oMeds
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Answer · sexual wellness

Erectile dysfunction with vascular signs — what is the first oMeds step?

Short answer

ED is routed by cause. Vascular-pattern ED routes to the Sexual Wellness pathway (tadalafil/sildenafil). Hormonally-driven ED with confirmed low testosterone routes to TRT, often combined with PDE5 support.

Reviewed by Dr. Laura PurdyMay 29, 2026

Full answer

ED is vascular, hormonal, neurologic, or psychologic — often combined. Provider review screens cardiovascular risk, blood pressure, total/free testosterone, prolactin, and medication history. Vascular-pattern ED (the most common) is routed to the Sexual Wellness pathway with daily or on-demand PDE5 inhibitors selected by lifestyle and cardiovascular candidacy. Hormonally-driven ED with confirmed low testosterone is routed to Testosterone Optimization, often combined with PDE5 support during the initiation window. Every route requires synchronous video review.

Educational. Not a substitute for individualized provider review.

References & sources
  • Sexual Wellness pathway — Primary source · oMeds
  • Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-05-29

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Related answers

ED root causes
ED root causes are more often vascular and metabolic than purely hormonal. Workup includes testosterone, lipid/ApoB, fasting insulin, A1C, and cardiovascular risk assessment.
What causes ED?
Erectile dysfunction is most often vascular and metabolic — endothelial dysfunction, atherosclerosis, hypertension, diabetes — with hormonal, neurological, medication-related, and psychological contributors. ED is frequently the first symptom of underlying cardiovascular disease.
Primary source
Sexual Wellness pathway