Complementary and alternative ED therapies that might be beneficial include:

• Ginseng root (Panax ginseng)
• Pycnogenol (a homeopathic remedy made from the bark of the French maritime pine tree)
• Prelox (a supplement containing pycnogenol and L-arginine)
• Puncture vine (Tribulus terrestris)

It is unclear how these remedies work to treat ED, but it is thought that they may stimulate nitrous oxide production, which the body uses to induce erections.

Summary

Erectile dysfunction (ED) often occurs in older people, but it can also occur in younger men—even in teens. However, the causes of ED in younger men may be different from the causes in older men.

In most cases, ED is treatable. There are a variety of conventional and alternative ways to address ED, and a combination of treatments that address the factors contributing to the condition can help people address their symptoms.

A Word From Verywell

If you have ED at any age, talk to your doctor. You may then be referred to see a urologist for further evaluation and treatment.

It's also important to be open and honest about the condition when you are having sex with someone. When you are communicating with a partner, you can explore incorporating sexual activities that do not rely on penetration, such as vacuum pumps, sex toys, role play, mutual masturbation, and oral sex, into your experience.