Erectile Dysfunction In The 20s: What Men Need To Know

What is erectile dysfunction?

Erectile dysfunction (ED)¹ is the inability to produce or maintain an erection during sex. 

The cause of ED can be organic or non-organic. Physical issues cause organic ED, whereas psychological problems, such as stress and relationship concerns, cause non-organic ED.

The process of an erection starts with excitement and sexual arousal in the brain. This increases the blood flow to the penis while reducing the blood flow from the penis. 

The blood flow change creates a pressure buildup, leading to an erection. You may experience erectile dysfunction due to a disruption at any point in this process.

Can young men have ED?

Yes. Although people may think ED happens with age and only older adults get ED, this is not true. You can get ED for many reasons, and it can occur as early as your 20s.

How does age affect ED?

More older men develop ED than younger men, with over 70%² of men over 70 showing signs of ED. 

The risk factors for ED include lifestyle factors such as poor diet, excess consumption of alcohol, smoking, obesity, and low physical activity. 

These lifestyle factors are known for their contribution to chronic diseases such as heart disease, type 2 diabetes, and cancer. 

Like ED, these conditions are more common as people age because they have lived with these risk factors for longer. The cumulative effect of these lifestyle factors adds up over time, causing more issues to appear. 

Heart disease and diabetes are strongly linked¹ to ED. If you have either of these conditions, you have a high chance of having ED. 

It’s important to note that these factors lead to organic ED. Non-organic ED caused by psychosocial stress can affect men of all ages and doesn’t change with age. 

How common is erectile dysfunction in your 20s?

The age that men start presenting with ED is getting younger, which means more and more men in their 20s will be experiencing ED. 

One study³ estimated that the percentage of men with ED under 40 years old is 22%. 

Scientists have historically categorized younger men under 40 as one group, mainly psychogenic symptoms leading to their ED. However, a 2014 study⁴ found that 15–72% of men aged 18–39 have various organic reasons for their ED. 

This increase in men under 40 presenting with ED could be because of an increase in ED cases, or it could mean more men are reporting their ED symptoms to their doctors. If this increase is due to an uptick in reporting, it could indicate a greater trust of young men in their primary care physician. 

What causes ED in your 20s?

Most men in their 20s have a low risk of developing ED due to their young age. This results in younger men being overlooked and dismissed. 

It is much more common for young men to be experiencing ED as a result of non-organic psychological stress or as a side effect of a medication they are on. 

Hypertension

Hypertension⁵ (high blood pressure) can cause organic ED, just as ED can lead to hypertension. This process is caused by underlying damage to your blood vessels, often due to lifestyle factors. It’s not normally a condition you would see in someone in their 20s, but some young people may develop hypertension due to genetic factors. 

Weight

In young, non-diabetic, obese men, the risk of ED increases as body mass index (BMI) increases. Of these men, those with more fat distributed around their abdomen are at a greater risk. This means that if you have a high BMI and a “beer belly,” you have a higher chance of developing ED. 

Diabetes

Type 2 diabetes is most commonly related to ED. Having either of these conditions is a risk factor for developing the other.

However, as type 2 diabetes is a condition mainly caused by long-term exposure to lifestyle factors, it affects less than 5% of Americans⁶ aged 18–44. Due to this, it is less likely the cause of ED is in your 20s.

Type 1 diabetes is a condition where the disease onset is much younger, including in children and young adults. Both type 1 and type 2 diabetes can damage your blood vessels if they are not well-controlled. Because of this, if you have type 1 diabetes, it may be contributing to your ED. 

Alcohol

Excessive alcohol intake may be a risk factor for ED. In low amounts, alcohol appears to reduce the risk of developing ED. Moderate consumption can have protective benefits on the cholesterol composition of the body and help with blood flow and other variables associated with ED. 

Drugs

In terms of recreational drug use, there is strong evidence that suggests that smoking is a risk factor for ED. Tobacco smoking can damage your blood vessels and cause ED. It is a dose-dependent relationship, meaning the more cigarettes you smoke, the higher your risk of developing ED. 

For this reason, you may think that men in their 20s haven’t been smoking for long enough. Younger, heavy smokers, who smoke 20 or more cigarettes daily, still face significant risk. They are more likely to develop severe ED than those who smoke less. 

Using other recreational drugs such as cannabis is a risk factor for blood vessel damage and the development of ED.

Many people are unaware that many medications have side effects that can affect your sexual function. This is called treatment-emergent sexual dysfunction⁷ (TESD) and can cause ED. 

Common medications that cause ED include antidepressants. Because it can be an uncomfortable topic, some doctors won’t explain these potential side effects when prescribing these drugs, and people often don’t want to talk to their doctors about their ED symptoms. The TESD is likely to stop when you stop taking the medications. 

However, this is not always easy to fix, as antidepressants and antipsychotics are often long-term treatments. Some management strategies are available, so if this issue seems familiar to you, please talk to your doctor about your symptoms. 

