Erectile dysfunction in young men

Published 22 October 2026

Erection problems are not confined to later life: in one real-world study cited by European urology guidelines, one in four men seeking first help for new erectile dysfunction was under 40, and almost half of those younger men described it as severe. Anxiety is a recognised cause, but it should be a conclusion reached after a proper look, not an assumption.

Can young men get erectile dysfunction?

Yes. Erectile dysfunction means a persistent difficulty getting or keeping an erection firm enough for satisfying sex, at any adult age. The NHS says an occasional lost erection is usually down to stress, tiredness or alcohol and is nothing to worry about.

The causes in your 20s and 30s are the same families as in older men: blood vessels, nerves, hormones, medicines, recreational drugs and the mind. Some are simply easier to miss, because everyone assumes it must be nerves.

Is erectile dysfunction in young men psychological or physical?

Often both. The European Association of Urology (EAU) guidelines describe erectile dysfunction as organic (physical), psychogenic (psychological) or mixed, but caution that most cases are mixed, and suggest speaking of a primarily physical or primarily psychological cause instead.

A man whose erections first faltered for a physical reason will understandably start to worry about the next attempt, adding a psychological layer. An assessment works out which threads are present, so treatment can match them.

How performance anxiety stops an erection

An erection is a relaxation response: the smooth muscle in the erectile tissue has to relax so blood can flow in and be held there, and the body’s stress response pulls the other way. Wondering whether it will happen this time can be enough to prevent it, and one bad experience can start a loop of worry and lost erections. The EAU describes this situational form, linked to a partner, performance pressure or distress. It is a real, treatable problem and nothing to be embarrassed about.

What do morning erections tell you?

They are a clue, not a verdict. Erections during sleep, often noticed on waking, happen without sexual thoughts or performance pressure. If you regularly wake with a firm erection, or can get a full erection on your own but not with a partner, your blood supply and nerves can at least produce one, which shifts the likelihood towards situational factors such as anxiety.

A specialist test, nocturnal penile tumescence and rigidity monitoring, records erections over at least two nights. Men with a primarily psychological cause usually have normal results, but a sleep erection is not the same as one during sex, and age, depression and sleep itself can confound the result.

• Good morning erections do not rule out a physical contributor, such as raised blood pressure, an early blood sugar or cholesterol problem, or a medicine side effect.
• Their absence does not prove a physical cause, because low mood and sleep quality affect them too.
• A gradual fade matters: the EAU lists fewer morning erections, with a lower sex drive, among the more specific symptoms associated with low testosterone.

Scroll the table sideways to see every column

Can erectile dysfunction be an early warning sign in your 20s or 30s?

It can, which is a strong reason not to dismiss it. The EAU guidelines state that erectile dysfunction significantly increases cardiovascular risk, cite long-term data showing raised predicted risk in younger men with it, especially those under 50, and conclude that it should be regarded as a forerunner of cardiovascular disease.

Why the penis can show vascular change early is explained on our erectile dysfunction treatment page. In your 20s and 30s there is usually more time to address blood pressure, cholesterol, blood sugar, weight and smoking before they cause problems elsewhere, and regular exercise and weight loss can themselves improve erectile function.

A less common cause is an old injury, such as a pelvic fracture or a heavy blow to the perineum (between the scrotum and the back passage). The EAU singles out young men with this history for specialist vascular tests, because some may be suitable for treatment aimed at the damaged artery itself.

Could low testosterone be the cause?

Sometimes, and it should be checked properly rather than guessed. The EAU lists low mood, reduced motivation and fatigue among symptoms associated with low testosterone (in guidance on age-related low testosterone). Because levels follow a daily rhythm, an early-morning fasting sample is used, and a low result is repeated before anything is decided.

If testosterone is genuinely low, the next question is why. Testosterone replacement suppresses the body’s own sperm production, so anyone who may want children should not start it without specialist advice. Our testosterone replacement therapy page explains how we assess this.

Can anabolic steroids or self-sourced testosterone cause erectile dysfunction?

Yes, both while you take them and after you stop. The NHS lists erectile dysfunction, shrunken testicles, a reduced sperm count and infertility among the effects of anabolic steroid misuse in men.

When testosterone or a related steroid comes from outside, the hypothalamus and pituitary gland sense the high level and stop signalling the testicles to make their own; the EAU lists these steroids among drug-induced causes of low testosterone. When the steroids stop, the body’s own production does not switch back on straight away. For sperm counts, the EAU says recovery usually takes six to twelve months from stopping, based on limited evidence; how long hormone levels and erections take varies. The NHS lists low sex drive and depression among withdrawal symptoms.

If you use, or have used, steroids or testosterone from outside medical care, please tell us; it changes how blood results are read. Because coming off anabolic steroids suddenly can bring on those withdrawal symptoms, the NHS advises seeing a GP, who may refer you to a drugs counsellor to plan how to stop safely. If fertility matters to you, see our male fertility page.

Which medicines can affect erections in younger men?

