ED in your 20s: common causes and when to get checked

In short: erectile dysfunction (ED) is less common in your 20s than later in life, but it is far from rare. A large US study of sexually active men aged 18 to 31 found that about 1 in 7 reported at least mild ED (Calzo et al., J Urol 2021). At this age, anxiety, low mood and relationship strain are frequent contributors, yet reviews of young men with ED also find physical causes that are worth ruling out (Nguyen et al., Sex Med Rev 2017). This page covers what the studies found, the usual causes, and when to get checked. For how the numbers change across later decades, see our guide to ED by age.

Can a man in his 20s have ED?

Yes. ED is the ongoing trouble getting or keeping an erection firm enough for sex, and nothing about that definition depends on age (NIDDK, Definition & Facts). In one Italian clinic, 26% of men seeking first help for new ED were 40 or younger, the youngest was 17, and almost half of those younger men had severe ED on a standard questionnaire (Capogrosso et al., J Sex Med 2013). So a 25-year-old with erection problems is not unusual, and he is not imagining it.

An occasional off night is different. NIDDK describes ED symptoms as getting an erection sometimes but not every time you want to have sex, an erection that does not last long enough, or being unable to get one at all (NIDDK, Symptoms & Causes). It is the repeated pattern, not a single evening, that counts.

How common is ED in young men?

Studies of younger men report anywhere from about 1% to about 30%. A 2017 review from Florence notes that the figures vary widely because studies define ED, recruit men and measure erections in different ways (Rastrelli and Maggi, Transl Androl Urol 2017). The table gathers the main findings.

Most of these cases are mild. Both the US and Swiss studies used the same short questionnaire: in the US study 11.3% had mild and 2.9% moderate to severe ED (Calzo et al., J Urol 2021), while in the Swiss study 25.5% had mild ED and under 5% had anything more (Mialon et al., J Adolesc Health 2012). A 2017 review summed it up as ED in young men being an increasingly common condition, with large studies putting the figure as high as 30% (Nguyen et al., Sex Med Rev 2017).

What is the main cause of ED in young men?

There is rarely one single cause. Reviews sort ED in young men into psychological causes, such as depression, anxiety and partner difficulties, and physical ones, which include blood vessel, hormone, nerve, medicine and structural problems (Nguyen et al., Sex Med Rev 2017). NIDDK lists the same broad groups for men of any age: health conditions that affect blood vessels, nerves or hormones; certain medicines; mental or emotional issues; and lifestyle behaviors such as smoking, heavy drinking, too little physical activity and recreational drug use (NIDDK, Symptoms & Causes).

A clinic-based review from Florence argues that the old split between “psychological” and “physical” is out of date, because ED usually comes from several parts acting together, and once one part starts the problem, the others tend to follow (Rastrelli and Maggi, Transl Androl Urol 2017). A worry that began after one bad night can sit on top of a physical issue, and the reverse.

Is ED in your 20s usually psychological?

Psychological factors are common at this age, but “it is all in your head” is not a safe assumption. In the Swiss study, poor mental health was directly linked with ED after accounting for other factors, alongside poorer physical health, a shorter sexual life and taking medicine without a prescription (Mialon et al., J Adolesc Health 2012), and in the US study anxiety and antidepressant use were both linked with moderate to severe ED (Calzo et al., J Urol 2021). One pediatric urology practice reported that most of the adolescent ED cases it saw were attributed to a psychological cause such as anxiety or depression (Pantazis et al., Curr Urol Rep 2024).

The other side matters too. In the Florence clinic’s younger patients, aged 18 to 44, the physical component played the main role, which the authors took as a reason to look properly for physical causes even in fit-looking young men (Rastrelli and Maggi, Transl Androl Urol 2017). These are links found in groups of men, not a diagnosis for any one person.

Patterns clinicians look at

The 2017 review describes some patterns that tend to differ between the two groups (Nguyen et al., Sex Med Rev 2017). They are clues for a clinician to weigh, not a self-test.

Our guide to ED vs performance anxiety goes further into telling the two apart.

How do anxiety and performance pressure cause ED?

