Dr Deborah Lee of the Dr Fox Online Pharmacy tackles those questions you were afraid to ask…
Are you a young man worried about your erections? If so, you need to read this.
Until recently, erectile dysfunction (ED) was more common in older men. But worrying new data shows ED is increasing in young men under the age of 40.
- What does the research show?
- What are the underlying reasons?
- What can be done to reverse this trend?
New ED research
ED affects 29.3% of men under 40
In a 2022 UK study of 12,490 men, 29.3% (almost 1 in 3) men aged under 40 reported ED. In men aged over 40, this was 45.6%. Overall, 2 out of 5 men aged 18 and over were affected by ED. ED may be the first sign of impending cardiovascular disease and serves as an opportunity to improve lifestyle factors and improve cardiac outcomes.
The authors commented that doctors frequently think ED at a young age is transient and unlikely to have a serious underlying cause, meaning many men miss out on the recommended cardiometabolic investigations.
Other studies have had similar findings
In a 2017 medical literature review, the authors also reported a prevalence of ED in men under 40 of 30%. Causes of ED were classified as either psychogenic or organic.
Psychogenic causes included men with depression, anxiety and relationship difficulties. They often had a sudden onset to their ED, and a lower libido but were able to have spontaneous or self-stimulated erections.
Organic causes were classified as due to vascular disease, hormonal issues, neurological, structural or cause unknown. This type of ED tended to come on slowly, with the patient having a normal or low libido.
For both groups, phosphodiesterase inhibitors (PDE5Is) continued to be the most common form of treatment.
US study shows ED affects 14.3% of men under 30
In a 2020 US study of men aged 18 – 30 years, 14.3% reported ED. 11.4% reported mild ED and 2.9% reported moderate/severe ED. Risk factors included anxiety and depression, use of antidepressants and tranquilizers. 30% of the men in the study admitted to misuse of ED medication – such as using ED medication with amphetamines to prolong a sexual encounter or taking supplements such as horny goat weed with ED drugs. This is very dangerous and can even be fatal.
Studies from around the world
European studies have reported ED in men under 40 to be between 1% -10%. Studies from Australia and America show ED prevalence may be as high as 1 in 4 men under 40.
Reasons for the rise in ED in young men
These findings may be explained by looking at the stress of modern life and the changes in various lifestyle factors and medical conditions. Let’s look at these one by one.
Young men have high stress levels
The current cost of living crisis means that millions of adults are experiencing financial anxiety. The 2025 Annual Burnout Report found that 1 in 3 (34%) of adults has suffered extreme work stress ‘always’ or ‘often’ in the past 12 months. 9 out of 10 adults (81%) have felt extreme pressure at some point. It is young people who seem to be more affected by work stress than older people. A higher proportion of those aged 18-24, 25-34 and 35-44 need time off work due to stress than those aged 45 and over, in whom work absence due to stress has declined.
Reasons for work-related stress included 48% having to work unpaid overtime, 46% doing extra hours because of the cost-of-living crisis and 44% who felt isolated at work. 25 -34-year-olds were most likely to feel extreme stress due to being overwhelmed by their workload or worrying about redundancy or job security. In addition, workplace support systems have been unable to cope with the increase in demand, leaving workers with worsening stress and poorer mental health.
Why does stress cause ED?
Stress is hugely damaging for erectile function. When you feel stressed your body perceives danger. Your brain activates the sympathetic nervous system (SNS) preparing for ‘fight, fright and flight’. Your heart races, your blood pressure rises and you start to sweat. Activation of the SNS switches off the parasympathetic nervous system (PSNS) which is needed for relaxation and dilatation of the penile blood vessels to produce an erection.
Stress also raises cortisol levels and lowers testosterone levels which is not conducive to sex. It also raises blood pressure which damages the cells lining arterial walls, so they are less responsive to the vasodilator effect of nitric oxide.
