Erectile Function in Physically Active Young Men: Psychological, Behavioral and Training-Related Factors
DOI:
https://doi.org/10.12775/JEHS.2026.87.67453Keywords
erectile dysfunction, young adults, mental health, physical activity, muscle dysmorphia, anabolic steroids, MIPSAbstract
Introduction. Erectile dysfunction (ED) is increasingly reported among young men, including those who train regularly and maintain a physically active lifestyle. In this population, traditional risk factors are less prominent, while psychological components, body-image pressures, training overload and the use of substances aimed at improving appearance or performance appear to play a greater role. At the same time, ED may lead to a decline in psychological well-being, reduced self-confidence and impaired sexual quality of life.
Aim. The aim of this narrative review is to summarise current knowledge on the interplay between erectile function and mental health in physically active young men, with attention to epidemiology, underlying mechanisms, risk factors, diagnostic considerations and clinical implications.
Methods. This review is based on an analysis of literature indexed in PubMed, Scopus and Google Scholar from 2000 to 2025. Observational and experimental studies, systematic reviews and publications in the field of sport psychology were included.
Results. Available evidence suggests that ED may be more common among young men who train intensively, especially in those exposed to strong body-image expectations, excessive training loads, or the use of supplements and anabolic-androgenic steroids (AAS). Psychological factors such as anxiety, depressive symptoms and muscle dysmorphia appear to contribute both to the development of ED and to its consequences. The relationship between mental health and erectile function seems to be bidirectional.
Conclusions. Physically active young men represent a group in whom ED may remain undetected despite significant impact on well-being and sexual functioning. Clinical assessment should include screening for mental-health concerns as well as evaluation of training patterns and supplement use. Further research is needed to clarify mechanisms and develop strategies for prevention and early intervention in this population.
References
1. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates. J Urol. 1994;151(1):54–61.
2. Johannes CB, Araujo AB, Feldman HA, et al. Incidence of erectile dysfunction in men 40 to 69 years old. J Urol. 2000;163(2):460–463.
3. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile dysfunction in young men—a review of the epidemiology and risk factors. World J Mens Health. 2017;35(2):1–10.
4. Rowland DL, Motofei IG. The relationship between anxiety and sexual dysfunction. J Sex Med. 2013;10(4):1044–1056.
5. McCabe MP, Sharlip ID, Lewis R, et al. Risk factors for sexual dysfunction. BJU Int. 2016;117(2):260–272.
6. Pope HG, Phillips KA, Olivardia R. The Adonis Complex. New York: Free Press; 2000.
7. Hackney AC. Stress and the neuroendocrine system: the role of cortisol. J Endocrinol Invest. 2006;29(3):242–248.
8. Kanayama G, Hudson JI, Pope HG. Illicit anabolic-androgenic steroid use. Lancet. 2008;371(9618):683–693.
9. Mitchell L, Murray SB, et al. Muscle dysmorphia: current insights. Psychol Res Behav Manag. 2017;10:1–11.
10. Rahnema CD, Lipshultz LI, Crosnoe LE, et al. Anabolic steroid–induced hypogonadism. Fertil Steril. 2014;101(3):591–596.
11. Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153–165.
12. Capogrosso P, Colicchia M, et al. One patient out of four with newly diagnosed ED is a young man. J Sex Med. 2013;10(7):1833–1841.
13. Griffiths S, Murray SB. Muscle dysmorphia and supplement use. J Strength Cond Res. 2015;29(11):3141–3148.
14. Giuliano F, Clément P. Neurobiology of erection. Physiol Rev. 2006;86(4):1181–1220.
15. Pizzol D, Demurtas J, Celotto S, et al. Erectile dysfunction and depression: prevalence and associated factors in young men. Int J Impot Res. 2021;33(3):239–246.
16. Corona G, Lee DM, Forti G, et al. Age-related changes in general and sexual health. J Sex Med. 2010;7(4):1362–1380.
17. Sansone A, Sansone M, Romanelli F, Lenzi A. Endocrinology of overtraining syndrome. Mol Cell Endocrinol. 2018;472:51–58.
18. Bahr R, Mujika I. Overtraining syndrome. Br J Sports Med. 2020;54(2):102–104.
19. Bussey MD, Hill RM. Pornography-induced erectile dysfunction: a growing problem? Curr Sex Health Rep. 2020;12(4):236–244.
20. Lewis RW, Fugl-Meyer KS, et al. Definitions/epidemiology/risk factors of sexual dysfunction. J Sex Med. 2010;7(4 Pt 2):1598–1607.
21. Balon R. Mood, anxiety and sexual dysfunction. J Sex Med. 2008;5(6):153–158.
22. Muschamp JW, Hull EM. Neuroendocrine mechanisms of male sexual behavior. Neurosci Biobehav Rev. 2007;31(3):394–412.
23. Kalichman L, Breslav I. Endocrine responses to high-volume training. J Strength Cond Res. 2008;22(6):1881–1886.
24. Grieve FG. A conceptual model of factors contributing to muscle dysmorphia. Eat Disord. 2007;15(1):63–80.
25. Tod D, Edwards C, Cranswick I. Muscle dysmorphia in male weightlifters: risk factors and correlates. Body Image. 2016;18:69–75.
26. Russell BS, Gervais C. Exercise addiction: a systematic review. Curr Addict Rep. 2022;9:365–376.
27. Andersen ML, Tufik S. Effects of sleep deprivation on sexual function. Brain Res. 2007;1227:56–73.
28. Rosen RC, Althof SE. Psychogenic erectile dysfunction. Endocrine. 2021;73(1):1–11.
29. Ganesan K, Habbous S, et al. Lifestyle and erectile function: a review. Andrology. 2018;6(2):234–242.
30. Dohle GR, Arver S, Bettocchi C, et al. Guidelines on male sexual dysfunction. Eur Urol. 2018.
31. McBride JA, Carson CC. Diagnosing ED in young men. Urol Clin N Am. 2007;34(4):541–548.
32. Sansone A, Rebelos E, et al. Testosterone and physical performance. Front Endocrinol. 2021;12:706078.
33. Martínez-Sánchez LM, Kotzur-Barbrook L, et al. Sexual health in athletes. Sports Med. 2022;52(4):695–710.
34. Ricci E, et al. Alcohol, smoking and erectile dysfunction. J Sex Med. 2019;16(7):1031–1039.
35. Sato R, et al. Smartphone use and sexual dysfunction in young men. J Sex Med. 2023;20(1):31–38.
36. Counsilman JJ. Anxiety and sport performance. Sports Psychol Rev. 2018;27:145–160.
37. Gilchrist P, Wheaton B. Lifestyle sport, risk and identity. Int Rev Sociol Sport. 2017;52(7):745–764.
38. Paradis KF, Marshall J, et al. Self-esteem, body image and anxiety in young male athletes. Psychol Sport Exerc. 2019;45:101569.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Małgorzata Maliszewska, Marek Ząbczyński, Sabina Ściążko-Gancarczyk, Jagoda Węgrzyn, Maciej Gancarczyk

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 222
Number of citations: 0