Symptoms

Erectile dysfunction.

ED is rarely “just stress.” It's a sentinel symptom that something measurable is off, either vascular, hormonal, or neurological. The right workup is labs and a real history before anyone hands you a PDE5 prescription.

Most common causes

Low testosterone

Low T affects libido, morning erections, and the strength of erections. Total T below ~400 ng/dL with low free T predicts ED reliably.

Test for itTotal T (AM), free T, SHBG, estradiol, LH/FSH, prolactin

Vascular (the most underdiagnosed)

Atherosclerosis affects penile arteries first because they're smallest. Sudden-onset ED in a man over 40 is a cardiovascular signal, work it up.

Test for itLipid panel + apoB, hsCRP, A1c, blood pressure, ankle-brachial index if needed

Diabetes / insulin resistance

High glucose damages both vascular endothelium and autonomic nerve function. ED often precedes formal T2D diagnosis.

Test for itHbA1c, fasting glucose, fasting insulin, HOMA-IR

SSRIs, finasteride, beta-blockers, certain antihypertensives

All commonly cause or worsen ED. Worth a med review with your provider.

Test for itMed list review

Psychological (real, but not the place to start)

Performance anxiety, relationship stress, depression. Real causes, but usually downstream of one of the above.

Test for itPHQ-9 if indicated

What works at OPTML

TRT, if low T is confirmed

Restoring T resolves ED in many cases where low T is the cause. Often within 6-12 weeks.

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Find My Protocol

If you're not sure whether ED is hormonal or vascular, the intake routes you correctly. Cardiovascular risk gets flagged.

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Optimized Health labs

Run the full panel, most men with ED have more than one driver.

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Don't normalize starting on a PDE5 inhibitor without labs. ED in your 40s, 50s, or 60s is a signal to do a real workup. The pill addresses the symptom; it doesn't address the underlying issue, and it can mask a serious cardiovascular problem.

Stop guessing. Start with labs.

Find My Protocol routes you to the right panel and the right physician for this symptom, in 5 minutes.

Find my protocol → Decode my labs first