When to See a Doctor for ED: Warning Signs Not to Ignore

Erectile dysfunction isn't just a bedroom problem—it can be your body's early warning system for serious health issues. The 2024 Princeton IV consensus guidelines now recommend treating ED as a "risk-enhancing factor" for cardiovascular disease. Here's when to see a doctor and what it might mean.

⚠️ The Heart Disease Connection

ED and cardiovascular disease share the same underlying cause: atherosclerosis (clogged arteries). The arteries supplying the penis are smaller (1-2mm) than coronary arteries (3-4mm), so they clog first.

ED often appears 2-5 years before a heart attack or stroke. Men with ED have a 2x increased risk of cardiovascular events.

When to See a Doctor: The Short Answer

You should see a doctor for ED if:

→The problem persists for more than a few weeks
→You're over 40 (especially with cardiovascular risk factors)
→You have any of the warning signs listed below
→Self-help strategies haven't worked
→You want treatment to improve your sex life

Red Flag Warning Signs

These signs suggest ED may be signaling a more serious underlying condition:

ED Under Age 40 With No Psychological Cause

In younger men, ED is usually psychological. Physical ED in your 30s suggests something is affecting your vascular health early—and warrants investigation.

Gradual, Progressive Worsening

ED that slowly gets worse over months or years suggests physical causes (vascular, hormonal) rather than situational anxiety.

No Morning Erections

Morning erections indicate your "hardware" works. If they're reduced or absent, physical function may be impaired.

You Have Cardiovascular Risk Factors

High blood pressure, high cholesterol, diabetes, obesity, smoking, family history of heart disease—any of these make the ED-heart connection more likely.

You Have Diabetes

In men with diabetes, ED can be a sign of "silent" coronary artery disease with no other symptoms. It's especially important to get checked.

ED Plus Other Symptoms

Chest pain, shortness of breath, fatigue, leg pain when walking—combined with ED, these require prompt medical attention.

Recent Weight Gain or Low Energy

ED combined with fatigue, weight gain, depression, or loss of muscle mass may indicate low testosterone or metabolic syndrome.

What the 2024 Guidelines Say

The Princeton IV Consensus Guidelines (2024) recommend:

•ED should be treated as a "risk-enhancing factor" for cardiovascular disease assessment
•Men with ED at low-to-intermediate heart risk should consider coronary artery calcium (CAC) scoring
•Healthcare providers should routinely screen for ED as part of cardiovascular risk assessment
•ED medications (PDE5 inhibitors) are safe for most men with heart disease and may have cardioprotective effects

What to Expect at the Doctor

Basic Assessment

•Medical history: When ED started, how often, any triggers, other symptoms
•Medication review: Some drugs cause or worsen ED (blood pressure meds, antidepressants, etc.)
•Physical exam: Blood pressure, heart, and possibly genital examination
•Lifestyle questions: Smoking, alcohol, exercise, diet, stress

Blood Tests Often Ordered

•Blood glucose / HbA1c: Screens for diabetes or prediabetes
•Lipid panel: Cholesterol levels (cardiovascular risk)
•Testosterone: Low T can contribute to ED and low libido
•Thyroid function: Thyroid disorders can affect sexual function

Additional Tests (If Indicated)

•Coronary artery calcium (CAC) score: CT scan measuring plaque in heart arteries
•Stress test: If cardiovascular disease is suspected
•Penile doppler ultrasound: Measures blood flow to penis (rarely needed)
•Nocturnal penile tumescence test: Monitors nighttime erections (distinguishes physical vs. psychological)

Ready to Talk to a Doctor?

Online consultations make it easy to get an assessment—and treatment if appropriate.

Try Hims → Try Roman →

When It's Probably Not Urgent

You may not need to rush to the doctor if:

•It happened once or twice (occasional issues are normal)
•It's clearly linked to alcohol, fatigue, or stress
•You're in a new relationship and nervous (performance anxiety)
•Morning erections are normal and you can get erections when alone
•It's situational rather than consistent

However, if it persists for more than a few weeks or causes distress, it's worth getting checked—even if just to rule out underlying issues and discuss treatment options.

What Happens If Heart Disease Is Found?

If your doctor discovers cardiovascular issues during ED evaluation:

•Lifestyle changes: Diet, exercise, weight loss, quit smoking—these help both ED and heart health
•Medications: Statins for cholesterol, blood pressure meds, etc.
•ED medications still work: PDE5 inhibitors (Viagra, Cialis) are safe for most men with heart disease and may even have cardioprotective effects
•Exception: ED meds are NOT safe with nitrate medications (nitroglycerin)—can cause dangerous blood pressure drops

The Silver Lining

ED can actually be a good thing if it prompts you to discover and treat cardiovascular disease early—before you have a heart attack or stroke. Many men avoid the doctor until something serious happens. ED gets them in the door.

Options for Getting Evaluated

In-Person Doctor

• Primary care physician
• Urologist (ED specialist)
• Cardiologist (if heart concerns)
• Full physical exam possible
• May be covered by insurance

Telehealth/Online

• Hims, Roman, BlueChew, etc.
• Quick, discreet consultations
• Can prescribe ED medications
• Limited physical evaluation
• May refer you for in-person if needed

For straightforward ED treatment, telehealth is convenient. But if you have cardiovascular risk factors or warning signs, an in-person evaluation with blood work and physical exam is advisable.

Key Takeaways

1. ED is linked to cardiovascular disease — same underlying cause (atherosclerosis)
2. ED often appears 2-5 years before heart attack or stroke
3. Men with ED have 2x the risk of cardiovascular events
4. Red flags: ED under 40, gradual worsening, no morning erections, cardiovascular risk factors, diabetes
5. 2024 Princeton IV guidelines recommend treating ED as a cardiovascular risk factor
6. Get evaluated if ED persists beyond a few weeks, especially if you're over 40 with risk factors
7. Basic tests: Blood pressure, glucose, cholesterol, testosterone
8. ED treatment is still appropriate — medications are safe for most men with heart disease
9. Exception: ED meds + nitrates = dangerous. Tell all doctors about ED medications.

Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. If you're experiencing ED symptoms, especially with cardiovascular risk factors, consult a healthcare provider for proper evaluation.