Erectile and libido problems are not one condition. They are a symptom with eight plausible mechanisms, and the fix depends entirely on which one you have. This works through all eight, shows you the evidence for and against each, and tells you plainly where the evidence is missing rather than filling the gap with a confident guess.
This matters more than anything that follows. Not wanting sex and wanting it but failing to get hard are different problems with different causes, and lumping them together is why most assessments go wrong at the first step. Select everything that applies.
Get the exact panel your pattern needs from the Blood Test Selector, and assess the cardiovascular side properly with the Cardiac Risk Score.
The most informative single question is whether erections are normal during masturbation. A vascular or hormonal deficit does not know who is in the room, so preserved solo function points strongly toward a contextual cause. Preserved morning erections point the same way, though neither is proof on its own.
Yes, and it commonly appears first. Penile arteries measure one to two millimetres against three to four for coronary arteries, so the same degree of arterial disease restricts flow in the smaller vessel earlier. ED typically precedes cardiovascular disease by two to five years, and in one study 65% of men with coronary disease had ED before any cardiac event.
Because testosterone is one of eight mechanisms. If your desire is intact while the erection is not, that separation points away from hormones entirely and toward blood flow, medication or context. Normal testosterone rules something out rather than answering the question.
SSRIs and SNRIs, finasteride and dutasteride, beta blockers, thiazide diuretics, opioids and antipsychotics all have recognised associations. What decides whether yours is responsible is timing: a medication that started after your symptoms began cannot have caused them.
That is the classic description of veno-occlusive dysfunction, where blood enters the penis but is not held there. It points toward the vascular domain rather than desire or hormones.
