10 Causes of Erectile Dysfunction in Your 20s and What to Do About It

“Why can’t I get hard and I’m 20?” It’s a question more and more healthcare providers are being asked. Erectile dysfunction (ED) isn’t necessarily something you’ll only worry about later in life. For a surprisingly large number of young men, it’s happening now.

While physical causes like injury, excessive masturbation, obesity, and high cholesterol could be at fault, other possible causes of erectile dysfunction in your 20s include mental health concerns like depression, anxiety, or low self-esteem.

Trying to figure out what’s affecting you? We get it — and we have answers. But first, some background.

While we wish it were easier, there’s no single reason why a man might develop sudden erectile dysfunction at 21 years old… or any time in his 20s.

Erection issues can be caused by a range of factors, from physical ones like cardiovascular health issues to psychological ones like performance anxiety, depression, or overuse of pornography.

Getting hard is a complex, multi-step process that requires the brain, hormones, circulatory system, and numerous other parts of the body to work in unison. 

Erectile dysfunction can signal that something else isn’t right in your body. As we’ll explain below, ED could be a warning sign for issues like cardiovascular disease, high blood pressure, diabetes, and other potentially serious health problems and medical conditions.

Here are 10 possible underlying causes of experiencing ED at a young age.

Erections are all about healthy blood flow. If you have high blood pressure (aka hypertension), you may have an increased risk of developing erectile dysfunction due to the damage long-term elevated blood pressure can do to blood vessels. 

This damage can affect blood flow throughout your body, making it difficult for blood to flow into the soft tissues of your penis when you’re aroused.

ED due to vascular health conditions (those affecting blood vessels) may be more common in older men who’ve had high blood pressure for longer. But it can happen to men in their 20s. In fact, a 2021 study found that ED can be an early manifestation of cardiovascular disease.

Some research also suggests that high blood pressure reduces the body’s production of sex hormones like testosterone, which plays a major role in regulating sex drive and erectile function.

ED can also be an early warning sign of other vascular issues linked to ED, like atherosclerosis (hardening or blocked arteries), heart disease, high cholesterol, and diabetes.

As researchers learn more about what causes erectile dysfunction, science has observed a pretty clear link between obesity and ED.

ED is more common among men with cardiovascular disease or heart disease, a class of diseases significantly more common in people carrying excess body weight. And yes, it can happen in your 20s.

There’s also evidence that losing weight can boost sexual performance and help get rid of erectile dysfunction. In an Italian study, 31 percent of men with overweight or obesity who lost an average of 33 pounds in two years reported improved erectile function.

Like high blood pressure, obesity is also associated with low testosterone (hypogonadism). As mentioned, testosterone is a key hormone for healthy erections and sexual performance.

We’ve covered the relationship between ED and low testosterone levels in more detail in our guide to weight and erection quality.

Diabetes is one of the main risk factors for ED early or late in life. The chronic disease can damage blood vessels and affect blood flow, making it more difficult for the body to supply blood to the soft tissues of the penis.

Diabetes can also affect the nervous system, including the nerves in and around the penis, potentially affecting your ability to respond to sexual stimulation.

As our guide to diabetes and ED explains, these factors all contribute to an elevated risk of erectile dysfunction if you have diabetes.

If you have erectile dysfunction and prediabetes or other symptoms of diabetes, you may want to talk to a urologist or another healthcare professional about whether there’s a connection.

Adjusting your drinking habits might be one of the best lifestyle changes you can make for your sexual health and whole-body well-being. A younger man’s hangover may not last as long as an older guy’s, but the effects of drinking on his erections can still add up.

While a drink or two is unlikely to hinder your sexual performance permanently, drinking alcohol excessively can affect your erections in both the short and long term.

In a 2007 study, researchers found that men with alcohol dependence syndrome had a high rate of sexual dysfunction. Of the 100 men who participated in the study, 72 had one or several forms of sexual dysfunction, with ED among the most common.

A separate study from Hong Kong found that people who consumed more than three drinks a week were more likely to report erectile dysfunction than those who didn’t drink at all.