Mental health

Psychogenic factors, or non-organic causes of ED, contribute to many ED cases, especially in younger men. In many cases, you can improve these factors through things like therapy and couples counseling. 

Psychogenic factors that could be causing your ED include:

• Clinical depression

• Clinical anxiety disorder

• Performance anxiety or “stage fright”

• Lack of stimulation

• Relationship conflicts

• High psychological stress

• Sexual trauma

• Sexual identity or sexual orientation issues 

Medical disorders 

Men who have multiple sclerosis or epilepsy have an increased risk of developing ED. Trauma in and around the groin can also potentially cause ED. These disorders aren’t related to age, which can affect men in their 20s. 

Lastly, Peyronie’s disease, caused by an injury to the penis, can lead to ED. This disease takes time to develop, but up to 8% of men with Peyronie’s disease are under 40. Of those, 21% have ED. 

Condom use

Some men experience condom-associated erection problems (CAEP)⁸ due to ill-fitting condoms or how they affect the sensation in the penis. As you need to use condoms for safe sex, ensure you know how to use condoms correctly. Buying the right size can avoid CAEP.

Symptoms of ED in young men

The main symptoms of ED are the inability to produce or maintain an erection. ED symptoms can range from mild to severe. Mild would almost always be able to get and maintain an erection for sex, while severe would never be able to produce or maintain one. More severe ED symptoms are often apparent in older men. 

Complications of ED in young men

Not being able to properly sexually function can seriously impact your sex life and sexual satisfaction. Men experience a lot of stress and shame due to being unable to “get it up” or losing an erection during sex. This can negatively impact your mental and social well-being. 

If you have ED at a young age, even without the related conditions, you might be at an increased risk of developing them. 

As ED and these chronic diseases have risk factors in common, such as obesity, diet, alcohol, and smoking, ED may be an initial indicator that your current lifestyle may need improvement. 

Treatments for young men with ED

Lifestyle modifications 

The first port of call for treating ED in young men is trying lifestyle modifications. These include: 

• Weight loss which positively benefits ED

• The Mediterranean diet is a diet high in anti-inflammatories and antioxidants. It focuses on nuts, seeds, olive oil, whole grains, fruits, and vegetables. A study found that higher intakes of fruits and vegetables decreased the risk of ED in young men.

• Stop smoking, as smoking increases your risk of ED. If you stop smoking, you will decrease your risk.

• Reduce alcohol intake, especially if your alcohol intake is high. Reducing it to lower levels will help improve your ED.

• More physical activity improves erectile function. 

Psychological support

Especially in cases of non-organic ED, some mental health support can improve your symptoms. Because many different psychological factors can cause non-organic ED, many treatments exist. These include: 

• Therapy or medication to reduce anxiety or depression symptoms

• Therapy for general stress relief

• Support for past traumas

• Increased sexual stimulation

• Couples communication training 

Medications 

PDE-5 inhibitors⁹ are the most common medical treatment for men with ED. These drugs increase blood flow to your penis, giving you an erection. They require stimulation or sexual arousal to work. They include:

• Viagra

• Silvasta 

• Vedafil 

• Cialis 

• Levitra 

If you’re experiencing ED as a side effect of a medication you are taking, some options may help. If you stop taking the drug, your ED symptoms will also stop. 

Sometimes this is not recommended, as some medications that cause ED are essential for the long-term management of disorders such as depression or schizophrenia. These medications include antidepressants and antipsychotics. 

Please consult your doctor if you wish to stop taking medication because your ED is a problem. They may be able to help by prescribing a different medication that won’t give you ED, or they might try to improve your tolerance for the drug.

Testosterone therapy 

In cases where low testosterone levels may cause your ED, testosterone therapy¹⁰ may restore your sexual function. You can administer this therapy as an injection, skin patch, tablet, or topical gel. 

Vacuum erection devices

A vacuum device (a pump) is a non-invasive method to produce an erection. Placing this device over the penis creates a vacuum, increasing blood flow to the area and producing an erection. 

Penis implants

For men with severe ED, for which other treatments such as lifestyle changes and medications have not worked, a penis implant may be a good option to restore sexual function. 

Managing ED in your 20s

How you manage ED in your 20s won’t look that different from how you would handle it later in life. Implement the lifestyle modifications that are relevant to you, use the medicine that works best for you, and live a normal life. 

When do you visit a doctor?

You should visit your doctor at any point where you suspect you might have ED, or you know you have ED and feel like it negatively impacts your mental, social, or sexual health. 

You should also consult your doctor before stopping any medications if you are experiencing any side effects from the medications you are on. 

The lowdown

You can experience erectile dysfunction in your 20s; it is normal and common. Many things could be causing your ED, including lifestyle factors, medications, or psychological stress. 

Overall, there is no need to worry, as there are many changes you can make and medications you can take to help manage your ED. Speak to your doctor to get the ball rolling on your treatment plan.