Dear Dr. Roach: I’m 21 years old, and I have had trouble getting and maintaining erections since 2017. I don’t smoke or drink alcohol. What might be the possible cause? — I.A.
Answer: Erectile dysfunction is a common problem in older men, but it’s very uncommon in teenagers and young adults.
There are four major systems involved in erectile function. The heart and blood vessels need to be adequate, and while this is frequently a problem for older men with blockages, it would be rare but not impossible for a man your age. The nerves to the penis need to be intact, and nerve damage from trauma could occasionally cause this problem. You would have known about a nerve problem after the trauma began. Although it’s rare, I have had dedicated bicyclists note decreased erections after spending all day on the bike.
The hormones of the body need to be in balance. Low testosterone is a big issue and you should be checked, but high estrogens and prolactin also can cause ED. Your doctor should consider testing all of these hormone levels.
I’m glad you don’t smoke, but heavy cannabis use can lower testosterone enough to cause ED, even in young men. Finally, the brain is called the primary sex organ in humans for good reason: Psychological or relationship issues can certainly cause difficulty with erections.
Most 21-year-olds are transitioning from their pediatrician or adolescent medicine specialist to an adult medicine doctor, but any general doctor should be able to evaluate what might be going on.
