The workup
The ED workup, start to finish
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Erectile dysfunction is a symptom, not a diagnosis. The whole point of a workup is to answer one question — why— because the answer changes everything that comes after it, and occasionally it turns up something that matters more than the ED itself. A good clinician runs a systematic path, not a guess. Here's the entire thing, so you walk in already holding the map.
The story
The highest-yield part of the workup isn't a machine — it's the conversation. When did it start, and how? A sudden change with morning erections still intact points one way (often stress or a medication); a gradual, everywhere decline points toward the plumbing. Your clinician also walks your medications, sleep, mood, and relationship, because every one of them shows up here.
The body
A focused physical and your vitals. Erectile tissue runs on blood flow, so this is often where a broader problem first surfaces — erectile function is a signal, sometimes the earliest visible sign of vascular or metabolic trouble. Blood pressure, waistline, the genital exam, and signs of low testosterone get checked here, not assumed.
The labs
Blood work looks for treatable drivers and hidden risk at the same time: an early-morning testosterone(repeated if it's low), blood sugar / HbA1c and lipids, and thyroid or prolactin when the picture calls for it. Read your labs decodes what each one means — and this is the step that quietly screens for diabetes and heart risk. You can line up the blood workbefore your visit if you'd rather walk in with numbers.
The picture
Now it gets named. The clinician sorts the cause into vascular, hormonal, neurological, medication-related, or psychological— most often a mix of a few. That classification isn't academic: it's the diagnosis every downstream decision rests on.
The plan
Only now does treatment make sense — and it follows the cause. First-line PDE5 inhibitors, testosteroneif it's genuinely low, treating the metabolic or cardiovascular risk the workup surfaced, and the lifestyle levers that actually move erectile function. Matched to what's wrong, not picked off a menu.
When the basics aren't enough
Most men never need more than a history, an exam, and blood work — and it's worth knowing that up front. A minority need more. Specialized testing — overnight erection monitoring (nocturnal penile tumescence), a penile duplex ultrasound to look at blood flow directly, or an in-office injection test— is reserved for specific situations: younger men, a history of pelvic trauma or surgery, curvature (Peyronie's), or cases where first-line treatment fails and surgery is genuinely on the table. If a service runs none of this and still produces a prescription in ninety seconds, that's the tell in what a good telemedicine visit looks like.
The bottom line
The workup is the part actually worth paying for. Skipping it to buy pills from a checkout screen doesn't just risk treating the wrong thing — it skips the one evaluation that can catch diabetes or heart disease years before they announce themselves. Get the workup. If you still need the pills afterward, that part is easy, and cheaper than you'd think.
Sources & important note
Drawn from: AUA Erectile Dysfunction Guideline; NIDDK: Diagnosis of Erectile Dysfunction; and StatPearls: Erectile Dysfunction.
General education, not medical advice, and not a substitute for your own workup. Diagnosis and any testing or treatment belong to a licensed clinician who can examine you and knows your history.
Common questions
How is erectile dysfunction diagnosed?
With a systematic workup — a detailed history, a focused physical exam, and blood work — aimed at finding the cause, because the cause decides the treatment. Most men never need more than that.
What tests will a doctor run for ED?
A history and exam, plus labs like morning testosterone, blood sugar, and lipids. Specialized tests such as a penile ultrasound are reserved for specific situations, not routine cases.
Do I need a workup, or can I just buy the pills?
The workup is the part actually worth paying for — it is the screen that can catch diabetes or heart disease early. Skipping it risks treating the wrong problem and missing a bigger one.