Men's Health

Erectile Dysfunction: Causes & Treatment

Erectile dysfunction affects up to 40% of men over 40 and is frequently an early warning sign of cardiovascular disease — not just a standalone problem.

Prevalence over 40
Up to 40%
Important link
Cardiovascular disease — often precedes heart attack by 2-5 years
Key tests
Testosterone, glucose, lipids
First-line treatment
PDE5 inhibitors (sildenafil)

ED as a Cardiovascular Warning Sign

Because the blood vessels supplying the penis are smaller than coronary arteries, atherosclerosis often affects them first — meaning new erectile dysfunction, especially in men under 60, can be an early warning sign of underlying heart disease, sometimes appearing years before a heart attack.

Blood Tests to Consider

TestPurpose
Fasting glucose/HbA1cDiabetes is a major cause of ED
Lipid profileCardiovascular risk assessment
Testosterone (morning)Low testosterone can contribute to ED
TSHThyroid dysfunction can affect sexual function
PSAIf considering testosterone replacement or if urinary symptoms present

Causes

CategoryExamples
VascularAtherosclerosis, hypertension, diabetes — most common cause overall
HormonalLow testosterone, thyroid dysfunction
PsychologicalPerformance anxiety, depression, relationship issues
Medication side effectsSome blood pressure medications, antidepressants
LifestyleSmoking, excessive alcohol, obesity, lack of exercise

Treatment Options

TreatmentNotes
PDE5 inhibitors (sildenafil, tadalafil)First-line — effective for most causes
Testosterone replacementIf confirmed low testosterone
Lifestyle changesWeight loss, exercise, smoking cessation improve function
Psychological supportIf anxiety/relationship factors are significant
Vacuum devices, injections, implantsSecond/third-line options if tablets don't work
New ED Deserves a Cardiovascular Check-UpIf you're a man experiencing new erectile dysfunction, especially under 60, it's worth having your blood pressure, cholesterol, and blood sugar checked — treating ED alone without addressing underlying cardiovascular risk misses an important opportunity for prevention.
Is erectile dysfunction just a normal part of ageing?
While ED becomes more common with age, it's not an inevitable or 'normal' part of ageing that should simply be accepted — it usually has an identifiable and often treatable cause.
Can lifestyle changes actually reverse ED?
Yes — for men with ED related to obesity, smoking, or sedentary lifestyle, significant lifestyle improvements can meaningfully improve or resolve symptoms, sometimes without needing medication.
Are PDE5 inhibitors like sildenafil safe for everyone?
They're contraindicated with certain heart medications (nitrates) due to dangerous blood pressure drops — always disclose all your medications and heart history before starting.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.