The manosphere and men's health: unpacking the links between online communities, body dysmorphia and erectile dysfunction

The increasing prevalence of erectile dysfunction (ED) among young men highlights a multifactorial issue rooted in the interplay of mental health challenges, societal pressures on male body image and risky health behaviors. Anxiety, depression and body dysmorphic disorder (BDD), particularly muscle dysmorphia, have surged in recent years, exacerbated by online communities within the “manosphere” that glorify hypermasculinity and physical perfection. These forums frequently promote the use of anabolic steroids and finasteride, substances that carry significant health risks, including hypogonadism, endocrine disruptions and sexual dysfunction. Anabolic steroid use, while yielding short-term muscular gains, has long-term consequences such as impaired fertility, mental health decline and ED. Similarly, finasteride commonly prescribed for androgenic alopecia, has been associated with libido reduction and mood disturbances. Online platforms often downplay these risks, encouraging young men to adopt these substances without full awareness of their potential adverse effects. The confluence of these physical and psychological factors creates a vicious cycle of appearance-related anxiety and ED, further compounding mental health issues. This article emphasizes the need for urologists to integrate mental health awareness and screening for risky behaviors into clinical practice. Tools such as the Patient Health Questionnaire-9 (PHQ-9) and direct inquiry about anabolic steroid and finasteride use can aid in identifying at-risk patients. Collaborative, multidisciplinary care involving mental health professionals, endocrinologists and dermatologists is crucial for effective management. Public health initiatives to raise awareness about these issues and promote healthy standards of masculinity are also essential. By addressing the root causes of body image dissatisfaction and fostering open dialogue, clinicians and communities can play a vital role in mitigating the growing burden of ED among young men and improving their overall health and well-being.

Urology; Andrology; Sexual health; ED

[1] Bie F, Yan X, Xing J, Wang L, Xu Y, Wang G, et al. Rising global burden of anxiety disorders among adolescents and young adults: trends, risk factors, and the impact of socioeconomic disparities and COVID-19 from 1990 to 2021. Frontiers in Psychiatry. 2024; 15: 1489427.

[2] Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Translational Andrology and Urology. 2017; 6: 79–90.

[3] Esposito M, Salerno M, Calvano G, Agliozzo R, Ficarra V, Sessa F, et al. Impact of anabolic androgenic steroids on male sexual and reproductive function: a systematic review. Panminerva Medica. 2023; 65: 43–50.

[4] Kang WH, Loo MY, Leong XM, Ooi YF, Teo WQ, Neoh TJ, et al. Body dysmorphic disorder and depression among male undergraduate students in a Malaysian University. Frontiers in Psychiatry. 2022; 13: 977238.

[5] Velurajah R, Brunckhorst O, Waqar M, McMullen I, Ahmed K. Erectile dysfunction in patients with anxiety disorders: a systematic review. International Journal of Impotence Research. 2022; 34: 177–186.

[6] Sparks B, Papandreou C. The manosphere and men’s wellbeing: how healthcare can help young men find alternatives to toxic online spaces. The BMJ. 2023; 383: 2947.

[7] Mohideen H, Hussain H, Dahiya DS, Wehbe H. Selective androgen receptor modulators: an emerging liver toxin. Journal of Clinical and Translational Hepatology. 2023; 11: 188–196.

[8] Mantri S, Agarwal S, Jaiswal A, Yelne S, Prasad R, Wanjari MB. Bodybuilding: a comprehensive review of performance-enhancing substance use and public health implications. Cureus. 2023; 15: e41600.

[9] Pope HG III, Katz DL. Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes. Archives of General Psychiatry. 1994; 51: 375–382.

[10] Bond P, Smit DL, de Ronde W. Anabolic-androgenic steroids: how do they work and what are the risks? Frontiers in Endocrinology. 2022; 13: 1059473.

[11] Armstrong JM, Avant RA, Charchenko CM, Westerman ME, Ziegelmann MJ, Miest TS, et al. Impact of anabolic androgenic steroids on sexual function. Translational Andrology and Urology. 2018; 7: 483–489.

[12] Kinter KJ, Amraei R, Anekar AA. Biochemistry, dihydrotestosterone. StatPearls Publishing: Treasure Island (FL). 2025.

[13] Cai Z, Li H. An updated review: androgens and cognitive impairment in older men. Frontiers in Endocrinology. 2020; 11: 586909.

[14] Mysore V. Finasteride and sexual side effects. Indian Dermatology Online Journal. 2012; 3: 62–65.

[15] Thompson IM Jr, Goodman PJ, Tangen CM, Parnes HL, Minasian LM, Godley PA, et al. Long-term survival of participants in the prostate cancer prevention trial. The New England Journal of Medicine. 2013; 369: 603–610.

[16] Irwig MS. Persistent sexual side effects of finasteride: could they be permanent? Journal of Sexual Medicine. 2012; 9: 2927–2932.