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9 Causes of Erectile Dysfunction in Your 20s

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Geoffrey C. Whittaker

Published 11/04/2020

Updated 03/04/2024

“Why can’t I get hard and I’m 20?” It’s a hard thing to have to type into a search bar while you should be living optimistic and carefree. Unfortunately, for a surprisingly large number of young men, ED isn’t something to treat later in life — it’s happening now. And it’s not uncommon.

In fact, according to the National Institutes of Health, about 30 million American men are affected by erectile dysfunction — that’s roughly one in every five adult men.

First, we want to remind you to take a deep breath. What you’re experiencing is more common than you probably think. And luckily, it’s also very treatable. 

While physical causes like injury, excessive masturbation, obesity and high cholesterol could be at fault, the possible causes might also include mental health concerns — depression, anxiety, low self esteem and more. 

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

Erectile Dysfunction in Your 20s: Causes and Treatment Options

A quick Google search for “ED in 20s” will lead you to one obvious conclusion: there’s no singular cause of erectile dysfunction. 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 potentially even overuse of pornography.

Recent census data showed that more than a third of the population is over the age of 45, but in a small 2013 study, researchers noted that one out of every four men seeking treatment for erectile dysfunction is below the age of forty.

More concerning, about half of the men under the age of 40 in the study suffered from severe erectile dysfunction, meaning they were unable to attain or maintain an erection firm enough for penetrative sex.

Research also indicates that erectile dysfunction is a growing problem. A 1999 study published in BJU International concluded that ED would likely affect 322 million men worldwide by 2025 — an increase of about 170 million compared to the mid-nineties.

But why?

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

Erectile dysfunction can signal that something else isn’t right in your body. As we’ll explain below, erectile dysfunction is often caused by issues like cardiovascular disease, high blood pressure, diabetes and other potentially serious health conditions and medical conditions.

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High Blood Pressure (Hypertension)

Erections are all about healthy blood flow. If you have high blood pressure (aka hypertension), you may have an elevated risk of developing erectile dysfunction due to the damage long-term high blood pressure can cause to your blood vessels. It may be more likely for this to be an issue in older men who have had high blood pressure for longer, but it’s possible it could impact men in their 20s.

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.

Some research also indicates that high blood pressure reduces your body’s production of sex hormones like testosterone — which plays a major role in regulating your sex drive. Testosterone levels are associated with sex drive and erectile function.

Having Obesity

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

ED is more common in people with cardiovascular disease or heart disease — a class of diseases that’s significantly more common in people who have overweight or obesity. And yes, it can happen in your twenties.

There’s also evidence that losing weight can boost sexual performance and help get rid of erectile dysfunction. In an Italian study, 31% 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 a lower level of testosterone — a key hormone for healthy erections and sexual performance. We explained the relationship between ED and low testosterone levels in more detail in our guide to weight and erection quality.

Diabetes

Diabetes is one of the main risk factors for ED early or late in life. It can damage blood vessels and affect your blood flow, making it more difficult for your body to supply blood to the soft tissues of your penis. It can also affect the nerves in and around your penis, potentially affecting sexual stimulation.

As we explained in our guide to diabetes and ED, these factors all contribute to an elevated risk of erectile dysfunction if you have diabetes. If you have prediabetes or other symptoms of diabetes, you may want to talk to a healthcare professional about whether it’s connected.

Alcohol

Your drinking habit might be one of the lifestyle changes you need to make as a college student or a recent grad. Not surprisingly, alcohol isn’t great for erectile health, and while a younger man’s hangover may not last as long, 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 percent had one or several forms of sexual dysfunction, with erectile dysfunction among the most common. 

A separate study from Hong Kong found that people who consumed more than three drinks per 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 — there’s a risk your drinking could be a contributing factor to erectile dysfunction. 

Drugs

Young men are young enough to remember the anti-drug campaigns that bombarded them in school — but we’re pretty sure that if those campaigns included ED, they’d 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 erectile dysfunction in people who abuse drugs such as cocaine.

Even recently legalized recreational drugs, such as cannabis, are closely linked to erectile dysfunction and other sexual dysfunctions in some research.

