What Causes Erectile Dysfunction in Your 20s

Erectile dysfunction (ED) is something that only happens when you get older … right?

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Not exactly.

While the risk of ED increases with age, younger people can also have trouble getting or keeping an erection.

“A healthy sex life can enhance your overall well-being,” notes urologist Neel Parekh, MD. “If you’re experiencing erection problems, don’t be embarrassed to talk to your healthcare provider. ED is highly treatable, especially in your 20s and 30s.”

What age does ED start?

Erectile dysfunction can happen at any age. Research studies vary, but experts estimate that somewhere between 1% and 14% of men under 40 experience ED. The condition becomes more common with age, with approximately 52% of men between 40 and 70 experiencing some degree of ED. (The studies didn’t include people with penises who don’t identify as male.)

Reasons why men in their 20s and 30s may have ED

An erection requires a coordinated effort between your blood vessels, nerves, muscles and hormones. A breakdown in any part of the system can lead to ED.

Changes in your penis performance can say a lot about your health. “When people seek care for ED, it’s often an opportunity to find underlying health conditions,” says Dr. Parekh.

If you’re young, that may include:

1. Psychological and emotional factors

According to Dr. Parekh, psychological issues are the most common cause of ED at a younger age. What’s happening in your head can affect your body — and vice versa.

ED can be a symptom of mental health conditions such as depression and anxiety. Stress in your life and relationship troubles can also play a role in ED.

And once you start having erection problems, it can be a vicious cycle. Having an issue even once can trigger anxiety about your performance that leads to ongoing troubles.

“Society places a lot of pressure on young people,” Dr. Parekh recognizes. “They often have unrealistic expectations about sexual performance from what they’re watching online.”

2. Medications

ED and decreased sex drive can be side effects of many medications. The most common medications people in their 20s and 30s take that can contribute to ED include:

Antidepressants.
Hair loss medications, such as finasteride (Propecia®).

3. Vascular conditions

Healthy blood flow is essential for sex. Vascular conditions (issues with your blood vessels) can affect blood flow, making it difficult to achieve or sustain an erection.

If you’re under 40, ED could be an early sign of cardiovascular problems, like:

Vascular disease and ED are also related to other common conditions:

Diabetes packs a double punch in ED by slowing blood flow and causing nerve damage.
Obesity increases your risk of vascular disease, diabetes (diabesity) and low testosterone — all of which can cause ED.
COVID-19 can cause ED-inducing inflammation in your blood vessels, as well as impact your psychological health.

4. Neurological conditions

Getting an erection relies on nerve signals from your brain. Some neurological conditions can block those signals, including:

5. Structural issues

Problems with the structure of your penis and surrounding tissues can also impact performance. A structural issue may be due to:

Pelvic surgery for conditions such as colon cancer or inflammatory bowel disease.
Traumatic injury to the penis, bladder or pelvis.

Certain conditions can also affect the structure — and function — of your penis:

Hypospadias: A condition present at birth in which the urethra opening (where urine exits the body) isn’t at the penis tip.
Peyronie’s disease: A curved penis that’s present at birth or develops over time.

6. Endocrine disorders

Hormones are chemical messengers in your body. The most common hormone linked to ED is testosterone, which fuels your sex drive.

Testosterone levels naturally decline with age. If you’re young, low testosterone could be due to a range of conditions, like:

Anabolic steroid use.
Genetic conditions, such as Klinefelter syndrome.
Testicle injury.

Low testosterone can cause ED, but it’s not always to blame, says Dr. Parekh. Not all people with low testosterone develop ED.

7. Lifestyle factors

Your entire body works better when you’re healthy. Lifestyle factors that can cause ED include:

Alcohol and diet: Too much alcohol can cause setbacks in bed. And an unhealthy diet can lead to a wide range of diseases that can cause ED.
Substance use: Substance use and ED go hand in hand. For example, one study found that people who use marijuana are twice as likely to have ED.
Physical inactivity: Not getting enough exercise can increase your risk of developing ED-related health conditions.
Smoking: Cigarette smoking is a significant risk factor for ED. And the more you smoke, the greater the risk.

How to treat ED at a young age

The first step in treating ED is to figure out what’s causing it. Your provider will ask you about your medical history and do a physical exam. They may also order tests for:

Diabetes.
High cholesterol.
Low testosterone.

Depending on what’s causing ED, your provider may recommend one or more treatment approaches:

Lifestyle changes

Lifestyle changes alone can often reverse ED. Proven strategies include:

It’s not always easy to make these changes, notes Dr. Parekh. Ask your provider about resources to help you adopt healthier habits.

Sex therapy

Dr. Parekh often refers patients and couples to psychotherapy. “It’s a safe treatment option that allows people to work through psychological or relationship issues,” he says. “It can really help improve self-awareness and self-confidence.”

Therapists can be difficult to find. The American Association of Sexuality Educators, Counselors and Therapists can help you find a professional in your area — or one who offers virtual care.

ED medication

Oral medications for ED are everywhere. But should you take them without a prescription?

“Getting the right kind of medication and dose is important,” states Dr. Parekh. “So, it’s important to get a prescription.”

For younger people, he recommends getting a prescription for a daily low dose of oral medication. Low doses of ED meds won’t give you an erection just by taking them. But they allow for more spontaneity and stronger erections when the time is right. That often helps with the confidence aspect of ED.

“When combined with lifestyle modifications and sex therapy, people typically see good results,” says Dr. Parekh. But it’s important to note that this is only a temporary treatment: ED medications aren’t for long-term use.

Interventional treatments

If these treatments aren’t effective, your provider will talk to you about other ways to improve your erections. That may include:

Although interventional treatments are less common in younger people, they can help improve your sexual health. Be open and honest with your provider about your goals for sex and intimacy with your partner. Working together, you can find your way back to a satisfying sex life.

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