Calzo JP, Austin SB, Charlton BM et al: Erectile Dysfunction in a Sample of Sexually Active Young Adult Men from a U.S. Cohort: Demographic, Metabolic and Mental Health Correlates. J Urol 2020; 2: 539.

Most published medical literature on erectile dysfunction (ED) focuses on men in middle age and older. For such men, ED is an independent marker of cardiovascular disease and the underlying evaluation is directed toward defining contributory cardiometabolic risk factors. Initial management stresses activity and dietary changes to improve cardiovascular fitness.¹

ED in younger men is often attributed to a psychogenic etiology and management is skewed toward addressing the presumed mental health disorder. These traditional approaches to the diagnosis and treatment of younger men with ED remain largely underexamined. Treatment patterns for these men—medication usage, whether treatment is supervised by a physician or not, and use of over-the-counter supplements to treat ED—are also poorly understood. It is important to understand whether younger men with ED reflect a distinct pathophysiology, different from that of older men.

We sought to examine these questions through a large U.S. prospective cohort, the Growing Up Today Study, of men 18 to 31 years old who were sexually active during the past year. Men were evaluated with the International Index of Erectile Function Questionnaire (IIEF) for the presence of moderate-to-severe ED versus no ED or mild ED for purposes of our study. Men were questioned about their recent usage of ED medications and/or supplements and how they obtained the product. Self-reported demographic and medical—including mental health—indicators were also recorded.

Of 2,660 men evaluated, the overall prevalence of ED in our cohort—14%—was similar to other previously published community cross-sectional studies. However, we noted 3% of respondents reported moderate-to-severe ED, which is a higher prevalence than has been previously reported. Only a small percentage of men (2%) reported using ED medications or supplements. Of these men 20% reported potential misuse of prescription drugs that may have included using a medication prescribed for someone else or purchasing medication without a prescription.²

Interestingly, age and metabolic risk factors (such as waist circumference, diabetes, or hypertension) were not associated with greater odds of ED. Men who were not married or not living with a partner, who reported antidepressant use, or who reported anxiety or using tranquilizers had greater odds of moderate-to-severe ED. However, depression was not independently associated with ED after controlling for antidepressant medication use. These findings indicate that cardiometabolic risk factors often associated with ED in older men may not reliably apply to younger patients.

Limitations of our study include a lack of granular data on other possible causes of ED including testosterone deficiency, neurological disorders, testosterone supplementation/anabolic steroid use, and consumption of alcohol, tobacco, or other drugs. It is also possible that men with more severe ED may have been underrepresented in our study, which examined only those men who were sexually active within the last year. Finally, the limited racial/ethnic and socioeconomic diversity of our cohort may limit broad applicability of our results.

The results of our study underscore the importance of asking younger patients about symptoms of erectile dysfunction. In particular, those men being treated for anxiety and depression should be screened for erectile dysfunction. While more study is needed to further define other clinical correlates, these results may be helpful to counsel concerned young patients about the prevalence of ED in their age group.