Anxiety pulls attention onto the erection itself, and that distraction gets in the way of arousal. The Florence review describes how anxiety is often involved at the start of a man’s sexual life, and how one or more difficult experiences can knock confidence, raise fear and lead to avoidance, which makes the next difficulty more likely (Rastrelli and Maggi, Transl Androl Urol 2017). NIDDK also lists stress, loneliness, low self-esteem and negative body image among the emotional issues that can cause or worsen ED (NIDDK, Symptoms & Causes).

The loop can be broken. The American Urological Association (AUA) says referral to a mental health professional should be considered for men being treated for ED, partly to reduce performance anxiety (AUA Erectile Dysfunction Guideline). Our guide to overcoming performance anxiety covers the approaches that have evidence behind them.

Do depression and its medicines play a part?

They can, and the link runs both ways. Studies of young men tie depression to ED, and a prospective Swiss study found that impaired mental health and depression were linked with ED both persisting and newly appearing over about 15 months, while lifestyle, drug use and body mass index were not (Rastrelli and Maggi, Transl Androl Urol 2017). The same review notes that ED has been reported with SSRI antidepressants, lithium and benzodiazepines (Rastrelli and Maggi, Transl Androl Urol 2017), and in the US study of men 18 to 31, antidepressant use was tied to more than 3 times the odds of moderate to severe ED, even after accounting for a history of depression (Calzo et al., J Urol 2021).

If you take a medicine and notice a change, the right move is to talk to the prescriber rather than stop it on your own. NIDDK lists antidepressants, sedatives and several other common medicines among those that can cause ED (NIDDK, Symptoms & Causes).

What physical causes show up in your 20s?

Physical causes do appear at this age. In the Italian clinic, younger men with new ED had fewer other health conditions, a lower average body mass index and higher testosterone than older men, yet they were more likely to smoke and to use illicit drugs (Capogrosso et al., J Sex Med 2013). The table lists the physical groups the reviews describe and what a clinician might check.

Sources for the table: NIDDK, Symptoms & Causes; Nguyen et al., Sex Med Rev 2017; AUA Erectile Dysfunction Guideline; Rastrelli and Maggi, Transl Androl Urol 2017.

Hormones deserve a precise note. In the Florence data, testosterone level in the youngest men was not tied to how severe their ED was, but lower testosterone was linked with fewer spontaneous erections and fewer sexual thoughts (Rastrelli and Maggi, Transl Androl Urol 2017). The AUA guideline says men with ED should have a morning total testosterone level measured (AUA Erectile Dysfunction Guideline).

Can ED in your 20s be an early health signal?

It can be. The AUA says that when ED is present in younger men it predicts a marked increase in the risk of future cardiac events, and that young men with ED in particular would benefit from heart risk factor screening (AUA Erectile Dysfunction Guideline). The Florence review explains why: a young man’s absolute risk is low, but ED can mark a high relative risk, and finding heart and metabolic risk factors early is the chance to change course (Rastrelli and Maggi, Transl Androl Urol 2017).

That is a link seen across groups, not a forecast for you. Most young men with ED will not have heart trouble soon, but a simple check of the basics is a sensible response. Our guide to ED in your 30s and 40s looks at how that signal plays out in the following decades.

What about porn and masturbation?

These questions come up most often at this age, and the evidence is less settled than online claims suggest. In the Swiss study, ED was linked with a shorter sexual life, meaning fewer years of sexual experience, alongside mental and physical health (Mialon et al., J Adolesc Health 2012), and a 2024 review lists online pornography among the topics in current research on young men (Pantazis et al., Curr Urol Rep 2024). Neither source shows that porn or masturbation causes ED. Our page on whether masturbation causes ED sets out what the research actually shows.

Is ED in your 20s treatable?

Yes. NIDDK says ED can often be treated, and a health care professional can help find the cause and talk through the options (NIDDK, Definition & Facts). The AUA guideline lists the options men should be told about, including oral PDE5 inhibitor medicines, vacuum devices and other treatments, with counseling and lifestyle changes alongside where they fit (AUA Erectile Dysfunction Guideline). The 2017 review notes that PDE5 inhibitors remain the mainstay of treatment, and stresses finding the underlying cause first (Nguyen et al., Sex Med Rev 2017).

