Trouble getting or keeping an erection firm enough for sex is called erectile dysfunction, or ED. A lower-than-normal hormone level, known as low T, is one of its possible causes, and ED is also an early warning sign that a man may be at higher risk of atherosclerosis, the buildup of plaque inside the arteries. If you have ED, tell your doctor, and ask in the same conversation about your blood vessels, your blood sugar and your hormone level.
Whether ED is just part of getting older
Getting older makes ED more common without making it a natural part of aging. An estimated 30 million to 50 million men in the United States have ED. At age 40 about 40% of men are affected, and 70% report having ED by age 70.
Age is one of several things that make ED more likely, and the others include:
- certain diseases or conditions, such as diabetes, heart disease and obesity
- some medicines, such as blood pressure medicines and antidepressants
- anxiety and stress
- smoking cigarettes or drinking too much alcohol
How common ED is among men your age tells you how many share it, and nothing about which of those is behind yours. ED can be a sign of health problems, and if you do not see your doctor, those problems will go untreated. A health care professional can help find the cause of your ED and talk with you about treatments.
Where a low hormone level sits among the possible causes
The most common diseases and conditions that can lead to ED include six groups, and a low hormone level belongs to one of them, hormone issues:
- diabetes
- chronic health conditions, such as chronic kidney disease, obesity and overweight, and chronic obstructive pulmonary disease
- heart and blood vessel diseases, such as atherosclerosis, high blood pressure and stroke
- hormone issues, such as low T and thyroid imbalance
- nerve damage or disorders, such as multiple sclerosis, spinal cord injuries and damage from pelvic surgery
- problems of the male reproductive system, such as an enlarged prostate and penile curvature, also called Peyronie's disease
Men's levels of the hormone behind low T fall naturally with age, and a lower-than-normal level may be the cause of some men's ED, or can explain why some men often feel tired, depressed or have a low sex drive. Men with diabetes, especially those who are older and overweight, are more likely to have low T.
Thyroid imbalance is another hormone issue that can lead to ED. Fatigue, weight gain, trouble tolerating cold and dry, thinning hair are among the symptoms of an underactive thyroid, though many of these, fatigue and weight gain above all, are common, and having one does not necessarily point to a thyroid problem. A blood test might confirm an underactive thyroid (see Why is your hair coming out in handfuls, and for how long?).
Medicines are a separate group. Many common medicines, prescribed or bought over the counter, can cause ED as a side effect, among them antidepressants, appetite suppressants, antihistamines, blood pressure medicines and water pills, some pain relievers, and sedatives. If you take one of these, or a prescription weight medicine, do not stop it on your own: the health care professional assessing your ED may review any medicines you take to see whether one is causing it.
Some mental health or emotional issues, including anxiety, depression, stress and low self-esteem, can either cause ED or make it worse, and depression, anxiety and low self-esteem are also among the possible complications of ED, so the link can run in both directions.
Why your arteries and blood sugar come into it
ED is one of the problems plaque in the arteries can cause. As plaque builds up, your arteries narrow, which reduces the supply of oxygen-rich blood to tissues and organs, and full or partial blockages can also cause heart attack, stroke, vascular dementia, heart failure or limb loss.
Feeling well tells you little about plaque in your arteries. Early stages of atherosclerosis often do not cause symptoms. Symptoms may first appear under physical or emotional stress, when the body needs more oxygen. In some people, symptoms may go unnoticed until plaque buildup causes serious problems. See your doctor often so plaque buildup can be checked early, and if you have ED, ask about your risk of it in particular.
Plaque in the leg arteries has a pattern of symptoms of its own. Pain, aching, heaviness or cramps in your legs while walking or climbing stairs, which stop when you rest, are symptoms of peripheral artery disease, which is most often plaque buildup in the arteries of the legs. The pain is often in the calf, though it can be in the buttocks, thigh or foot, and some people with the disease have different symptoms or none (see Is calf pain when you walk the same as a night cramp?).
Blood sugar comes into it because blood vessels and nerves can be damaged by the effects of high blood glucose, and that damage can lead to sexual problems. A change in sexual function may be a sign that you have diabetes. Men with diabetes may develop ED 10 to 15 years earlier than men without it, more than half of men with diabetes will get ED, and men who have diabetes are more than 3 times more likely to develop ED than men who do not.
If you already have diabetes, ED could be a sign that you need to manage your diabetes differently, so raise it with the health care professional who treats your diabetes. If nobody has tested your blood sugar recently, ask your doctor whether a test is due.
Heart attack and stroke, which plaque can also cause, cannot wait for an appointment. The symptoms of a heart attack include chest pain, heaviness or discomfort, pain or discomfort in one or both arms, your back, shoulders, neck or jaw, and shortness of breath when resting or doing a little activity. If you think you might be having a heart attack, call 911 whether or not you are certain, and let the ambulance take you to the hospital. Sudden numbness or weakness, especially on one side of the body, sudden confusion or trouble speaking, and sudden trouble seeing are among the signs of a stroke, and if you notice any of them, call 911 right away. Every minute matters with either one.
What an assessment for ED involves, and what to say to start one
A health care professional diagnoses ED from your medical, sexual and mental health history, a physical exam, and lab and other tests. Most of the history is information only you hold, so have it ready before the visit:
- which of the symptoms of ED describes yours: getting an erection sometimes but not every time you want sex, getting one that does not last long enough for sex, or being unable to get one at any time
- every prescribed and over-the-counter medicine, vitamin and supplement you take
- how things stand with climax, ejaculation, erection and sexual desire, since the review of your sexual activity includes questions about all four
- how you have been feeling, since you will also be asked about your mental health and emotions
- any other symptoms you have noticed, such as tiredness, feeling cold, thinning hair, or leg pain that comes on with walking and stops when you rest
Your doctor may ask your partner questions about your relationship and how it affects your ED, so if your partner is willing, bring them along.
During the physical exam, a health care professional often checks for blood vessel and nervous system issues, hormonal problems, and injury to or physical problems with the penis, such as Peyronie's disease, so a hormone level is one result among several. To find the cause, they may use blood tests, including thyroid and prostate tests, and ultrasound imaging that shows how blood flows through the penis. A nighttime erection test, which you might do at home or in a sleep lab, can help show whether your ED is due to a physical problem. In an injection test, a health care professional injects a medicine into the penis to see how full it gets and how long an erection lasts, and that test is usually done in a health care professional's office.
Book the visit with your own doctor, ideally the one who already has your blood pressure, cholesterol and blood sugar results, and open with the reason: "I have had trouble with erections for about a year. I would like to know my risk of plaque buildup, whether my blood sugar needs testing, and whether my hormone level needs checking."
If your weight care runs through NicoCares, send your care team a note about the erection trouble through Spruce, the messaging app tied to your NicoCares account, since changes in your health belong there, and name your weight medicine to the doctor who examines you along with your other medicines. For chest pain or sudden weakness on one side, call 911 rather than writing to the team.
