Markets 
Harlan Randell was a late bloomer in the bedroom.
The 24-year-old Brit didn’t lose his virginity until 21 — and when he finally took the leap, he ran into an unexpected obstacle that would haunt him for years: erectile dysfunction.
“I was absolutely mortified,” Randell, a sports distribution customer service and logistics specialist, told The Post.
He’s hardly alone.
Not long ago, ED was primarily seen as an older man’s issue, typically affecting patients over 50 with underlying health problems. But that stereotype is going soft.
Younger men are increasingly facing troubles in the bedroom, with studies suggesting more than a quarter of men under 40 can’t get or maintain an erection firm enough for satisfying sex.
The Post spoke to six urologists and two sex therapists who reported seeing a steady stream of men in their 20s and 30s seeking help for ED — with even younger patients joining the mix.
“We’re clearly seeing an increase in concern by older teenagers that they have erectile dysfunction,” said Dr. Lane Palmer, chief of pediatric urology at Cohen Children’s Medical Center in Queens. “We’re getting one or two calls a week seeking a consultation.”
So what’s behind the surge of young men in their sexual prime struggling with performance? Here’s what the experts have to say.
Hardware trouble
For years, ED was thought to be mostly a psychological issue. But for men who fit the classic patient profile, doctors now know physical problems often play a major role — especially anything that interferes with blood flow to the penis.
“When we see an older patient come to the office and they have ED, they often have some combination of obesity, diabetes, high blood pressure and medications to treat those conditions, which can contribute to ED, along with some underlying cardiovascular disease,” said Dr. Jason B. Carter, a board-certified urologist and medical advisor to Aeroflow Urology.
Low testosterone, common in men 45 and older, may also affect sexual function, particularly libido. Lifestyle factors like smoking, substance use and poor diet can make matters worse.
“Typically, older gentlemen are going to be more likely to have erectile inconsistencies because of biological factors,” said Rocky Tishma, co-founder of Manhattan Sex Therapy Group.
“But recently, a lot of younger men are coming in after going through a primary care provider or a urologist and finding there’s nothing wrong physiologically,” he added.
In fact, all of the experts The Post spoke to agreed: The ED affecting many young men can’t be traced to anything that would show up in a blood test or physical exam.
“In my clinical practice, we are seeing a clear and steady increase in younger men presenting with symptoms of ED,” said Dr. Bilal Chughtai, chief of urology at Plainview Hospital in New York. “What’s particularly notable is that these patients are often otherwise healthy.”
Mind over mojo
“A very large portion of ED in younger men is what’s called psychosomatic, basically stress- and anxiety-induced,” said Dr. Leon Telis, a board-certified urologist and director of the Men’s Health Program at Mount Sinai Hospital.
Much of that stress comes from the constant messages about sex young men get from friends, social media and pornography.
In the US, 57% of young adults ages 18 to 25 watch porn at least once a month. One survey found that two-thirds of Gen Z began watching before age 16, subtly shaping their ideas of sex.
Tishma often sees a pattern: Young men have no problems getting erections in the morning or while masturbating, but the moment they try to be intimate with another person, their penises don’t rise to the occasion.
“It ends up being a lot of stress, anxiety and psychological issues that are keeping them from being able to show up in their body how they want to when they’re interacting with another person,” he said.
While watching porn isn’t automatically a bad thing, Telis explained that it can desensitize young men to real-world intimacy. “Their arousal level with what they imagine is going to be much higher than what is happening in reality,” he said.
“What are we left with? We’re left with a bunch of young men in their 20s and 30s who are convinced they have a broken d—k.”
Dr. Joel Hillelsohn
It can also create an unrealistic expectation for performance in bed.
“Pornography is often an exaggeration of sexuality,” Palmer said. “Now with AI, who knows what kinds of imaging and messaging are going to be created, and that’s just going to stir up more anxiety and more concern.”
Randell knows this struggle firsthand. He went to his doctor with concerns about ED, and all the tests came back normal — yet the problem persisted.
“I would definitely say that it was due to my anxiety and porn exposure from a very young age,” Randell said. Researchers have linked higher rates of ED to men who began watching pornography early in life.
“Social media and body dysmorphia definitely played a part too,” Randell admitted. “I have always loathed my body, so that added an extra layer of anxiety.”
Part of the problem is that anxiety doesn’t just live in the mind — it affects the body too. Erections rely on the parasympathetic nervous system, which releases nitric oxide to fill the penis with blood, explained Dr. Joel Hillelsohn, a board-certified urologist at NYU Langone Ambulatory Care Chelsea.
Even a fleeting worry about performance prompts the brain to release adrenaline, the body’s fight-or-flight hormone, which constricts blood vessels and softens the penis.
“If you are nervous about maintaining erections, you will secrete adrenaline and make your erection worse,” Hillelsohn said.
Just one experience like this can set the stage for performance anxiety that affects erections moving forward, a phenomenon called the “sexual tipping point.”
“It becomes a pattern — and a pattern is very hard to break,” Hillelsohn said. “What are we left with? We’re left with a bunch of young men in their 20s and 30s who are convinced they have a broken d—k.”
Growing awareness, shrinking penises
While experts agree ED has risen among young men, they note that the wider conversation around the issue has also made more patients comfortable seeking help for a problem that was once — and sometimes still is — relatively taboo.
“I think it’s actually become more socially acceptable to have ED,” Hillelsohn said. “This has always persisted and patients have just suffered in silence.”
A lot of that shift comes from the internet, Palmer said. “It’s not uncommon now with Dr. Google to type in the symptom and then walk into a doctor’s office and say, ‘I have this problem.’”
Experts theorize that the rise in direct-to-consumer websites selling treatments like Viagra, Cialis and testosterone replacement therapy have also fueled the trend.
“Everywhere you look you see an advertisement for companies like Ro or Hims that have made erectile dysfunction medication so easily available now that I think people are much more willing to talk about it,” Telis said.
But whether all of these young men actually need drugs is another matter.
“Many younger men are turning quickly to medications like sildenafil (Viagra) or tadalafil (Cialis), often through direct-to-consumer platforms without a comprehensive evaluation,” Chughtai said. “While these medications can be effective, they don’t address the underlying cause, especially when the issue is psychological or lifestyle-driven.”
Determined to get to the bottom of his ED, Randell limited his masturbation and porn use and got a prescription for Viagra. It helped, but he said the real game-changer was being in a relationship with someone who made him feel safe in the bedroom.
“She understands that it’s not an insult or anything she’s done,” Randell said. “The biggest change was her knowing how to put my nerves at ease.”
These days, he rarely reaches for Viagra, finding that his anxiety around sex — and the ED that came with it — has largely faded.
“It wasn’t my body being broken,” Randell said. “Just my mind not connecting to it.”
Read the full article here
