Erectile Dysfunction: Causes and Which Tests to Take

Erectile dysfunction is an awkward topic to discuss, but from a medical point of view it matters beyond intimate life. Often it is not a standalone "breakdown" but an early sign of what is happening with the blood vessels and metabolism throughout the body. Let's look at the main causes of erectile dysfunction and which tests to take to find out where the problem comes from — without discussing treatment, which is a doctor's job.

What Erectile Dysfunction Is

Erectile dysfunction is a persistent difficulty in achieving or keeping an erection sufficient for sexual life. Occasional episodes happen to everyone and are usually linked to fatigue, stress or alcohol. It becomes a problem when the difficulty recurs regularly over several months. Causes are divided into vascular, metabolic, hormonal, neurological, medication-related and psychogenic.

Vascular and Metabolic Causes

The most common group of causes is vascular and metabolic. An erection depends on healthy blood flow, so the same processes that damage the heart's vessels affect it too. Diabetes, high cholesterol, hypertension, excess weight and smoking narrow and damage vessels. This is why erectile dysfunction often appears years before a heart attack and is a reason to check cardiovascular risks.

Hormonal and Psychogenic Causes

Some cases are linked to hormones: low testosterone, thyroid disorders, raised prolactin. Separately there is a psychogenic cause — anxiety, depression, relationship stress; it is suggested by preserved night and morning erections despite difficulty in a specific situation. Causes often combine, so a work-up looks at both the body and the overall background.

Which Tests to Take for Erectile Dysfunction

A sensible minimum is chosen for the vascular-metabolic and hormonal versions. Usually it is glucose and glycated hemoglobin (diabetes), a lipid profile (cholesterol and vascular risk), testosterone (hormonal background), TSH (thyroid) and prolactin. The set is chosen by a doctor by age and complaints, not "everything at once". After a certain age the question of PSA is discussed separately.

Lipid Profile and Blood Sugar

Two tests are especially important because they link erectile dysfunction with general health. A lipid profile shows cholesterol levels and the risk of atherosclerosis, while glucose and HbA1c reveal hidden diabetes — a common cause a man may not know about. Their deviations are not only about erection but about the heart, so they matter in themselves.

Testosterone, TSH and Prolactin

The hormonal version is checked as a set: testosterone is taken in the morning because the level fluctuates through the day; with a low result the test is repeated and LH and FSH are added. TSH screens for thyroid disorders, prolactin for rare but important pituitary causes. The age-related decline in testosterone is a separate large topic covered in the article on testosterone after 30.

What to Do with the Results

Do not make a diagnosis from a single line: a single deviation is a reason to look into things, not a verdict. The combination of tests and complaints is assessed by a doctor (urologist or andrologist), if needed with a cardiologist and endocrinologist. If the report is unclear, you can upload it for decoding — the service explains the values in plain language and suggests questions for your doctor.

This article is for informational purposes only and does not replace a doctor's consultation. The cause of erectile dysfunction and the set of tests are decided by a specialist individually.