Smoking

Smoking is closely linked to erectile dysfunction — and smokers are at an erectile disadvantage at any age. In a 2015 scientific review, researchers noted that cigarette smokers have an elevated risk of developing erectile dysfunction compared to people who don’t smoke.

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

The nicotine in cigarettes can also cause your arteries to narrow, affecting the flow of blood throughout your 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.

Sexual Performance Anxiety

Not every problem that affects young men is physical, however. In fact, sexual performance anxiety is a common problem affecting up to 25 percent of men.

With this condition, you might feel nervous or anxious about your appearance or sexual performance before and during sex. Performance anxiety can affect men and women of all ages. It can even hit young, otherwise healthy men who don’t see it coming.

As we explained in our guide to sexual performance anxiety and ED, feeling anxious or nervous before and during sex is closely associated with sexual dysfunction.

Difficulty Using a Condom

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 for you to lose your erection. This is known as a 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 occur 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 while having sex.

Porn

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 that result from the limitless novelty, quantity and unique potential for escalation of internet-based porn.

Choose your chew

Want to know how to fix erectile dysfunction at 20 or thereabout? 

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

We suspect one reason for this is fear of the unknown. So, how do you treat ED? It’s pretty simple — some of the most effective options are highlighted below.

Talk to a Healthcare Provider

Talking to a healthcare provider is essential to root out problems like diabetes, cardiovascular disease or high blood pressure. And it’s a lot more effective than whatever else googling “Sudden erectile dysfunction 21 years old” will lead you to. 

A healthcare provider might prescribe medication or recommend another type of treatment that may help to improve your health and sexual function. They can also help you identify medications that might have ED as a side effect.

If you’re not seeing the results you want, always talk with your healthcare provider about the ED medications you use and see if other options are available.

Consider ED Medications

Prescription medications for ED may sound scary to a 20-year-old, but as erectile dysfunction treatments go, they’re actually among the safest and most reliable options. 

Names like sildenafil (generic for Viagra), tadalafil (generic for Cialis), vardenafil (generic for Levitra) and avanafil (sold as Stendra) are FDA-approved medications available to treat erectile dysfunction.

These medications (called PDE5 inhibitors) work by inhibiting a certain enzyme that may prevent your erection from getting started — but they’ve come a long way since your dad’s little blue pill days. For instance, our chewable ED meds hard mints make taking ED medication easy and convenient.

Strive for a Healthier Lifestyle

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

Making changes to your habits and lifestyle to improve your health may help treat erectile dysfunction and boost your sexual performance. If you’re in your 20s and have symptoms of ED, try making the following changes:

  • If you have obesity or overweight, try to lose weight. 

  • Avoid consuming too much alcohol. 

  • If you smoke, quit.

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

One thing you may also want to consider is pelvic floor exercises. There’s some evidence that pelvic floor exercises may help improve erectile function.

We dug into the science behind these exercises and put together a list of basic movements you can do at home in our guide to ED exercises.

Put Your Mental Health First

You can put your mental health first in several ways, including:

  • Taking steps to manage stress and anxiety. Treatment options such as counseling, sex therapy and sexual performance anxiety therapy may help you get over performance anxiety and other psychological causes of ED.

  • Working on low self-esteem. Self-esteem issues may cause some penile problems in the form of performance anxiety for young people engaging in sexual activity.

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

  • Talking 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 sexual performance-focused conversations easier.

And 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.

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Although erectile dysfunction is more prevalent in older men, it’s normal and far from uncommon to experience erectile dysfunction at 20. 

Dealing with ED can be stressful, especially when it affects budding relationships or a sex life that’s newer than your car. Here are some fast facts about the issue:

  • Yes, ED can affect men in their 20s.

  • One common problem for young men is psychological ED, which doesn’t have a physical component.

  • Luckily, almost all cases of ED are treatable with a combination of FDA-approved medications and lifestyle changes.

  • Solutions like online therapy and online psychiatry can help with the mental conflicts keeping you from getting hard.

If you’re in your 20s and have ED, don’t be afraid of talking to a healthcare provider. You’re not alone in your problem, and they can help you understand your options. We can help in the meantime.

Concerned about erectile dysfunction? Our guide to the most common treatments for erectile dysfunction goes into greater detail about the options available for treating ED and improving your sexual performance.

