A conversation before a blood draw
A proper ED evaluation starts with questions about onset, frequency, erection firmness, morning erections, masturbation, desire, medicines, sleep, stress, smoking, alcohol, medical history, and relationship factors. Some clinicians use the IIEF-5 or SHIM questionnaire to measure severity.
Physical examination
Depending on your situation, clinicians may check blood pressure, weight or waist size, heart and blood-vessel risk, and the penis and testicles. A focused nerve or hormonal examination may be needed. Telehealth is useful, but it does not replace every examination.
The common lab tests
Blood glucose or HbA1c can identify diabetes or prediabetes. A lipid panel helps assess cardiovascular risk. Morning total testosterone is often recommended in ED evaluation, particularly with low desire or signs of deficiency. A low result usually needs confirmation on a second morning. Thyroid, prolactin, kidney, and other tests are selected based on findings rather than routinely ordered for everyone.
When specialized tests help
A urologist may recommend penile Doppler ultrasound or other tests when the diagnosis remains uncertain, there is injury, curvature, severe or treatment-resistant ED, or a specific vascular concern. Most men do not need these as their first step.
What to ask at your visit
Ask: Could this signal cardiovascular disease? Which medications might matter? Which labs fit my history? Should I see a urologist, sleep specialist, or therapist? What are my options for symptom relief while we investigate the cause?
Explore trustworthy resources
NIH/NIDDK: Erectile Dysfunction · American Urological Association guideline · European Association of Urology guideline
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