Several can. Two are particularly relevant to younger men:

• Antidepressants, including SSRIs. The NHS lists difficulty getting or keeping an erection, low sex drive and difficulty reaching orgasm among the common side effects of antidepressants, and notes that for some people these carry on after stopping. Do not stop an antidepressant suddenly or without talking to your prescriber.
• Finasteride for hair loss. The NHS lists problems getting an erection and less interest in sex as common side effects (more than 1 in 100 people), which can sometimes continue after stopping. It lists low mood as a rare but serious side effect, and advises anyone taking it for hair loss who develops low mood to stop it straight away and call their doctor or 111; if you have thoughts of harming yourself, call 999 or go to A&E.

Some blood pressure tablets, antipsychotics and anti-androgens are also on the EAU list. Apart from the finasteride low-mood warning above, if a medicine might be involved, talk to the prescriber about alternatives rather than stopping on your own.

Do alcohol, smoking, recreational drugs and cycling make a difference?

They can, and they are among the causes most within your control.

• Alcohol: the NHS names drinking too much as a usual reason for erection problems, and advises no more than 14 units a week.
• Smoking: a recognised vascular cause in the EAU guidelines.
• Recreational drugs: cocaine, cannabis, heroin, methadone and synthetic drugs are all on the same guidelines’ list of drug-induced causes.
• Poppers: amyl nitrite must never be combined with erectile dysfunction tablets. The EAU calls this an absolute contraindication, because it can cause an unpredictable fall in blood pressure.
• Cycling: if you cycle for more than 3 hours a week, the NHS suggests stopping for a while.

Does pornography cause erectile dysfunction?

The evidence is mixed. A 2019 review of observational studies found little or no evidence that pornography use causes erectile dysfunction. One study linked self-reported problematic use more clearly than use in general with erection problems; other studies found small or no associations. The direction of any link is unclear, and most of the research relies on self-reported answers.

If erections are reliable with pornography or alone but not with a partner, that pattern is worth discussing, because it usually points to the situational threads above, which can respond well to treatment.

Could Peyronie’s disease or another condition be involved?

Yes. Peyronie’s disease, in which scar tissue causes a bend, a lump or pain on erection, usually starts later in life, but the EAU notes that it also occurs in men under 40 and that erectile dysfunction is common alongside it. See our Peyronie’s disease page and surgery options.

Examination can also reveal conditions a man had not suspected, and the EAU lists type 1 diabetes, multiple sclerosis, spinal cord problems, a tight foreskin and previous pelvic or urethral surgery among physical causes. That is why a physical examination is normally part of the assessment.

When are erection problems an emergency?

Rarely, but the exceptions matter:

• With new back pain: if back pain comes with sudden erection problems, loss of feeling around the genitals or back passage, numbness or weakness in both legs, or new trouble peeing or controlling your bowels, the NHS advises calling 999 or going to A&E.
• An erection lasting more than 3 to 4 hours, or a painful erection lasting more than 1 hour if you have sickle cell disease: call 999 or go to A&E. Cannabis and cocaine can cause it; for treatment-related causes, see treatments compared.
• A sudden crack or pop during sex, with pain, rapid loss of the erection and swelling: go to A&E, as this may be a penile fracture, for which European guidelines recommend prompt surgical repair.

For urgent worries that are not emergencies, NHS 111 (online or by phone) can advise.

When should a young man see a specialist?

The NHS advises seeing a GP or sexual health clinic if erection problems keep happening, as they can be a sign of a treatable condition. A specialist assessment is particularly worthwhile if:

• the problem keeps recurring and is not tied to one stressful period
• tablets, prescribed or bought, have not helped, or you want the cause found first
• morning erections and sex drive have faded along with your energy
• you use, or have used, steroids or testosterone
• you have a bend, a lump, pain, or a past pelvic or perineal injury
• it is affecting your mood, relationship or confidence

What does a specialist assessment involve for a younger man?

It starts with a conversation. We take a detailed medical and sexual history, covering how firm and lasting erections are during sex and on waking, and any problems with desire, ejaculation or orgasm. We also ask, in confidence, about things that are easy to leave out: steroids, supplements, hair-loss treatment, recreational drugs, alcohol, cycling, sleep, pornography and your relationship.

The rest of the assessment, including examination and blood tests, is described on our erectile dysfunction treatment page. If penile Doppler ultrasound is suggested, it helps to know that anxiety can itself produce falsely abnormal results. Where anxiety, low mood or relationship factors seem to be involved, your consultant can discuss psychosexual support alongside any medical treatment.

Our consultants practise at Guy’s & St Thomas’, named by Newsweek in 2025 as the number one urology service in Europe. Read what happens at a first appointment, or see fees and insurance; self-funding patients need no GP referral.

How is erectile dysfunction treated in young men?

Treatment follows the cause, and often has more than one strand: dealing with a trigger such as a medicine, steroids, alcohol or long rides; stopping smoking, exercise and weight loss; and psychological treatment, where the EAU recommends cognitive behavioural therapy, including the partner where possible, combined with medical treatment when indicated. Tablets such as sildenafil and tadalafil can be used alongside these steps, never with nitrate medicines or poppers. Hormone treatment is considered only when testosterone is confirmed low on repeat testing, with fertility discussed first.

For a side-by-side look at the options, see erectile dysfunction treatments compared, and our erectile dysfunction treatment page for how we approach care. If you are tempted to buy tablets online, the NHS warns that many websites sell fake medicines. To arrange a consultation, call +44 7889 318584 (lines open Monday to Friday, 8am to 4pm) or contact us.

Frequently asked questions

References and further reading