24 Sources

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  2. Capogrosso P, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice. J Sex Med. (2013, Jul.). https://pubmed.ncbi.nlm.nih.gov/23651423/
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  4. Dean, R. C., & Lue, T. F. (2005). Physiology of penile erection and pathophysiology of erectile dysfunction. The Urologic clinics of North America, 32(4), 379–v. https://doi.org/10.1016/j.ucl.2005.08.007https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351051/.
  5. U.S. Department of Health and Human Services. (n.d.-f). Treatment for erectile dysfunction - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment.
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  7. Dorey, G., Speakman, M.J., Feneley, R.C.L., Swinkels, A. and Dunn, C.D.R. (2005), Pelvic floor exercises for erectile dysfunction. BJU International, 96: 595-597. https://bjui-journals.onlinelibrary.wiley.com/action/showCitFormats?doi=10.1111%2Fj.1464-410X.2005.05690.x.
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  9. Park, B. Y., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., Klam, W. P., & Doan, A. P. (2016). Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behavioral sciences (Basel, Switzerland), 6(3), 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039517/.
  10. Maiorino, M. I., Bellastella, G., & Esposito, K. (2014). Diabetes and sexual dysfunction: current perspectives. Diabetes, metabolic syndrome and obesity : targets and therapy, 7, 95–105. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949699/.
  11. Nunes, K. P., Labazi, H., & Webb, R. C. (2012). New insights into hypertension-associated erectile dysfunction. Current opinion in nephrology and hypertension, 21(2), 163–170. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004343/.
  12. Ayta, I. A., McKinlay, J. B., & Krane, R. J. (1999). The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU international, 84(1), 50–56. https://pubmed.ncbi.nlm.nih.gov/10444124/.
  13. Del Río, F. J., Cabello, F., & Fernández, I. (2015). Influence of substance use on the erectile response in a sample of drug users. International journal of clinical and health psychology : IJCHP, 15(1), 37–43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224805/.
  14. Moon KH, Park SY, Kim YW. Obesity and Erectile Dysfunction: From Bench to Clinical Implication. World J Mens Health. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479091/
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  16. Sanders, S. A., Hill, B. J., Janssen, E., Graham, C. A., Crosby, R. A., Milhausen, R. R., & Yarber, W. L. (2015). General Erectile Functioning among Young, Heterosexual Men Who Do and Do Not Report Condom-Associated Erection Problems (CAEP). The Journal of Sexual Medicine, 12(9), 1897-1904. https://onlinelibrary.wiley.com/doi/abs/10.1111/jsm.12964.
  17. Betjes, E. (2014, January 7). What are condom-associated erection problems (CAEP)?. ISSM. https://www.issm.info/sexual-health-qa/what-are-condom-associated-erection-problems-caep/.
  18. Lee, A. C., Ho, L. M., Yip, A. W., Fan, S., & Lam, T. H. (2010). The effect of alcohol drinking on erectile dysfunction in Chinese men. International Journal of Impotence Research, 22(4), 272-278. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/
  19. Pyke R. E. (2020). Sexual Performance Anxiety. Sexual medicine reviews, 8(2), 183–190. https://pubmed.ncbi.nlm.nih.gov/31447414/.
  20. Kovac, J. R., Labbate, C., Ramasamy, R., Tang, D., & Lipshultz, L. I. (2015). Effects of cigarette smoking on erectile dysfunction. Andrologia, 47(10), 1087–1092. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485976/.
  21. Akil, L., & Ahmad, H. A. (2011). Relationships between obesity and cardiovascular diseases in four southern states and Colorado. Journal of health care for the poor and underserved, 22(4 Suppl), 61–72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250069/.
  22. Schwarcz, M., Swerdloff, R. S., & Wang, C. (2009). Obesity, low testosterone levels and erectile dysfunction. International Journal of Impotence Research, 21(2), 89-98. https://www.nature.com/articles/ijir200842.
  23. U.S. Food and Drug Administration (FDA). How Smoking Affects Heart Health. (2021). https://www.fda.gov/tobacco-products/health-effects-tobacco-use/how-smoking-affects-heart-health
  24. American Heart Association. How Smoking and Nicotine Damage Your Body. (2023). https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/how-smoking-and-nicotine-damage-your-body
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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