James is 25 years old and in good health. He has been in a committed relationship for the past four years. He loves his partner, and they intend to start a family. However, James has been struggling with erectile dysfunction. He has undergone a full physical exam, and so far, no treatable cause has been identified.
Dealing with erectile dysfunction has been a stressful experience for both James and his partner. Like most young men, James believed erectile dysfunction was only a problem for the elderly and those with chronic diseases. Unfortunately, erectile dysfunction can impact men and their relationships at any age, including in their 20s and 30s.
Erectile dysfunction can be a sensitive subject to broach. However, as with any medical issue, it is essential to fully understand what causes erectile dysfunction in young men and review the available treatment options.
Table of Contents
Understanding Erectile Dysfunction
Erectile dysfunction (ED) is defined as the inability to obtain and maintain an erection suitable for sexual intercourse. Being receptive to sexual stimulation is the first step toward achieving an erection. Hormones, such as testosterone, must be at optimal levels for the message to be transmitted from the brain to the penis.
Once this occurs, blood flow increases into the corpus cavernosum of the penis, causing pressure to rise and an erection. This process may appear simple, but problems with the circulatory or nervous system can easily prevent it from taking place.
How Common Is ED In Young Men?
The short answer is that it is more common than you might think. One in every four men with newly diagnosed erectile dysfunction is under the age of 40. Almost half of the men in the study were in their twenties and thirties and had severe ED, defined as the inability to maintain a firm enough erection for penetrative sex.
When compared to older men with ED, young men with ED had a lower rate of comorbid medical conditions, a lower body mass index, and a higher mean circulating testosterone level. Furthermore, younger men with ED smoked cigarettes and used illicit drugs more frequently than older men with ED.
Another study involving 27,000 men from eight countries found that the prevalence of ED was 8% in men between the ages of 20 and 29 and 11% in men between the ages of 30 and 39.
When looking at a graph that shows the prevalence of men in their 20s and 30s seeking treatment between 2010 and 2015, you can’t help but notice the percentage tripled in those five years.
Causes Of ED In Young Men
Lifestyle factors can significantly influence erectile function, particularly in younger men. Smoking, alcohol use, drug use, and obesity are all known contributors, but several additional lifestyle elements also play a meaningful role in sexual health. Chronic stress, for example, can interfere with the brain’s ability to initiate the hormonal and neurological cascade necessary for an erection. Elevated cortisol levels can also disrupt testosterone production and reduce libido.
Poor sleep quality is another common factor in younger men. Sleep deprivation lowers testosterone levels, increases fatigue, and impairs mood regulation—three key components of healthy sexual function. Studies have shown that even one week of reduced sleep can meaningfully decrease testosterone in otherwise healthy young men.
Sedentary behavior and lack of regular exercise can also worsen ED by contributing to poor cardiovascular health and decreased blood flow. Regular physical activity—particularly strength training and aerobic exercise—can improve circulation, reduce stress, support healthy hormone levels, and improve overall sexual function.
These lifestyle influences often overlap with psychological factors, creating a cycle where stress, poor sleep, and inactivity perpetuate anxiety and performance challenges. Addressing these modifiable contributors is an important part of ED treatment in younger men.
Physical Causes
The physical causes of ED may include the following:
Nerve damage or malfunction:
- Spinal cord injury
- Multiple sclerosis
- Parkinson’s disease
- Lumbar disc disease
- Pelvic surgery
- Diabetes mellitus
- Nerve damage in the groin
Blood vessel disease:
- High blood pressure
- Diabetes mellitus
- Abnormal blood lipids, high cholesterol
- Cigarette smoking
Endocrine causes:
- Low testosterone levels
- Hyperthyroidism
- Hypothyroidism
- Diabetes
- Hyperprolactinemia
Medication use:
- Thiazide diuretics used to treat high blood pressure
- Digoxin used to treat heart arrhythmias
- 5α-reductase inhibitors used to treat benign prostatic hyperplasia
- Anti-androgens used to treat prostate cancer
- Luteinizing hormone-releasing agonists and antagonists used to treat prostate cancer
- Antidepressants
- H2 blockers used to treat gastritis and ulcers
- Opiates used to treat pain
Lifestyle Factors
- Smoking
- Alcohol use
- Drug use
- Overweight and obesity
Psychological Causes
The complex process of achieving an erection begins in the brain. Conditions that change the levels of neurotransmitters (messengers) in the brain can interfere with this process. Examples include:
- Depression
- Performance anxiety
- Stress
- Post-traumatic stress disorder
- Consumption of pornography
- Relationship issues
How Young Men Can Treat And Manage ED
The first step in treating ED is determining the cause. Your doctor will take a medical, sexual, and psychosocial history and do a complete physical exam. This is often all that is required to make a diagnosis and discuss potential treatment options.
