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ED May Signal Prediabetes in Men Younger Than 40

ED could be performance anxiety or something more serious, such as undiagnosed prediabetes.

A doctor tests the blood of a male patient.

Illustration by Tré Carden

Published: October 29, 2023

Key Points

Erectile dysfunction is common but less so in younger men.
Diabetes and ED are closely connected and often co-occur.
Men younger than age 40 who have ED should be screened for undiagnosed prediabetes or type 2 diabetes, according to recent research.

Understanding the facts about diabetes and erectile dysfunction (ED) in younger men can help you take control of your health.

Erectile dysfunction—the persistent inability to achieve or maintain an erection long enough or firm enough for penetrative sex—can be a natural effect of aging or a harbinger of underlying illness, such as type 2 diabetes (T2D).

In guys younger than 40, it's often the latter.

Is it unusual to have erectile dysfunction if you are under 40?

It's not unusual for younger men to experience "whiskey dick" or performance anxiety on occasion, but recurrent problems could be cause for concern.

ED primarily affects men who are 40 and older and is usually a result of cardiovascular disorders or long-term type 2 diabetes. However, up to 30 percent of guys under 40 may have ED, too, according to a 2017 scientific review.

In younger men, psychological challenges, such as depression, chronic stress and anxiety, are usually to blame, though physical causes—such as diabetes and heart disease—can contribute.

What's the relationship between ED and the risk for prediabetes in men under 40?

Ample evidence suggests that erectile dysfunction and diabetes are connected.

ED has long been called a "canary in a coal mine" because it can be the first sign of a deeper problem, such as a hormonal, vascular or neurological condition, said Nannan Thirumavalavan, M.D., a urologist at University Hospitals Cleveland Medical Center.

"If they haven't had recent blood work already, we test men presenting with ED for elevated blood sugars, cholesterol and low testosterone," he said. "Trouble with erections can often be a result of elevated blood sugars (or prediabetes)."

About 8.5 million adults in the United States have undiagnosed diabetes, and about 25 percent of them are between the ages of 18 and 44, according to the Centers for Disease Control and Prevention (CDC).

About 1 in 4 people ages 19 to 34 have prediabetes, per the CDC.

Sexual dysfunction is just one of the numerous adverse effects of type 2 diabetes. In severe cases, disease complications can be disabling and even life-threatening, according to Mayo Clinic.

A 2023 retrospective study indicates that, in younger men, ED may precede prediabetes and full-blown diabetes by several months.

What does the 2023 study reveal about men who experience ED?

Men age 40 and younger who have ED are about 34 percent more likely to develop prediabetes or type 2 diabetes than guys without it, suggested the 2023 study published in Preventive Medicine. Seventy-five percent of guys developed prediabetes or type 2 diabetes within a year of an ED diagnosis.

Researchers from Saint Louis University drew these conclusions after reviewing electronic health data obtained from 1,915,468 men between 2008 and 2022.

The findings build on previous research that pinpointed several risk factors for both conditions, including obesity, low testosterone, hyperlipidemia—elevated lipids such as cholesterol and triglycerides in the blood—depression and anxiety.

The research also affirms the importance of testing and early intervention in younger men with ED, the study authors wrote.

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What's the difference between diabetes and prediabetes?

People with prediabetes have blood sugar levels that are higher than average but not elevated enough to constitute diabetes, according to the CDC.

Prediabetes is usually a part of a larger issue called metabolic syndrome, said Jacob Teitelbaum, M.D., a board-certified internist in Kailua-Kona, Hawaii. This group of conditions can raise a person's risk of coronary heart disease, stroke and type 2 diabetes, per the National Institutes of Health (NIH).

Typically, men with metabolic syndrome or prediabetes have some degree of insulin resistance, meaning the body can't properly use insulin, the hormone responsible for regulating blood sugar levels, Teitelbaum said.

There's also a link between metabolic syndrome, diabetes and low testosterone.

Men with type 2 diabetes are about twice as likely to have low testosterone compared to guys without the condition, according to the American Diabetes Association (ADA). The hormone is perhaps best known for its role in sexual and reproductive function and muscle-building, but it also helps the body process blood sugar.

