Erectile dysfunction (ED) can be caused by physical problems, psychological factors, or a combination of both.
The most noticeable symptoms of ED include:
- the inability to get or keep an erection
- low sex drive
- anxiety about sexual performance
Many men find it difficult to discuss a sexual health problem such as ED. However, it’s important to discuss your ED openly and honestly with your doctor. Various treatment options exist. With help, most men will find a treatment that works for them.
Even when ED doesn’t start with psychological problems, it can cause them. If you have ED, you may want to talk to a mental health professional. A sex therapist can also help you deal with any emotional and relationship problems that may have occurred because of ED. But the best place to start is always your primary care doctor.
Your doctor should be your first stop for ED diagnosis. ED has many potential causes, so you may need a comprehensive physical examination to diagnose it.
The first steps to diagnosing ED are usually straightforward. Then your doctor may refer you to a specialist if more information is needed.
Urologists specialize in urinary and reproductive health. They can help diagnose any abnormalities in your reproductive system.
Your doctor may refer you to a urologist if you don’t have any underlying health or mental conditions, such as cardiovascular disease, high blood pressure, or anxiety, but you still have symptoms of ED.
Issues with your prostate gland can cause erectile dysfunction. Your urologist may examine your prostate for conditions that can cause erectile dysfunction, including:
- polyuria, or excessive urine volume
- prostate cancer or treatment for prostate cancer
- enlarged prostate or treatment for enlarged prostate
- nerve damage resulting from radical prostatectomy
Your urologist may perform a physical exam by taking your blood pressure and examining your penis and testicles. A rectal exam, in which your doctor uses a finger to feel your prostate gland, may be necessary to check the health of your prostate. This test shouldn’t cause you more than minimal discomfort.
Your urologist may also ask about any diuretics you’re taking or about your caffeine and alcohol consumption. These can all cause or contribute to ED. Your urologist may recommend changing a medication that acts as a diuretic (increases urine production) or drinking fewer diuretic liquids (such as coffee) if they may be causing your ED.
Endocrinologists are hormone specialists. Blood tests can help determine whether your hormone levels are abnormal. Low testosterone levels can cause or contribute to ED.
Some hormonal conditions can cause ED, including:
- andropause (sometimes inaccurately called “male menopause”), in which your body doesn’t produce enough growth hormones or androgen; it may lead to weight gain, lower bone density, and body hair loss
- high levels of prolactin, a hormone that controls the production of sperm; when too much is produced, it can cause symptoms in men such as a decreased sex drive, infertility, and galactorrhea (the production of breast milk)
- irregular thyroid hormones, such as when too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormone is produced
Your doctor may refer you to an endocrinologist if any of the symptoms of these conditions appear alongside symptoms of ED.
Your endocrinologist may give you several additional tests, including:
- a fertility test to make sure you’re still producing healthy sperm
- a prolactin level test to make sure your body isn’t producing too much prolactin
- the sex hormone binding globulin (SHBG) test to see how your testosterone is binding to blood proteins
- the dehydroepiandrosterone sulfate (DHEAS) test to make sure you’re not producing too much testosterone or androgen