The fact that erectile dysfunction (ED) increases with age is no surprise; after all, it’s a truth self-evident that by the time we get into late middle age, virtually every function of the human body can get glitchy, and an appendage that’s expected to harden, grow, and literally shapeshift at a moment’s notice is no exception. But ED’s strong association with the passing of time belies the facts, as in recent years, studies have shown that more young men are experiencing ED. Why is that?
In a 2012 study from The National Center for Biotechnology Information (NCBI), researchers found that 30% of men under the age of 40 experienced ED. A 2013 study from the center of 439 men with ED, meanwhile, found that 26 percent of them — one out of four — were under 40. The average age was just 32.
This prevalence is startling, given that young men are less likely to have the sort of illnesses linked to the condition than their older peers, such as heart disease and diabetes. Additionally, younger guys are more likely to have leaner body masses and higher testosterone levels, which can keep ED at bay. With that in mind, it’s time to take a long, hard look at what’s up with what’s, well, not up.
Underlying health issues
When a young guy has unexplained ED, the first thing that needs to be ruled out is a serious health problem. Even though major diseases are less likely to cause ED among young guys than older ones, Mayo Clinic urologist Landon Trost tells Mic that diabetes, hypothyroidism, familial hyperlipidemia, and cardiovascular conditions can potentially lead to ED in otherwise seemingly healthy young men. “This only makes up a small percentage of cases that we see, but they can be potentially serious conditions, so it is worthwhile to do baseline assessments at least once to rule them out,” Dr. Trost says.
Put simply, erections are governed by a balance between your body's rest-and-digest (parasympathetic) and your fight-or-flight (sympathetic) systems. When you're experiencing anxiety, the sympathetic system goes into overdrive, Dr. Trost tells Mic, it can be challenging to get or stay hard.
“If your body is facing a stressful situation—for example, being chased by a bear—it’s not an ideal time for an erection," he explains. Fleeing large carnivores doesn’t have to be part of your day-to-day life, as the body is hardwired to react to modern stressors in much the same way. When you frequently feel anxious in sexual situations, "it can lead your body to have an automatic trigger to shut down an erection every time the situation presents itself,” Dr. Trost explains, adding that the longer the anxiety lasts, the more difficult it can be to break the cycle.
One cause of this problem could be the way that drug companies have deemed having any type of erection trouble unacceptable, said Nicole Prause, a neuroscientist who specializes in sexual behavior in the Guardian. “Everyone has erectile problems from time to time,” she says. “It would be weird if you didn’t.” Talking to your partner about the issue can help as can talking to a therapist.
According to a recent study published in the Journal of Abnormal Psychology, there was a 71% increase in the amount of serious psychological distress experienced by young adults ages 18-25 between 2008 and 2017. That’s a striking uptick, and it may well be a contributor to the prevalence of ED among young, physically fit men.
Dr. Trost notes that while depression often isn’t directly associated with erectile dysfunction, it is commonly linked to low libido, due to how it limits the release of "positive" neurochemicals like dopamine, serotonin, and catecholamines.
Lack of exercise
According to a study published in the journal Preventative Medicine, the average physical activity level of 19-year-old Americans is comparable to that of 60-year-olds. Worse, the same study found that, on average, men's physical activity drops off more than that of women's as we age. But the more you exercise, the better chance you have of reducing your risk of ED.
“The introduction of a cardiovascular routine 30 minutes, three times weekly can improve erectile function by the equivalent of a half of a Viagra,” says Dr. Trost.
The Center for Disease Control and Prevention (CDC) reports that over a third of American adults aged 20-39 are obese. While the causes of obesity vary, Dr. Trost notes that the condition can reduce total testosterone in men, impair penile function, and result in a concealed penis due to a suprapubic fat pad, regardless of the reason. "In the United States, diabetes and obesity are responsible for 8 million cases of erectile dysfunction," reported a 2014 study by the NCBI, adding that as a man's BMI increases, so does his risk of having ED.