When men under 40 show up at their doctors’ offices complaining of erectile dysfunction, they’re often dismissed as suffering from a psychogenic problem or being drug seekers. Viagra, after all, is a fun pill to play with. But recent studies demonstrate that the issue may be both physical and treatable.

Here’s what the science isn’t telling us: Erectile dysfunction rates in young men are rising. There is no observable trend except the one seeing more physicians taking younger patients seriously. While it’s never been a secret that a rusted sword can get stuck in the holster, researchers have been spending time trying to draw conclusions from ED data collected using ominous-sounding procedures like penile duplex ultransonography and intracavernous injections.

The reason for this medical movement actually has very little to do with sex. A man’s ability to get an erection has become a metric for his overall well-being, especially in terms of cardiovascular health, so there’s a growing concern among researchers that there’s a lot more going on than poor performance when young men complain to their doctors about ED. The concern is that it’s a symptom of much more serious conditions.

Adding to the renewed interest in the field, guys seem to be becoming more comfortable talking about their issues in the bedroom. Earlier this year, Guardians of the Galaxy star Chris Pratt admitted to having a low sex drive while he was dealing with weight issues. Even rappers, for whom hardness equals manhood, are becoming more comfortable talking about performance issues. As Mic pointed out, Childish Gambino’s rapped about being “nervous as fuck and could not get it up,” while ScHoolboy Q admitted on Hot 97 that his addiction to “lean” (read: cough syrup) was ruining his sex life.

Weight gain, nerves, and drug use all count as legitimate reasons young men might be experiencing ED, according to a review in the Asian Journal of Andrology published last year. The study reported that 15 to 20 percent of younger men who come to their doctors with ED actually do have physical or “organic” reasons for going limp, most of which are related to vascular, neurologic, and endocrine health. Another review published in the journal Urologia Internationalis in 2013 reports that the percentage of young men with organic causes of ED might be even higher — anywhere from 15 to 72 percent.

There’s no shortage of recent studies outlining cases of organic ED in men under 40. An original study, published in The Journal of Sexual Medicine, found that, in a sample of 439 Italian patients, one in four men seeking help for ED was actually younger than 40, and half of those men actually suffered from severe ED. That’s just one of many examples saying the same thing: ED in young men isn’t purely psychological.

The takeaway here isn’t that young men need to be afraid, but that young men need to be proactive, to shake off the shame and speak honestly with a medical professional — especially if they don’t believe performance anxiety is causing their erectile dysfunction. The flip side of that is that doctors need to listen instead of making ungrounded psychological diagnoses. Turns out that getting it up is a bit of a team effort. Everyone can lend a hand.