ED is a vascular signal
The penile arteries are small, and they show endothelial dysfunction before coronary arteries do. New-onset ED in a man under 60 is a reason to look at cardiovascular risk.
✦ Men's Health
Morecommon.Morefixable.
ED is rarely just a bedroom problem. It's one of the earliest signs of vascular and hormonal changes that are worth understanding and addressing.
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✦ The pattern
“For most men under 60, ED has a clear cause. Finding it changes what we do about it.”
Erectile dysfunction affects roughly half of men over 40, and the majority don't bring it up with a doctor. It's worth bringing up, because in most cases there's a real explanation, and a real fix.
The causes split broadly into vascular, hormonal, neurological, and psychological, and they often overlap. A thorough work-up tells us which lane we're in and points directly at the treatment.
✦ Worth knowing
Three things to hold onto.
Testosterone is part of the picture
Low free testosterone blunts libido and can impair erectile function directly. It's not always the cause, but it's often a contributor and it's always worth checking.
Medications are often the culprit
SSRIs, beta-blockers, certain antihypertensives, and finasteride are common causes. Identifying a medication cause changes the entire approach.
✦ The work
How I think about erectile dysfunction.
01
The work-up
Full hormone panel (total and free testosterone, SHBG, estradiol, LH, FSH, prolactin), cardiovascular risk markers (ApoB, fasting insulin, hsCRP, HbA1c), thyroid, sleep history (OSA is a common and under-recognized cause), medication review, and an honest conversation about psychological contributors.
02
What I treat
Testosterone optimization when low. Targeted supplementation (L-citrulline, pycnogenol, others with good evidence). Cardiovascular risk reduction. Sleep apnea referral. Where appropriate, PDE5 inhibitors, used at the right dose, monitored, and not as the only answer.
03
The psychological layer
Performance anxiety, relationship stress, depression, and unprocessed stress all contribute to ED and are often intertwined with the physical picture. I work with both, and I can refer into IFS therapy when that's the right fit.
✦ How I'd work with youConsidered.
Considered.
Tested.
Re-tested.
Most men see meaningful improvement within three months when we find the right cause and address it directly. The goal is not just function but understanding what the signal was pointing at.
Therapies I'd likely use
✦ Common questions
You're probably wondering.
I'm embarrassed to bring this up. Is that normal?
Yes, and it's one of the main reasons men wait years before getting help. This is a medical issue. I've had this conversation many times, and I'm not going to make it awkward.
My GP offered me Viagra. Is that enough?
It may help with symptoms, but it doesn't explain the cause. If you're under 60 and this is new, I'd want to know why it's happening before just treating the symptom.
Can this actually be fixed without medication?
Often yes, depending on cause. Testosterone optimization, sleep treatment, cardiovascular work, and targeted supplementation resolve many cases without PDE5 inhibitors. When medication is the right tool, I'll say so.
✦ Next step
Ready to talk it through?
Book a free 15-minute discovery call. I'll listen, you'll ask questions, and we'll decide together if this is the right fit.
Men's Health · Erectile Dysfunction