Erectile dysfunction in men: causes, blood tests, and treatment

Erectile dysfunction (ED) is common, but that does not make it any easier to deal with. It can affect confidence, relationships, and overall wellbeing, and it is often about more than just sex. ED means regularly finding it hard to get or keep an erection firm enough for sex. A one-off occasion is usually nothing to worry about, but if it keeps happening, it may be worth looking into.

It’s also far more common than many men realise. Research suggests that around 52% of men aged 40 to 70 experience some degree of erectile difficulty [1]. The reassuring news is that ED is often treatable, and in some cases, it can also highlight a different health condition.

This article looks at what erectile dysfunction is, the most common causes behind it, and why it can sometimes be a sign of wider health issues rather than a standalone symptom. We will also cover when an ED blood test may be helpful, as well as treatment options that can improve erections and overall health.

• What are the symptoms of erectile dysfunction?
• Why does erectile dysfunction happen?
• The most common ED causes
• ED can be an early warning sign
• When an ED blood test may help
• How is ED diagnosed?
• Erectile dysfunction treatment: what actually helps?
• How can I manage erectile dysfunction naturally?
• The part nobody wants to talk about
• When to seek medical advice

What are the symptoms of erectile dysfunction?
 

You may have ED if you regularly have:

1. Trouble getting an erection
2. Difficulty maintaining an erection
3. Reduced interest in sex

Other sexual disorders related to ED are premature ejaculation, delayed ejaculation, and anorgasmia (the inability to achieve orgasm).

If you have any of these symptoms regularly, it is advised you speak to your doctor to investigate the potential underlying cause and determine whether treatment is required.

Why does erectile dysfunction happen?
 

ED doesn’t always have one single, clear cause. It’s usually the result of something getting in the way of blood flow, nerve signals, hormone balance, mood, confidence, or a mix of all. Medically speaking, ED causes can include vascular, hormonal, neurological, psychological, medication-related, and structural issues, with mixed causes common [2].

A useful way to think about it is this:

• Poor blood flow can make erections weaker
• Low testosterone can affect sexual desire and sometimes erections
• Stress and anxiety can interrupt arousal
• Diabetes can damage blood vessels and nerves
• Some medicines can make ED more likely
• Relationship strain can turn occasional problems into an ongoing pattern

The most common ED causes
 

Erectile dysfunction can happen for a few different reasons, and often, there is more than one factor involved.

For many men, it starts with blood flow. Conditions such as high blood pressure or cholesterol, diabetes, and heart disease can all make it harder for enough blood to reach the penis, which can affect erections.

Hormones can play a part, too. Low testosterone will not be the cause in every case, but it can sometimes be linked with ED, especially if it comes with low sex drive, tiredness, or fewer morning erections. Other hormone imbalances, such as elevated prolactin, may also be worth considering in some cases.

There is also the mental side of things. Stress, anxiety, low mood, relationship pressure, or worries about performance can all affect arousal and make ED worse. 

Lifestyle can have a big impact as well. Smoking, carrying extra weight, drinking too much alcohol, not moving enough, and poor sleep can all affect erectile function over time. The encouraging part is that improving these areas can often help with erections and overall health.

ED can be an early warning sign
 

One of the most important things to know about erectile dysfunction is that it’s not always “just a bedroom issue”. In some men, it’s one of the earliest visible signs of vascular disease.

Why? Because the blood vessels in the penis are smaller than the arteries serving the heart. If blood flow is starting to struggle, erections may be affected before chest pain or other obvious heart symptoms appear. Research suggests ED can show up around two to five years before a cardiovascular event or diagnosis in some men [3]. That gives ED real value as an early warning sign.

That does not mean every man with ED has heart disease, but it does mean persistent ED is a good reason to take a wider look at blood pressure, cholesterol, blood sugar, weight, smoking, and overall cardiovascular risk. 

When an ED blood test may help
 

If erectile dysfunction is happening regularly, a blood test can be a useful next step. It will not explain every case, but it can help uncover some of the more common causes of erectile dysfunction.

An Erectile Dysfunction Blood Test is especially worth considering if you want to understand whether your symptoms could be linked to issues such as:

• Testosterone levels
• Cholesterol
• Blood sugar
• General cardiometabolic health

An ED blood test helps move things from guesswork to something clearer. Rather than wondering what might be behind the problem, testing can help reveal whether there is an underlying issue that needs to be addressed.

How is ED diagnosed?
 

Investigating ED can start with a blood test or booking a consultation with a specialist.This is your opportunity to explain what is happening, whether it is occasional or regular, and whether your sexual desire has changed.The doctor will also want to know about any changes in stress levels, medication, illness, or relationship factors. Blood pressure and general health checks are also commonly part of the picture. 

