Erectile Function in Physically Active Young Men: Psychological, Behavioral and Training-Related Factors

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.