More young men have poor mental health
There’s no doubt mental health has declined in young people in recent years. In 2000, 24% of those age 18-24 suffered from depression, anxiety and bipolar disorder. However, 10 years later, in 2021/2023 this figure had increased to 34%. Over half a million 18–21-year-olds were prescribed antidepressants in 2021-2022 – antidepressants can cause ED.
How does poor mental health cause ED?
Your mental health is closely linked to your physical health. In depression, men lose interest in many things, including sex. They also suffer from low self esteem and anxiety- both of which don’t help sexual function. Antidepressants are a common cause of ED. Depression is often bound up in relationship issues which are also harmful for good erections.
ED-associated medical conditions
Obesity
Obesity levels have been steadily rising. In general, men are more likely to be obese than women. 67% of men are currently overweight or obese compared to 61% of women. A recent 2025 House of Commons report shows that overall, 33% of those aged 25-34 are currently overweight and 24% are obese. In the 35–44-year-old age group, 35% are overweight and 32% obese. These levels are similar in older age groups and even higher in those aged 75 and above.
Why does obesity cause ED?
Obesity leads to lower testosterone levels and even raises oestrogen levels in men. It also damages the endothelium – the cells lining blood vessel wall which are crucial for producing an erection – as well as raising levels of systemic inflammation. Being overweight or obese causes stress and low self-esteem which have a negative effect on erectile function. Obesity increases the risk of high blood pressure and type-2 diabetes (T2DM) both of which are linked to ED.
Type-2 diabetes (T2DM)
There has been a worrying rise in T2DM in people under 40. Diabetes UK has reported a 40% rise in the diagnosis of type-2 diabetes in those aged under 40, between 2016-17 and 2022-23. This is distinct change as T2DM was always known to be a condition that usually affected older people. Disadvantaged groups are most affected. To add to this concern, around 1.2 million people with T2DM remain undiagnosed in the community – many men don’t know they have it.
Why does T2DM cause ED?
Over time, diabetes causes nerve damage to the nerves that supply the penis. This is called diabetic neuropathy. High blood glucose levels also damage the walls of the arteries and makes them unable to relax properly. Good diabetic control can significantly reduce the risk of developing ED in diabetic men.
High blood pressure
This is also surprisingly common in young men aged under 40. 2024 data shows that 9% of young adults aged 16-44 have hypertension – based on a reading of 140/80 or above. Hypertension appears to be twice as common in men as in women. Other data shows that globally, the diagnosis of hypertension has been increasing over the past 25 years.
Of great concern, 140,00 young men aged 16-24 are unaware they have high blood pressure. This means 66% remain undiagnosed in the community according to ONS figures. Young people will live longer with raised blood pressure, meaning they are exposed for longer to its damaging effects on the heart, kidneys, retina and arterial walls – including those in the penis.
Why does high blood pressure cause ED?
The lining of the arterial walls is also damaged by high blood pressure, also meaning they cannot dilate properly to fill with blood to cause an erection. It also results in a reduced production of nitric oxide, which is essential to produce an erection. Sometimes high blood pressure is linked to lower testosterone levels. Lowering blood pressure and maintaining good blood pressure control reduces the risk of ED.
Young men are more likely to smoke
Men are more likely to smoke than women. 2025 UK data shows that 18.9% of men aged 25-34 are current smokers. This is the age and sex group in the UK with the highest prevalence of smoking.
Why does smoking cause ED?
Smoking is incredibly dangerous for erectile function. It damages the endothelium, the cells lining arterial walls, such that these cannot relax appropriately to allow the penile tissues to fill up with blood. It lowers the amount of nitric oxide (NO) which is produced in penile tissues which is essential to cause vasodilation. Stopping smoking in young men is one of the best things they can do to improve their erections.
Many men have swapped to vaping
Men may believe that vaping is safer for their health. In fact, very few studies have assessed the link between vaping and ED.
Why might vaping cause ED?