If ED is mainly about anxiety, one plan makes sense. If it’s linked to low testosterone, diabetes, or vascular health, that points in a different direction. Therefore, it’s important to know the root cause before starting any sort of treatment.

Erectile dysfunction treatment: what actually helps?
 

Treatment for ED has come a long way, and several options can help.

For many men, medication such as sildenafil (Viagra) or tadalafil is often the first thing offered. These drugs increase blood flow to the penis and help up to two-thirds of men to have improved erections when taking it. In the UK, you do not need a prescription to get sildenafil, and it can be purchased discreetly online or in a pharmacy. [4,5].

Your doctor may also recommend some lifestyle changes such as a healthy diet or exercise if they believe lifestyle may be playing a role in your ED.

How can I manage erectile dysfunction naturally?
 

While medical treatment may be necessary in some cases, there are things you can try to see if the situation improves:

• Lose weight if you are overweight - Being overweight or obese is a significant risk factor for ED, with one study showing 79% of men with erectile disorders having a BMI of 25 or higher. If you are overweight and experiencing erectile problems, getting your BMI within the healthy range of 18-25 could improve things.
• Quit smoking - There is overwhelming evidence that smoking worsens erectile function as smoking damages the blood vessels in the body, including the penis. Quitting smoking should be a priority not just to improve sexual performance, but also for overall health.
• Eat a healthy diet - Eating healthy food reduces your risk of cardiovascular problems resulting from high cholesterol. As blood flow problems often cause ED, maintaining healthy blood vessels through a diet of fruits, vegetables, whole grains, and healthy fats could improve erectile function.
• Exercise regularly - Exercise increases blood flow around the body and has significant benefits for our cardiovascular health. More specifically, pelvic floor or kegel exercises could improve erectile function by strengthening the bulbocavernosus muscle - a necessary muscle for achieving an erection and ejaculation.
• Reduce stress - Stress and anxiety can interrupt how the brain sends messages to the penis to allow extra blood flow. One study found men following an 8-week stress reduction programme showed significant improvement in erectile function [6]. Meditation, exercise, and spending time outdoors can all help lower stress levels. You may also wish to talk to a professional who can help you manage long-term stress.
• Reduce alcohol consumption - ED is common in men who drink heavily. Alcohol not only reduces libido, but it also decreases blood volume and increases angiotensin, a hormone associated with ED. Sticking to below the recommended 14 units of alcohol per week could see an improvement in erectile function.
• Avoid long periods of cycling - There is some evidence that cycling for long periods can cause compression of the genitals, leading to impaired vascular function. If you are an avid cyclist, it could be worth cutting back to see if this improves your ED.

The part nobody wants to talk about
 

ED can feel very personal, but it is not a personal failing. It is a health issue, and a common one at that. For some men, the main impact is physical. For others, it is the effect on confidence, relationships, and how they feel about themselves.

When ED happens more than once, it can start to create pressure around sex. Worrying about it happening again can make it harder to relax, which can worsen the problem. Over time, that can lead to frustration, avoidance, and a loss of confidence, even in otherwise healthy relationships. It can also be difficult to talk about, which is why many men put off getting help.

That cycle is real, and it deserves support rather than silence. The important thing to remember is that ED is common, often treatable, and not something anyone has to just put up with.

When to seek medical advice
 

If ED is happening regularly, getting worse, or showing up alongside things like low sex drive, fatigue, weight changes, stress, or other health concerns, it is worth looking into.

A good next step is to speak to a specialist or consider a blood test to check for common underlying causes, such as low testosterone, high cholesterol, or blood sugar issues. Even when ED feels difficult to talk about, getting answers can make it much easier to work out what to do next.

It’s important not to ignore ED and hope it goes away on its own. In many cases, the cause is something that can be treated or improved once you know what is behind it.

References

1. NHS inform (no date) Erectile dysfunction (impotence). (Accessed 23 April 2026)
2. European Association of Urology (2026) EAU Guidelines on Sexual and Reproductive Health. (Accessed 23 April 2026)
3. Asafu-Adjei, D. (2025) What can erectile dysfunction tell you about your heart health? UChicago Medicine, 19 June. (Accessed 23 April 2026)
4. NHS (2022) Common questions about sildenafil. (Accessed 27 April 2026)
5. NHS (2022) Common questions about tadalafil. (Accessed 27 April 2026)
6. Kalaitzidou, I., Venetikou, M.S., Konstadinidis, K., Artemiadis, A.K., Chrousos, G. and Darviri, C. (2014) ‘Stress management and erectile dysfunction: a pilot comparative study’, Andrologia, 46(6), pp. 698–702. doi: 10.1111/and.12129.