So if you’re a heavy or frequent drinker, or even just enjoy a drink socially, your drinking could be a contributing factor to erectile dysfunction. It can create problems when alcohol is in your system (sometimes called “whiskey dick”), as well as other times due to alcohol’s effect on overall health.

If I stop drinking, will my ED go away? Our blog has insight.

Young men may not remember the anti-drug campaigns that bombarded them in school. But if those campaigns included ED, they’d probably have more lasting effects on impressionable young minds.

Using illicit drugs could increase your risk of developing erectile dysfunction and other sexual issues. Although in-depth research in this area is limited, there are clinical reports of ED in people who abuse drugs such as heroin.

Even recently legalized recreational drugs, such as cannabis, are closely linked to sexual dysfunctions like ED in some research.

Smoking is bad for overall health, but did you know it can mess with erectile health, too? Quitting smoking is one of the best things you can do for impotence.

In a 2015 scientific review, researchers noted that cigarette smokers have an elevated risk of developing erectile dysfunction compared to folks who don’t smoke.

Cigarettes and other tobacco products can also damage your cardiovascular system. Specifically, the chemicals in these products can wreak havoc on your heart and blood vessels, increasing your risk of developing high blood pressure and other cardiovascular conditions often linked to ED.

What’s more, the nicotine in cigarettes can cause arteries to narrow, affecting blood flow throughout the body. Since erections are all about healthy blood flow, this isn’t a good thing for your sexual performance.

Our full guide to smoking and ED goes into more detail about the effects of cigarettes on erections and sexual health.

Not every problem affecting young men’s erectile health is physical. In fact, sexual performance anxiety is a common problem for up to 25 percent of men of all ages.

With this condition, you might feel nervous or anxious about your appearance, relationship, or sexual performance before and during sex.

Performance anxiety can crop up at any age. But according to research, erectile dysfunction in fit and healthy young men is often associated with this psychological condition.

Learn more in our guide to sexual performance anxiety and ED.

Call it a problem of inexperience, but if you use condoms incorrectly, struggle to put them on the right way, or run into other problems while using this form of contraception, it’s far from uncommon to lose an erection. This is known as condom-associated erection problem (CAEP).

CAEP can occur while you’re putting on a condom or just before, like if you feel anxious about making a mistake during condom application. It can also happen during sex if your condom isn’t put on properly, feels overly loose or tight, or reduces sexual stimulation.

Erectile dysfunction caused by condom issues is more common than you may think, especially for men in their twenties. In a 2015 study involving 479 men aged 18 to 24, almost 14 percent had CAEP while putting on a condom.

Another 16 percent had CAEP during penis-in-vagina sexual intercourse, while roughly 32 percent had CAEP while putting the condom on and during sex.

Though studies are limited, some research has found that watching porn can change the way your brain responds to sexual stimulation. This may result in a form of ED referred to as porn-induced erectile dysfunction.

Unlike some causes listed above, porn-induced ED isn’t caused by a disease or physical factor. Instead, it might be due to changes in the way you respond to sex resulting from the limitless novelty, quantity, and access to internet-based porn.

Getting too little sleep, or having poor-quality sleep, can throw your hormones out of balance, increase stress, and hinder sexual performance. 

In particular, sleep apnea has been associated with erectile dysfunction, potentially due to decreased testosterone levels and nighttime oxygen drops. Prioritizing sleep may not only improve your mood and energy but also your sexual health.

Experts recommend that adults get seven to nine hours of quality sleep per night. To make sure this happens, consider whether your nighttime routine is conducive or harmful to your rest goals. 

For instance, ditching screens right before bedtime, ensuring that your bedroom is a sleep-promoting environment, and getting on a disciplined sleep-wake schedule can help you get your sleep on track.

As a younger guy, ED can feel embarrassing. After all, most guys who feel like they’re too young to struggle to get an erection might deny there’s a problem until it’s too big to ignore.

