Author: Kate Daniel - 5 min read
Erections involve a complex mix of psychological, neurological, hormonal, and vascular factors. When one part of that system is off, erectile dysfunction can show up.
ED is also common. According to Cleveland Clinic, rates increase by roughly 10 percentage points per decade of age. That means about 40 percent of men in their 40s, 50 percent in their 50s, and so on experience some degree of ED. Even more men encounter misinformation about what actually causes it.
While ED becomes more common with age, younger men experience it too, often for different reasons. Johns Hopkins Medicine defines ED as the persistent inability to achieve or maintain an erection. Knowing what’s true and what’s not can help you take control of your health and move forward with confidence.
"ED is a bellwether of future cardiovascular problems in younger men."
Below are six common inaccuracies about ED, and what clinicians say instead.
Inaccuracy 1: ED means there’s something wrong with your penis, and only your penis
Physical changes to the penis can contribute to ED. These include age-related changes, injuries, Peyronie’s disease, and prior surgery or radiation to the pelvic area. Mental health can also play a role.
But ED often reflects health issues that affect far more than the penis, especially in younger men.
“ED is a bellwether of future cardiovascular problems in younger men,” said Martin Gross, M.D., a urologist at Dartmouth Hitchcock Medical Center. “If ED is occurring earlier than expected and the penile arteries are having difficulty getting adequate blood flow, it stands to reason that other important blood vessels, like those supplying the heart, may also be at risk.”
Conditions such as diabetes, high blood pressure, high cholesterol, smoking, obesity, and excessive alcohol use can all damage the small arteries that supply blood to the penis. Gross notes that he often encourages men under 40 with ED to speak with their primary care provider or a cardiologist for further evaluation.
Inaccuracy 2: ED is “all in your head”
Psychological factors absolutely matter, but erections are not simply a matter of willpower.
Stress, anxiety, and depression can all interfere with sexual response. These conditions can also worsen physical contributors to ED. Some medications used to treat mental health conditions can affect libido or erectile function as well.
Chronic stress, for example, places strain on the cardiovascular system. Antidepressants are known to cause sexual side effects in some men. Addressing mental health through therapy, stress management, medication adjustments, or lifestyle changes can improve sexual health as well.
ED is often both physical and psychological, not one or the other.
Inaccuracy 3: ED means you’re not attracted to your partner
Relationship issues can affect intimacy, but they are not the most common cause of ED.
“I would say the vast majority of the time when people are having erectile dysfunction, it has nothing to do with their partner,” said Chris Kyle, M.D., M.P.H., a urologist based in Springfield, Oregon. “It has something to do with their physiology.”
Kyle emphasizes that it’s important for partners not to take ED personally and for couples to communicate openly.
“One of the first things I counsel people about is communication,” he said. “Being clear and saying, ‘It’s not that I’m not interested. My body just isn’t working the way I want it to right now.’”
Open communication often reduces pressure, which alone can improve sexual experiences.
“...when people are having erectile dysfunction, it has nothing to do with their partner. It has something to do with their physiology."
Inaccuracy 4: ED is a direct result of low testosterone
Testosterone plays a role in sexual health, but it is not the primary driver of erections for most men.
“Most of my patients with ED have perfectly normal testosterone levels,” Gross said. “And many patients with low testosterone have normal erectile function.”
Testosterone is more closely associated with libido and spontaneous erections, such as overnight or morning erections. Erections triggered by sexual stimulation rely on a complex process involving blood flow and nerve signaling, not testosterone alone.
Gross adds that while testosterone levels are worth checking in some cases, testosterone therapy by itself is not an appropriate treatment for ED. Research supports this view. Testosterone therapy does not consistently improve erections in men without a deficiency and offers limited benefit in moderate to severe ED.
Kyle notes that low testosterone is more often linked to low desire rather than mechanical erectile problems.
Inaccuracy 5: Tight underwear causes ED
This one refuses to die.
Tight underwear can affect sperm production by raising testicular temperature. Studies have shown men who wear boxers tend to have higher sperm counts than those who wear briefs.
But there is no evidence that underwear choice affects erectile function. ED is about blood flow, nerves, hormones, and mental health, not fabric choice.
Inaccuracy 6: Lifestyle doesn’t impact erections
Lifestyle has a real impact on erectile health.
“Smoking and drinking are terrible for arteries,” Gross said. “Imagine your arteries as delicate pipes. Now imagine pushing toxic chemicals through them for years. Eventually, they lose their ability to function properly.”
The arteries that supply blood to the penis are especially small and sensitive. Damage shows up there early.
Kyle adds that while there is no instant fix, strong evidence supports the role of healthy habits. Regular exercise, balanced nutrition, good sleep, limited alcohol, and avoiding smoking all support better erectile function over time.
The Takeaway
ED is rarely caused by one single factor. It is usually the result of overlapping physical, psychological, and lifestyle influences.
Understanding the real causes of ED helps remove shame, reduce misinformation, and open the door to effective treatment. The earlier you replace myths with facts, the easier it becomes to take steps that support both sexual health and overall well-being.