However, studies have shown that vaping has a similar effect on the endothelium as smoking, in that airway inflammation from vaping causes vascular inflammation and reduced production of NO. High quality studies on vaping and its effects specifically on the penile vessels and tumescence are urgently needed.
Young men drink more alcohol
Men under 40 are most likely to drink harmful amounts of alcohol. Data from the Global Burden of Disease study 2020 has shown that 59% of those who drink harmful levels of alcohol are aged 15-39. And that three quarters of these harmful drinkers were men.
Why does alcohol cause ED?
Alcohol negatively affects every stage of the sexual experience – arousal, erectile function, ejaculation and orgasm. It also lowers hormone production and reduces the sperm count, causing infertility.
Cocaine and illicit drug use is common in young men
Cocaine use has doubled in the UK over the past 10 years. 10.3% of UK adults admitted to the use of cocaine in 2023. 79% of cocaine-related deaths are in males. Many now feel that cocaine is cheaper on a night out than a round of drinks.
How does cocaine cause ED?
Cocaine often improves sexual function in the beginning, but as time passes it interferes with the body’s natural processes leading to lower libido, erectile dysfunction and even genital numbness.
Mixing cocaine and Viagra is dangerous as it can cause priapism – painful prolonged erections which if not treated urgently can lead to gangrene of the penis and penile amputation.
Viewing pornography is common in men
The rise in the use of pornography mirrors the increase in erectile dysfunction. Up to 70% of men use pornography regularly. Some studies show porn use is greater in younger than older men. A link between ED and use of porn has been noted. This has led to the development of the term porn-induced erectile dysfunction (PIED).
How does porn cause ED?
The exact mechanisms are unclear but intense sexual images may overload the brain reward systems leading to arousal tolerance.
What to do about ED in young men
Improve lifestyle factors
If you are a young man worried about ED, you can see there are many possible factors that could be underlying your problem. We live is a stressful world. To improve your erections now and in the longer term, you need to consider all these risk factors and see what you can do to improve them. Stopping smoking and vaping, losing weight, drinking less alcohol, and staying away from drugs are all important. ED can be seen as a wake-up call for better health.
See the doctor
Anyone can have an occasional poor erection, but if the problem keeps happening and you are unable to have a good enough erection to have sex, go to the Sexual Health Clinic or see your GP.
Try not to be embarrassed
Try not to be embarrassed. As you can see, so many other young men are having the same problem. The doctor is used to seeing men with this problem and will do their best to put you at your ease.
The ED consultation
The doctor will ask about stress and relationship issues. Basic tests will include having your blood pressure checked, your urine checked for glucose (to exclude diabetes) and having some blood tests such as testosterone and other hormone tests, thyroid function tests, prolactin, and a lipid profile.
ED medication – phosphodiesterase inhibitors
The first-line treatments are a type of medication called phosphodiesterase inhibitors (PDE5s). These are Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) and Spedra (avanafil). They vary slightly in how to take them, how long they last etc… Your doctor will help decide which may be the best one for you. These can be prescribed for you, or you might prefer to purchase them from a reputable online pharmacy.
Counselling and ED
You may also need to see a sex and relationship therapist. Some men will benefit from specialist psychosexual counselling. Your doctor can advise you on how to get in touch with these services.
Final thoughts
ED is serious. It can’t be a coincidence that at present, the UK birth rate is at all-time low. Having good sexual function is imperative for a man to be in good health, and for survival of the human species. The world has become a stressful place to live in, and this stress is having enormous repercussion on male sexual health.
If you are worried about your erections, it’s time to seek help. Don’t try and ignore it and hope it will go away – go for help and the sooner the better.
- What could you do today to start improving your erectile function?
Don’t forget, all Salon Gold policies for salons include FREE access to a counselling helpline. Qualified counsellors are on hand whenever you need them to provide free confidential support and advice by phone to all policyholders, their employees and their families. Counselling is offered for those suffering from emotional upset or feeling worried and anxious about a personal or work-related problem.
