Erectile Dysfunction in Young Men: Anxiety, Lifestyle or Something Physical?

Erection problems are often thought of as something that happens to older men. They are not. In one study of men seeking help for new erection problems, one in four was under 40¹. If it is happening to you, it is common, it is treatable, and it is worth understanding the cause.

Occasional problems are normal

Most men sometimes fail to get or keep an erection. The NHS says this is usually caused by stress, tiredness or drinking too much alcohol, and is nothing to worry about². It becomes worth looking into when it happens often.

Is it anxiety or something physical?

In younger men, psychological causes are common, but physical causes still need to be ruled out. Some clues help, though they are not a diagnosis:

• Morning erections. Depending on the cause, you may still get erections at other times, such as when you wake up². Normal erections at night or on waking suggest the blood vessels and nerves are working, which points more towards a psychological cause³.
• The situation. European guidelines describe “situational” ED, linked to a particular partner, worry about performance, or distress³. If erections are fine when you are alone but not with a partner, anxiety is a likely part of the picture.
• A gradual change in every situation, including on waking, makes a physical cause more worth checking.

A doctor will usually ask about your erections, sex drive and general health, and check your blood pressure, blood sugar, cholesterol and an early-morning testosterone level³.

Performance anxiety and the stress cycle

Anxiety, depression, stress, feeling isolated and low self-esteem can all cause ED or make it worse⁴. A single bad experience can start a cycle: you worry it will happen again, the worry gets in the way, and it does happen again.

Breaking that cycle is very possible. A counsellor or sex therapist can help lower anxiety and stress about sex, and may suggest your partner comes to some sessions⁵. European guidelines recommend cognitive behavioural therapy, including the partner where it helps, alongside medical treatment³.

Lifestyle factors

Several everyday habits are linked to ED⁴³:

• Alcohol: heavy drinking, both on a night out and over time.
• Smoking.
• Recreational drugs, including cannabis, cocaine, heroin and synthetic drugs.
• Anabolic steroids, used for bodybuilding.
• Too little physical activity, and being overweight.

Changing these can help: doctors may suggest stopping smoking, cutting down on alcohol, stopping recreational drugs, being more active and keeping to a healthy weight⁵.

Physical causes not to miss

Even in young men, ED can be the first sign of a health problem⁴:

• Diabetes. Erection problems can be an early sign. See our guide to diabetes and erectile dysfunction.
• High blood pressure or cholesterol. In one study, younger men with ED had a higher estimated risk of future heart disease, so European guidelines treat ED as a possible early warning sign³.
• Hormone problems, such as low testosterone or thyroid problems.
• A curved penis (Peyronie’s disease).
• Medicines, especially antidepressants. See our guide to medicines that can cause ED.

Do ED pills help if the cause is anxiety?

They can. Sildenafil (Viagra) was tested in men with physical, psychological and mixed causes of ED, and the label reports that it worked regardless of the cause⁶. Guidelines suggest combining talking therapy with medical treatment, so a tablet works best alongside tackling the anxiety itself, not instead of it³.

ED tablets are prescription medicines (in the UK, sildenafil is also available from a pharmacy after a consultation with a pharmacist)⁷. Get a check-up rather than borrowing a friend’s tablets, so other causes are not missed.

A dangerous combination: poppers and ED pills

Never take an ED tablet with poppers (amyl nitrite and similar). European guidelines list recreational nitrites as an absolute no with ED tablets, because together they can make blood pressure fall dangerously and unpredictably³. The same applies to nitrate medicines for chest pain.

Getting help

• Your GP or a sexual health clinic is a good first step. They see erection problems every day.
• A counsellor or sex therapist if anxiety, stress or relationship issues are part of it⁵.
• Do not stop any prescribed medicine on your own, even if you think it is the cause; ask your doctor about alternatives⁵.

For an overview of treatments, see what is erectile dysfunction? If you also have premature ejaculation, see our guide to premature ejaculation treatment. Our ED medicines page lists the treatments we supply.

ED tablets we supply include Viagra 50 mg, Cialis 10 mg and generic sildenafil such as Suhagra 100 mg. All need a prescription, and a check-up first is a good idea.

Frequently asked questions

Is ED normal at 25?

Occasional problems are normal at any age, often due to stress, tiredness or alcohol. Erection problems that happen often are not something you just have to live with. They are common in young men and treatable, but worth a check-up.

Can anxiety cause ED?

Yes. Anxiety, stress and depression are common causes, and worry about performance can create a cycle. Counselling or therapy, sometimes with an ED tablet, can help break it.

Can young men take Viagra?

Adult men of any age can be prescribed ED tablets if they are suitable. It is still worth seeing a doctor first, because ED in a young man can be the first sign of another health problem.

How do I know if my ED is psychological?

Normal erections when you wake up or when you are alone, with problems only in certain situations, point towards a psychological cause. A doctor can check for physical causes to be sure.

Can cannabis or steroids cause ED?

Yes. European guidelines list cannabis, other recreational drugs, anabolic steroids and heavy drinking among the causes of ED.

Sources & references

1. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Epidemiology and prevalence.
2. NHS. Erectile dysfunction (impotence). Page last reviewed 28 July 2023.
3. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Management of erectile dysfunction.
4. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Erectile Dysfunction. Last reviewed October 2024.
5. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Erectile Dysfunction. Last reviewed October 2024.
6. US National Library of Medicine, DailyMed. Viagra (sildenafil) prescribing information.
7. NHS. Sildenafil (Viagra). Page last reviewed 29 July 2026.

Related reading

• ED or low testosterone?
• Is Viagra over the counter?
• Viagra not working? What to try next
• How to take sildenafil
• Sildenafil medicines
• Tadalafil medicines

This content is for informational purposes only and is not medical advice. If erection problems are affecting you, talk to a doctor or sexual health clinic. Used as prescribed by a licensed medical professional.