Guys who are overweight, obese or physically inactive are most at risk for low-T and prediabetes, as are those with a family history of diabetes.

When prediabetes is unaddressed, insulin resistance and hyperglycemia (high blood sugar) worsen, leading to full type 2 diabetes. Around one-third of people with prediabetes will develop type 2 diabetes within four to five years, said Absalon Gutierrez, M.D., an endocrinologist with UTHealth Houston.

Taking action can delay the onset of type 2 diabetes for as long as 10 years and potentially prevent it from occurring at all, he said.

What are the symptoms of prediabetes in men?

Usually, prediabetes presents no symptoms, Gutierrez said. However, one potential sign is darkened skin on body parts, such as the neck, groin or armpits, according to Mayo Clinic.

Some of the early markers of metabolic syndrome may include a "spare tire" around the waist, elevated "bad" cholesterol, hypertension, and a dropping but still technically normal testosterone level, according to Teitelbaum.

ED, loss of libido, depression and decreased motivation are common.

I'm prediabetic. Now what? How can men reverse the risk of prediabetes?

Research indicates it's possible to reverse prediabetes and prevent serious complications in most cases, Teitelbaum said.

It's unclear whether erectile function returns to normal after reversing prediabetes, Thirumavalavan said. However, ED is highly treatable, and many of the same measures to prevent type 2 diabetes promote sexual health.

Lifestyle modifications, dietary changes and weight loss are generally the best ways to stop prediabetes from progressing and to prevent related complications. A healthcare provider may recommend medication.

Making healthy choices, including not smoking and keeping cholesterol, blood sugar and blood pressure in check, are the best ways to prevent ED from worsening, Thirumavalavan said.

Prediabetics and men with metabolic syndrome should speak with their primary care physician or a prediabetes doctor for individualized advice, but some general guidelines apply.

Lifestyle changes

For people with prediabetes looking to reverse course, exercise can help raise insulin sensitivity, promote fat loss and alleviate stress, Gutierrez said. The Standards of Medical Care in Diabetes advises aiming for at least 150 minutes of moderate-intensity aerobic exercise each week.

About 30 minutes a day five times a week is ideal for most people, but you can break it up however you like.

Getting more sunshine may help; higher vitamin D levels are associated with improved insulin sensitivity, Teitelbaum said.

Adequate sleep is essential, too, according to Cleveland Clinic. People who consistently don't get enough sleep tend to have elevated levels of cortisol—the stress hormone—which can adversely affect blood sugar and other factors.

Diet changes

You don't need to eliminate entire food groups, but minimizing certain ingredients and eating more of others can make a difference.

Sugar is one thing to cut down on, as it's a significant contributor to weight gain and prediabetes, according to Teitelbaum. That's not easy. Up to 140 pounds of sugar are added to the average American's diet annually thanks to food processing. Men who cut out sweetened drinks often see major weight loss.

"Most sodas and fruit juices have three-fourths of a teaspoon of sugar per ounce, so one of those 48-ounce sodas hits you with a whopping 36 teaspoons of sugar while dramatically aggravating insulin resistance," Teitelbaum said.

Other high-sugar foods include cookies, cakes, white bread and many condiments, such as ketchup.

Following a healthy eating plan such as the Mediterranean or DASH diet can help promote weight loss and overall health, Gutierrez said.

These plans emphasize plants, lean proteins, healthy fats and whole grains while keeping highly processed foods, refined carbohydrates and red meat to a minimum.

Weight loss

Losing weight, a cornerstone to reversing metabolic syndrome and prediabetes, may be achievable through diet and exercise.

Addressing underlying conditions, including low-T and thyroid dysfunction, is important.

Research is mixed, but some studies suggest that, for men with low testosterone, hormone replacement therapy may help in reversing prediabetes.

If you're not having success with diet and exercise, a healthcare provider may suggest using medications, such as semaglutide or metformin, or bariatric surgery, Gutierrez said.