Author: Seth Thomas - 5 min read
When men finally bring up erectile dysfunction, many expect a single test or a quick prescription. In reality, diagnosing ED is more like putting together a puzzle. Clinicians are looking for patterns, contributors, and context so they can recommend something that actually works.
Here are the ten main things clinicians pay attention to when evaluating ED, and why each one matters.
1. How long it’s been happening
One of the first questions a clinician asks is simple: How long has this been going on?
ED that happens occasionally is common. ED that’s persistent for several weeks or months is more likely to reflect an underlying issue. Duration helps clinicians separate temporary disruptions like stress or illness from ongoing physical or psychological contributors.
According to the Mayo Clinic, ED is typically defined as a consistent inability to get or maintain an erection firm enough for sexual activity, not an occasional off night.
"In reality, diagnosing ED is more like putting together a puzzle."
2. Whether erections ever happen at all
Clinicians often ask about:
- Morning erections
- Erections during masturbation
- Erections during sleep
This isn’t about embarrassment. It helps distinguish between primarily physical and primarily psychological contributors.
If erections still happen in some situations but not others, that suggests nerves and blood flow are working, and factors like anxiety, stress, or relationship dynamics may be playing a role. If erections are absent across the board, physical causes become more likely.
This approach is commonly outlined in urology guidelines, including those from the American Urological Association.
3. Medical history and chronic conditions
ED rarely exists in isolation. Clinicians pay close attention to conditions that are strongly associated with erectile issues, including:
- Cardiovascular disease
- High blood pressure
- Diabetes
- Obesity
- Neurological conditions
Erections rely heavily on healthy blood vessels and nerves. Because of that, ED can sometimes show up before other symptoms of vascular disease become obvious. Harvard Health and the Mayo Clinic both highlight ED as a potential early marker of cardiovascular risk.
4. Medication and supplement use
This is a big one that often gets overlooked.
Many medications can affect erections, including some antidepressants, blood pressure medications, and treatments for prostate conditions. Over-the-counter supplements and recreational substances can also play a role.
Clinicians are not judging. They need a complete list so they can identify possible contributors and avoid dangerous interactions. This is especially important if ED medications are being considered, since drugs like nitrates cannot be combined with PDE5 inhibitors.
The FDA has clear guidance on these safety considerations.
"Clinicians increasingly view sexual health and mental health as
deeply connected."
5. Mental health and stress levels
Clinicians increasingly view sexual health and mental health as deeply connected.
Stress, anxiety, depression, and performance pressure can all interfere with sexual response. Even when there is a physical contributor, psychological stress can worsen ED or make it inconsistent.
The Mayo Clinic notes that emotional health issues often interact with physical causes, creating a feedback loop where anxiety about performance makes ED more likely to continue.
6. Relationship and communication context
This part surprises some men.
Clinicians may ask about relationship satisfaction, communication with a partner, and recent changes in intimacy. That’s because unresolved tension, lack of communication, or fear of disappointing a partner can contribute to ED or keep it going.
This does not mean the problem is “in your relationship.” It means intimacy does not happen in a vacuum, and clinicians want to understand the full context so recommendations are realistic.
7. Hormonal factors, when appropriate
Testosterone gets a lot of attention online, but clinicians are selective about testing.
Low testosterone can contribute to sexual symptoms like reduced libido, fatigue, and fewer spontaneous erections. However, it is not the most common cause of ED.
Guidelines from the Endocrine Society recommend hormone testing when symptoms suggest it may be relevant, rather than automatically testing every man with ED. Clinicians look for patterns that justify checking hormones, not just ED alone.
8. Lifestyle factors that affect blood flow and nerves
Clinicians also look at daily habits that influence sexual function over time, including:
- Physical activity
- Sleep quality
- Alcohol use
- Nicotine or tobacco use
These factors matter because erectile function depends on circulation, hormone balance, and nervous system regulation. Cleveland Clinic and Harvard Health both emphasize that lifestyle changes can meaningfully improve erectile function for many men, especially when combined with medical treatment.
This part of the evaluation is not about blame. It’s about identifying levers that can improve outcomes.
9. Severity and impact on quality of life
Not all ED affects people the same way.
Clinicians often ask how bothersome the issue feels and how it affects confidence, intimacy, and relationships. They may use validated questionnaires to understand baseline severity and track improvement over time.
This helps guide treatment decisions. Someone with mild, occasional ED may want a very different approach than someone with severe, persistent symptoms.
Cleveland Clinic notes that these tools help tailor treatment and measure progress more accurately.
10. Safety and treatment goals
Finally, clinicians focus on safety and expectations.
They want to know:
- What the patient hopes to improve
- Whether there are medical reasons to avoid certain treatments
- What success would realistically look like
ED treatment is rarely one-size-fits-all. Some men prioritize spontaneity. Others prioritize consistency. Some want non-drug options. Others are comfortable with medication. Diagnosing ED includes aligning treatment with the person, not just the symptom.
Why this approach helps
Clinicians look at ED as a health signal, not a personal failure. By asking these questions, they can identify contributing factors, rule out serious concerns, and recommend treatments that fit your body and life.
The earlier these conversations happen, the easier they usually are.