One caution for this age group: in the US study, only 2% of young men used an ED medicine or supplement, but nearly 3 in 10 of those were misusing prescription ED medicines (Calzo et al., J Urol 2021). Borrowed pills and unregulated products skip the safety check a prescriber does, so the choice of treatment belongs with a licensed clinician.

When to talk to a clinician

If ED keeps happening, at any age, a health care professional can help find the cause and talk through treatments (NIDDK, Definition & Facts). The AUA says the visit should include a medical, sexual and psychosocial history, a physical exam and selected lab tests, and that men should be told ED is a risk marker for heart and blood vessel disease and other conditions (AUA Erectile Dysfunction Guideline). It is especially worth booking if the problem started gradually, if you also have low mood or anxiety, if you smoke or carry extra weight, which the AUA lists among shared risk factors for ED and heart disease, or if it began after a new medicine. Our guide on when to see a doctor about ED covers what to expect and what to bring.

Sources

Every clinical statement on this page traces to one of these sources:

• NIDDK, Definition & Facts for Erectile Dysfunction, last reviewed October 2024. Definition of ED; ED is more common with age but not a routine part of aging; ED can often be treated; a health care professional can help find the cause: niddk.nih.gov, ED definition and facts
• NIDDK, Symptoms & Causes of Erectile Dysfunction, last reviewed October 2024. Symptoms of ED; conditions, medicines, mental or emotional issues and lifestyle behaviors that can lead to ED: niddk.nih.gov, ED symptoms and causes
• American Urological Association, Erectile Dysfunction (ED) Guideline. Medical, sexual and psychosocial history with exam and selective labs; ED as a risk marker for cardiovascular disease; marked increase in cardiac risk when ED is present in younger men; morning total testosterone; referral to a mental health professional to reduce performance anxiety; lifestyle modification; treatment options men should be informed of: auanet.org, ED guideline
• Calzo JP, et al. Erectile Dysfunction in a Sample of Sexually Active Young Adult Men from a U.S. Cohort: Demographic, Metabolic and Mental Health Correlates. J Urol 2021;205(2):539-544. 2,660 sexually active men aged 18 to 31; 11.3% mild and 2.9% moderate to severe ED; links with being single, anxiety, antidepressant and tranquilizer use; 2% used ED medicines or supplements and 29.7% of them misused prescription ED medicines: pubmed.ncbi.nlm.nih.gov/32935616
• Mialon A, et al. Sexual Dysfunctions Among Young Men: Prevalence and Associated Factors. J Adolesc Health 2012;51(1):25-31. 2,507 sexually active Swiss men aged 18 to 25 at military screening; ED prevalence 30% (25.5% mild); poor mental health directly associated; ED also linked with medication without a prescription, length of sexual life and physical health: pubmed.ncbi.nlm.nih.gov/22727073
• Capogrosso P, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man. J Sex Med 2013;10(7):1833-41. 439 consecutive men with new ED; 26% were 40 or younger (range 17 to 40); severe ED in 48.8% of younger men; fewer comorbidities, lower body mass index and higher testosterone, but more smoking and illicit drug use: pubmed.ncbi.nlm.nih.gov/23651423
• Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men: A Review of the Prevalence and Risk Factors. Sex Med Rev 2017;5(4):508-520. Prevalence in young men as high as 30% in large studies; psychological and physical causes and how their onset and features tend to differ; PDE5 inhibitors as the mainstay; identify the underlying cause: pubmed.ncbi.nlm.nih.gov/28642047
• Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol 2017;6(1):79-90. ED in 1% to 10% of European men under 40, with figures varying by method; physical, relational and psychological components acting together; physical component predominant in younger clinic patients; anxiety at the start of sexual life; depression and medicines such as SSRIs; testosterone findings in younger men; high relative cardiovascular risk: pubmed.ncbi.nlm.nih.gov/28217453
• Pantazis A, Franco I, Gitlin J. Erectile Dysfunction in Adolescents and Young Adults. Curr Urol Rep 2024;25(9):225-232. Review of current research, including online pornography; most adolescent cases in one practice attributed to psychological causes such as anxiety or depression: pubmed.ncbi.nlm.nih.gov/38922362