Erectile dysfunction root causes — vascular, metabolic, or hormonal?
ED root causes are more often vascular and metabolic than purely hormonal. Workup includes testosterone, lipid/ApoB, fasting insulin, A1C, and cardiovascular risk assessment.
Full answer
Erectile dysfunction root causes are more often vascular and metabolic than purely hormonal. The penile microvasculature is among the earliest affected by endothelial dysfunction, making ED an established early signal for cardiovascular disease — sometimes by 3-5 years. The provider-reviewed workup screens testosterone (total and free), estradiol, SHBG, prolactin, thyroid (TSH), metabolic (fasting insulin, A1C, lipid panel, ApoB), blood pressure, and medication effects. Treatment is matched to the dominant driver: hormonal optimization when low T is confirmed; PDE5 inhibitors for vascular contribution; metabolic optimization when insulin resistance is dominant.
Educational. Not a substitute for individualized provider review.
- Sexual health — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-05-29