One reason for this could be fear of the unknown, such as not knowing what the treatments are or what ED could mean for your overall health.

So, how do you treat ED? It’s pretty simple. We’ll go over the most effective and common options below.

Talk to a Healthcare Provider About ED and Overall Health

Talking to a medical professional is essential to identify and diagnose problems like diabetes, cardiovascular disease, or high blood pressure, all of which can contribute to ED.

Your provider can conduct a medical history and assess your symptoms to devise a unique treatment plan that fits your needs.

They might prescribe medication or recommend another treatment that may help improve your health and sexual function. Your healthcare provider can also help you figure out if you’re taking medications that might have ED as a side effect.

Consider ED Medications

The most popular and well-researched erectile dysfunction treatments are oral medications known as PDE5 inhibitors (short for phosphodiesterase type 5 inhibitors). 

They work by inhibiting the PDE5 enzyme to widen blood vessels and promote blood flow to the penis, which ultimately supports better erections.

FDA-approved ED medications include:

• Sildenafil (generic Viagra^®)

• Tadalafil (generic Cialis^®)

• Vardenafil (generic Levitra^®)

• Stendra^® (avanafil)

There are also chewable ED medications like Hims hard mints, which contain Sildenafil and Tadalafil at personalized dosages.

Strive for a Healthier Lifestyle

If you’re trying to fix or learn how to prevent ED, your lifestyle may offer the biggest clues about what needs attention.

Making changes to your habits and lifestyle to improve your health can help treat erectile dysfunction and boost your sexual performance. 

If you’re in your 20s and have symptoms of ED, consider making the following changes:

• If you have overweight or obesity, try to lose weight. (For some, weight loss medications can help.)

• Avoid drinking too much alcohol (and if you don’t already drink, there’s no reason to start now).

• If you smoke or use other tobacco products, quit.

• Eliminate drug use, for ED treatment and general well-being.

One thing you may also want to consider is pelvic floor exercises (aka Kegels). That’s right, these aren’t just for women. There’s some evidence that strengthening your pelvic floor muscles may help improve erectile function for guys, too.

Put Your Mental Health First

Prioritizing your mental health is never a bad idea and it may even help your sexual performance. You can:

• Take steps to manage stress and anxiety. Treatment options such as counseling and sex therapy may help you get over performance anxiety and other psychological causes of ED. It’s also good to find healthy ways to manage stress, like daily walks outside, meditation, or an exercise routine.

• Work on low self-esteem. Self-esteem issues may cause problems in the bedroom in the form of performance anxiety when engaging in sexual activity.

• Limit your porn consumption. If you think porn might be affecting your erections and sexual performance, try watching it less than you normally do, or avoid watching it entirely. It might also help to talk to a therapist.

• Talk to your partner. Sometimes, talking to your partner can help reduce anxiety and improve intimacy in the bedroom. Our guide to talking to your partner about ED explains how to make these conversations easier.

If you’re already dealing with mental health issues, remember that some antidepressants may cause ED, something you’ll want to discuss with a healthcare provider. But don’t discontinue using them without medical advice.

You might feel like you’re the only one your age dealing with this, but you’re not. Although erectile dysfunction is more prevalent in older men, it’s far from uncommon to experience ED at 20, 25, or 30.

Dealing with ED can be stressful, especially when it affects budding relationships or your sex life.

Here are some fast facts about the prevalence and causes of erectile dysfunction in your 20s:

• ED can happen to men in their 20s. Research shows that one out of every four men seeking treatment for ED is below the age of 40.

• One common problem for young men is psychological ED. Stress, sexual performance anxiety, relationship problems, and depression can all contribute to erectile issues.

• Erectile dysfunction can also signal cardiovascular issues. ED in young men can be an early warning sign of heart disease, high blood pressure, diabetes, and chronic health issues.

• Almost all cases of ED are treatable. ED treatments include FDA-approved medications, therapy, and lifestyle changes.

If you’re in your 20s and have ED, don’t let it go unaddressed. Get advice from a healthcare provider today to see what options are available.