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The United States of Erectile Dysfunction: 30million men have it

By Cassidy Morrison Senior Health Reporter For Dailymail.Com

13:29 12 Aug 2023, updated 13:37 12 Aug 2023

  • Roughly 30 million men have ED but sexual health experts say it’s much higher
  • States that fill ED scripts most have older populations and progressive ideals
  • READ MORE:  This hypnotherapist has the answer to erectile dysfunction

The number of men seeking treatment for erectile dysfunction has soared in recent years amid what some have described as a ‘silent epidemic’.

Viagra – the ‘little blue pill’ – is normally associated with old people but the most recent figures suggest an estimated 30 million American men now live with erectile dysfunction – nearly twice as many in the early 2000s.

Around a quarter of under-40s are though to struggle to get it up in bed, which has been linked to a rise in obesity rates, poor mental health, and an overconsumption of pornography. 

Northeastern states like Maine, Vermont and New Hampshire have relatively high median ages. ED is typically more common in older men

States where ED meds are most common





New York


Rhode Island



New Jersey 

States where ED meds are least common 




South Dakota






North Carolina 

Pill prescribing rates vary by state, but research shows the ones that lean left politically tend to have more little blue pills in circulation which, men’s health experts say, could translate to more open dialogue between patients and doctors about sexual health issues that are taboo in many conservative states.  

Dr Helen Bernie, Director of Sexual and Reproductive Medicine at Indiana University said: ‘What you see from that top 10 list, those are your more progressive states, right? New York, New Jersey, Pennsylvania, California, Nevada. 

‘Those are typically more progressive states where they have better reproductive rights so you would assume that maybe people talk about sex a little bit more, maybe it’s a little bit more ok to prescribe these medicines.’

Overall, Southern states had far fewer pill bottles in circulation, with the exception of Florida, where ED prescriptions made up 0.25 percent of the total filled there. 

‘Then you look at the alternative. Down south, the strong Bible Belt, there’s a lot strong religious tie and, just in general, people don’t talk about sex, we can only talk about abstinence or pregnancy. 

‘And so perhaps doctors aren’t asking their patients about sexual activities so they’re not prescribing as much of the medication. It’s taboo.’

Struggling to keep it up? What it might say about your health

Doctors are urging people to not be embarrassed about not being able to perform in the bedroom warning it could be a sign of heart disease, diabetes or a hormone imbalance. 

It is for this reason that Dr Bernie said that the true number of men with erectile dysfunction is likely much higher than the estimated 30 million. 

If a doctor living in a conservative-leaning area where sex is not freely discussed does not bring up a taboo subject in the safety of the exam room, the patient likely won’t either.

Erectile dysfunction is often a biomarker for a man’s overall health. An inability to get or maintain erection could be a result of undiagnosed high cholesterol or blood pressure or even a warning sign of cardiovascular disease.

Dr Bernie added: ‘I mean, that’s the most simple question you’re going to have to ask: Do you have any problems achieving or maintaining an erection? And by asking that simple question, you will get an answer and it will open up the dialogue between the patients to be able to actually ask questions and seek treatment options for preventative health.’

Erectile dysfunction is most often considered in older men because of the many age-related changes the body undergoes such as naturally declining testosterone levels, weakened pelvic muscles, and a loss of the necessary nerve function that helps the brain communicate with other systems in the body that leads to an erection. 

But in younger men, the source of the problem is often psychological. Performance anxiety and high levels of stress can affect the delicate balance of hormones in the body and functioning of the nervous system.

Testosterone levels typically peak at around the age of 20 followed by a slow descent throughout the rest of adulthood. At their highest, testosterone levels should be anywhere between 300 and 1,200 ng/dL. Once men hit their mid-thirties, testosterone levels begin declining by at least one percent per year.

Pornography use and overuse can also contribute to ED. Constant exposure to explicit images and videos desensitizes the viewer, making the brain less responsive to sexual stimuli such as your partner standing in front of you naked. 

And repeat exposure to porn can lead to the same disruptions in the brain as do hard drugs. 

The brain’s reward system releases dopamine when something that feels good happens, whether it’s finding food in the middle of a desert, snorting cocaine, or watching hardcore porn. 

Over time, the brain becomes used to the images and videos and does not get the same heavy hit of dopamine when the person presses play. This hinders the brain’s reward system and makes it more difficult for the brain to get excited for the real thing. 

But people’s penchant for porn likely won’t change any time soon. Internet viewing has ticked up consistently over the past two decades, suggesting that the pool of young men with ED will expand. 

And as the US population gets grayer by the year, the prevalence of erectile issues could potentially increase still further, translating to even bigger profit margins for the companies behind blockbuster drugs like Viagra and Cialis. 

Read More:The United States of Erectile Dysfunction: 30million men have it