If your symptoms point to a medical cause of ED, further lab work or testing may be ordered. ED can be a marker for underlying cardiovascular disease and other health conditions.
Lifestyle Changes
Blood vessel damage and reduced blood flow are among the most common physical contributors to ED. Smoking and nicotine constrict blood vessels, while certain dietary choices contribute to plaque buildup and inflammation that further impair circulation. In addition to improving diet and reducing alcohol or nicotine use, several key lifestyle changes can meaningfully support erectile function:
- Manage stress effectively. Chronic stress elevates cortisol, disrupts testosterone production, and impairs the neurological pathways involved in arousal. Mindfulness practices, therapy, journaling, or stress-management programs can all help regulate your body’s stress response.
- Get adequate, high-quality sleep. Aim for 7–8 hours of uninterrupted sleep per night. Testosterone levels peak during deep sleep, and chronic sleep deprivation is strongly linked to lower libido and increased ED risk.
- Exercise consistently. Aerobic exercise improves cardiovascular health and blood flow, while strength training supports testosterone production, muscle mass, and metabolic health. Together, they can significantly reduce the risk of ED and improve symptoms in men already affected.
- Reduce or eliminate smoking and nicotine. Smoking is a major cause of ED, even in men under 40. Quitting can quickly improve circulation and erectile quality.
- Limit alcohol intake. Excessive alcohol depresses the central nervous system and reduces sexual response. Moderate, mindful intake can reduce these effects.
These changes strengthen cardiovascular function, decrease inflammation, and support healthier hormone balance—all of which are essential for strong, reliable erections.
Medications And Other Treatment Options
“Men should be informed of all treatment options that are not medically contraindicated and supported in the shared decision-making process to determine the appropriate treatment (for ED). Although many men may choose to begin with the least invasive options (i.e., oral medications), the panel notes that it is valid for men to begin with any type of treatment, regardless of invasiveness or reversibility.” American Urological Association
There are many treatment options for ED, and as stated by the American Urological Association, men should be offered the full range of treatments.
Oral phosphodiesterase type 5 (PDE5) inhibitors such as Viagra, Cialis, Stendra, and Levitra: PDE5 is an enzyme that increases nitric oxide levels. Nitric oxide dilates blood vessels allowing more blood to flow into the penis. PDE5 inhibitors maintain high nitric oxide levels and blood flow into the penis.
Suppositories: Prostaglandin E1 (alprostadil) is available as a suppository.
Testosterone replacement therapy: Testosterone replacement therapy is recommended for men with hypogonadism.
Injectables such as Trimix: Trimix injectables comprise three different medications—phentolamine, papaverine, and alprostadil. These medications work together to improve blood flow into the penis.
Vacuum erection devices: A cylinder is placed over the penis to create a vacuum and draw blood into the corpora cavernosum. A band is left at the base of the penis when the cylinder is removed. The band prevents blood from exiting the penis. The band must be removed within 30 minutes, or damage to the penis may occur.
Penile implants and other surgical options: Men might consider having an internal penile pump (IPP) implanted when other treatment options have been exhausted.
Alternative Therapies
Since the etiology of ED is frequently multifactorial, your doctor may suggest a referral to a mental health Lifestyle changes remain a powerful part of managing ED, especially for younger men whose symptoms often have overlapping psychological and physical origins. In addition to nutrition, exercise, and vitamin D optimization, men should also consider:
- Consistent sleep habits to support testosterone and overall hormonal balance
- Stress-reduction techniques such as mindfulness, meditation, or guided therapy
- Limiting screen time and late-night device use, which may worsen sleep and increase anxiety
- Avoiding excessive pornography consumption, which can influence arousal patterns and contribute to performance anxiety in some men
Addressing these components enhances both erectile function and overall well-being, offering a more holistic approach to ED management.
