ED Causes and When to See a Doctor

Erectile dysfunction is rarely just a bedroom problem. In many cases, it is an early signal of broader cardiovascular, metabolic, or hormonal conditions that deserve proper medical attention. Understanding what drives ED — and when it requires in-person evaluation versus telehealth management — is the foundation of informed treatment decisions.

Physical Causes of ED

Cardiovascular and Circulatory Causes

Erection depends on healthy blood flow. Any condition that impairs vascular function can reduce erectile capacity:

• Atherosclerosis (arterial plaque): Narrowed penile arteries reduce blood flow during arousal. ED is often an early warning sign of systemic cardiovascular disease.
• Hypertension: High blood pressure damages arterial walls and reduces vascular responsiveness. Many antihypertensive medications also have ED as a side effect.
• High cholesterol: Contributes to arterial stiffness and reduced nitric oxide production, both critical for erection.
• Diabetes: Both Type 1 and Type 2 diabetes damage blood vessels and nerves involved in erectile function. ED is one of the most common complications of diabetes.

Hormonal Causes

• Low testosterone (hypogonadism): Testosterone is essential for libido and contributes to erectile function. Low testosterone is a common and treatable cause of ED.
• Elevated prolactin: Hyperprolactinemia suppresses testosterone production and is associated with both low libido and ED.
• Thyroid dysfunction: Both hypothyroidism and hyperthyroidism can affect sexual function.

Neurological Causes

• Multiple sclerosis, Parkinson's disease, and spinal cord injuries can interfere with nerve signals required for erection
• Pelvic surgery or radiation affecting prostate, bladder, or colorectal tissue can damage relevant nerves

Medication-Related Causes

Many commonly prescribed medications list ED as a side effect:

• Antihypertensives (especially beta-blockers and some diuretics)
• Antidepressants (SSRIs and SNRIs commonly reduce sexual function)
• Antiandrogens and certain prostate medications
• Opioid analgesics (suppress testosterone production with long-term use)

Psychological Causes of ED

• Performance anxiety: Fear of ED itself can create a self-reinforcing cycle where anxiety prevents arousal
• Depression and anxiety disorders: Both directly reduce libido and erectile function, and their medications can compound the issue
• Relationship stress: Interpersonal conflict and communication problems contribute to psychological ED
• Pornography-associated ED: An increasingly recognized pattern where high-frequency pornography use desensitizes arousal responses

When Telehealth Is Appropriate

Telehealth ED care is appropriate for most men with mild to moderate ED who have no major cardiovascular contraindications. Telehealth is particularly well-suited for:

• Men who have already been evaluated by a primary care physician
• ED that is primarily lifestyle or anxiety-related rather than severe organic disease
• Men seeking medication management for a known, stable condition
• Prescription refill management for established treatments

When In-Person Evaluation Is Recommended

• Sudden onset of severe ED with no prior history — particularly in younger men — warrants cardiovascular workup
• ED accompanied by chest pain, exertional symptoms, or significant cardiovascular risk factors
• Suspected low testosterone requiring comprehensive hormone panel and follow-up
• ED that has not responded to two or more oral medications at appropriate doses
• ED following pelvic surgery or radiation requiring specialist evaluation
• Significant psychological or relationship factors that would benefit from sex therapy or psychiatry

Frequently Asked Questions

Is ED always a sign of a serious health problem?

Not always. Occasional ED is normal and can result from stress, alcohol, fatigue, or anxiety. Persistent ED — especially in men under 50 — warrants evaluation because it can indicate early cardiovascular disease, diabetes, or hormonal issues.

Can ED be cured or just managed?

It depends on the underlying cause. ED caused by lifestyle factors, medication side effects, or hormonal deficiencies can often be resolved by addressing the root cause. Vascular ED typically requires ongoing management. Psychological ED often responds well to appropriate therapy.

At what age does ED become common?

ED prevalence increases with age — approximately 40% of men at age 40, rising to 70% by age 70. However, significant ED in younger men is increasingly common and warrants evaluation rather than assumption that it is age-related.

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