Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Beyond the prescription: trends and challenges in erectile dysfunction medications among young adult men

International Journal of Impotence Research (2024)Cite this article

Subjects

Abstract

We sought to assess erectile dysfunction (ED) medication use among males aged 18–40. Between June and July 2023, a cross-sectional survey on Qualtrics (Provo, UT) was disseminated via Research Match. Among 210 respondents, ED prevalence was 57.1% with 39.0% reporting prior ED medication use. Black or African American race (OR = 3.54, p < 0.001), Hispanic or Latino ethnicity (OR = 3.32, p = 0.01), and Medicare or Medicaid insurance status (OR = 6.07, p < 0.001) were associated with increased medication utilization. Income >$200,000 was associated with decreased medication usage (OR 0.23, p = 0.04). ED severity significantly correlated with higher medication usage. Primary care providers were the most common source of acquisition (47.6%), followed by online direct to consumer (DTC) platforms (31.7%) and personal connections (19.5%). Privacy (n = 51, 62.2%) and cost (n = 45, 54.9%) were key considerations in obtaining medications. Despite 73.2% of individuals receiving counseling regarding risks/benefits and 84.1% receiving instructions for proper use, only 28.0% correctly identified essential aspects of proper/appropriate use. Overall, we found a high ED prevalence and medication utilization rate. The preference for privacy in procuring medications suggests ongoing stigma around men’s sexual health. Despite extensive counseling, a significant knowledge gap remains indicating a pressing need for enhanced patient education.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

Readers interested in additional information regarding the study’s data, please contact the corresponding author.

References

  1. Laumann EO, West S, Glasser D, Carson C, Rosen R, Kang JH. Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the male attitudes regarding sexual health survey. J Sex Med. 2007;4:57–65.

    Article  PubMed  Google Scholar 

  2. Mark KP, Arenella K, Girard A, Herbenick D, Fu J, Coleman E. Erectile dysfunction prevalence in the United States: report from the 2021 National Survey of Sexual Wellbeing. J Sex Med. 2024;28;21:296–303.

  3. Madeira CR, Tonin FS, Fachi MM, Borba HH, Ferreira VL, Leonart LP, et al. Efficacy and safety of oral phosphodiesterase 5 inhibitors for erectile dysfunction: a network meta-analysis and multicriteria decision analysis. World J Urol. 2021;39:953–62.

    Article  CAS  PubMed  Google Scholar 

  4. Calzo JP, Austin SB, Charlton BM, Missmer SA, Kathrins M, Gaskins AJ, 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. 2021;205:539–44.

    Article  PubMed  Google Scholar 

  5. Mostafa T, Alghobary MF. Recreational use of oral PDE5 inhibitors: the other side of midnight. Sex Med Rev. 2022;10:392–402.

    Article  PubMed  Google Scholar 

  6. Wackerbarth JJ, Fantus RJ, Darves-Bornoz A, Hehemann MC, Helfand BT, Keeter MK, et al. Examining online traffic patterns to popular direct-to-consumer websites for evaluation and treatment of erectile dysfunction. Sex Med. 2021;9:100289.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dubin JM, Jesse E, Fantus RJ, Bennett NE, Brannigan RE, Thirumavalavan N, et al. Guideline-discordant care among direct-to-consumer testosterone therapy platforms. JAMA Intern Med. 2022;182:1321–3.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Research Match 2023 [updated 23 July 2023. Available from: https://www.researchmatch.org/about/.

  9. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    Article  CAS  PubMed  Google Scholar 

  10. Bechara A, Casabé A, De Bonis W, Helien A, Bertolino MV. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med. 2010;7:3736–42.

    Article  PubMed  Google Scholar 

  11. Pozzi E, Fallara G, Capogrosso P, Boeri L, Belladelli F, Corsini C, et al. Primary organic versus primary psychogenic erectile dysfunction: findings from a real-life cross-sectional study. Andrology. 2022;10:1302–9.

    Article  CAS  PubMed  Google Scholar 

  12. Aggarwal R, Yeh RW, Joynt Maddox KE, Wadhera RK. Cardiovascular risk factor prevalence, treatment, and control in us adults aged 20 to 44 years, 2009 to March 2020. JAMA. 2023;329:899–909.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Varma P, Junge M, Meaklim H, Jackson ML. Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: a global cross-sectional survey. Prog Neuropsychopharmacol Biol Psychiatry. 2021;109:110236.

    Article  CAS  PubMed  Google Scholar 

  14. Liu Q, Zhang Y, Wang J, Li S, Cheng Y, Guo J, et al. Erectile dysfunction and depression: a systematic review and meta-analysis. J Sex Med. 2018;15:1073–82.

    Article  PubMed  Google Scholar 

  15. Jesse E, Thirumavalavan N, Loeb A. Increase in direct-to-consumer telemedicine in urology. Curr Sex Health Rep. 2022;14:119–27.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol. 2017;6:79–90.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shahinyan RH, Amighi A, Carey AN, Yoffe DA, Hodge DC, Pollard ME, et al. Direct-to-consumer internet prescription platforms overlook crucial pathology found during traditional office evaluation of young men with erectile dysfunction. Urology. 2020;143:165–72.

    Article  PubMed  Google Scholar 

  18. Dubin JM, Wyant WA, Balaji NC, Ong WL, Kettache RH, Haffaf M, et al. Telemedicine usage among urologists during the COVID-19 pandemic: cross-sectional study. J Med Internet Res. 2020;22:e21875.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dubin JM, Aguiar JA, Lin JS, Greenberg DR, Keeter MK, Fantus RJ, et al. The broad reach and inaccuracy of men’s health information on social media: analysis of TikTok and Instagram. Int J Impot Res. 2024;36:256–60. https://doi.org/10.1038/s41443-022-00645-6

  20. Loeb S, Taylor J, Borin JF, Mihalcea R, Perez-Rosas V, Byrne N, et al. Fake news: spread of misinformation about urological conditions on social media. Eur Urol Focus. 2020;6:437–9.

    Article  PubMed  Google Scholar 

  21. Aguiar JA, Halpern JA, Hayon S, Brannigan RE, Dubin JM. Evaluation and characterization of testosterone-related mobile health applications. Int J Impot Res. 2024;36:448–9. https://doi.org/10.1038/s41443-023-00739-9

  22. Foster P, Luebke M, Razzak AN, Anderson DJ, Hasoon J, Viswanath O, et al. Stigmatization as a barrier to urologic care: a review. Health Psychol Res. 2023;11:84273.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ab Rahman AA, Al-Sadat N, Yun Low W. Help seeking behaviour among men with erectile dysfunction in primary care setting. J Men’s Health. 2011;8:S94–S6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA

    Jonathan A. Aguiar, Daniel R. Greenberg, Robert E. Brannigan & Joshua A. Halpern

  2. Department of Urology, Memorial Healthcare System, Aventura, FL, 33180, USA

    Justin M. Dubin

Authors
  1. Jonathan A. Aguiar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel R. Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert E. Brannigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joshua A. Halpern
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Justin M. Dubin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors meet the journal’s criteria for authorship, including. (1) Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results. (2) Drafted or revised the manuscript. (3) Approved the final version. (4) Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jonathan A. Aguiar.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study was reviewed and approved by the Northwestern University Institutional Review Board and completed in accordance with IRB approval #STU00219178.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aguiar, J.A., Greenberg, D.R., Brannigan, R.E. et al. Beyond the prescription: trends and challenges in erectile dysfunction medications among young adult men. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00902-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41443-024-00902-w

Search

Advanced search

Quick links