How much of a man’s self-identity is connected to his erections? For most men, whether they’re conscious of it or not, achieving an erection is intrinsic to their sense of manliness. As one team of psychologists puts it, “The ability to achieve an erection remains considered as a cornerstone of masculinity and sexual performance can be conceived as a proof of one’s masculinity.” Clearly, getting a hard-on is an essential sign of manhood.

Thus, most men feel some degree of threat to their manliness over the idea of erectile dysfunction (ED), defined as loss of erections sufficient for penetration. ED is not the same as an occasional inability to perform sexually, which may be due to a situation such as high stress or anxiety. Occasionally being unable to get it up is normal; reassuringly, erectile function returns when the situation is resolved. Clinical ED, on the other hand, means chronic lack of performance—it becomes more frequent, eventually becoming a constant problem. If this is the case, a guy may feel like he’s less of a man. That’s understandable, but maybe he should be more worried that he’s walking around with a serious health issue sneaking up on him.

Maybe he’s in the nearly 50% of men who don’t consider getting an annual check-up an important part of their self-care, so he’s missing important early clues picked up during a physical exam. Maybe he’s not aware that erections depend more on his heart health than his penis. There he is, freaking out psychologically over being less virile when the problem might actually be physical—and able to be corrected with lifestyle improvements and maybe a little help from a doctor.

ED may be a red flag for something deeper

Countless men don’t realize that ED might be a signal of an underlying condition that could potentially impair a man’s quality of life in the years ahead—or even shorten his life altogether. Here are three conditions for which ED might be a warning sign:

1. Prediabetes or diabetes: A recent study of over 3000 younger men (18-40) who were diagnosed with ED found that roughly 30% were diagnosed with prediabetes at the same time they were diagnosed with ED (prediabetes refers to higher than normal blood sugar). Within a year of ED diagnosis, 75% were found to have prediabetes or type II diabetes. If there’s any good news about this, it’s that “ED may offer the opportunity for earlier detection and diagnoses of T2D, particularly in younger men.” The authors recommend that younger men who present with ED should be screened for prediabetes/type II diabetes.^[i] It goes without saying that such screening should be done for men of any age if loss of erections becomes a regular condition.
2. Coronary heart disease: The American Heart Association tells us, “How men perform in the bedroom could suggest how healthy their hearts and arteries are.” In fact, ED may be the earliest sign that a man’s blood vessels are not in good working order. Put another way, “ED is a marker for both obstructive and non-obstructive coronary artery disease.”^[ii] In fact, ED in middle aged men is linked with 25% greater risk for “…an adverse cardiovascular event, including the presence of coronary heart disease, ischemic stroke, or transient ischemic attack.”^[iii] Experts recommended that all men with ED be screened for cardiovascular disease.
3. Low testosterone (low T): The male hormone testosterone plays a key role in men’s health. It regulates a man’s libido, bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm, says the National Institutes of Health. A simple blood test is all that’s needed to determine a man’s T level, which would normally be 300 nanograms per deciliter (ng/dL) or higher. ED can be a symptom of low T along with fatigue, depression, irritability, low sex drive, and reduced lean muscle mass. Since other conditions can cause these symptoms, a simple blood test is needed to determine if low T is the problem. If so, it is very treatable with testosterone replacement therapy.

As mentioned earlier, lifestyle improvements can go a long way toward a man’s sexual performance and satisfaction. Cardiovascular wellness is achievable through healthy, noninflammatory diet and a regular program of vigorous aerobic exercise. In addition, aerobics contribute to mood elevation and a good night’s sleep. In turn, being happy and energized make for better sex than being depressed and lethargic. Also, being in great condition generally boosts a person’s attractiveness—not a small factor in developing and keeping a loving relationship.

The fact of the matter is, if your penis is consistently “limping” in the bedroom, don’t put off getting a physical, and don’t hold back telling the full truth to your doctor. The earlier you detect high blood sugar, a cardiovascular issue, or low T the sooner you can return to robust wellness with every reason to believe a long, happy and healthy life lies ahead of you.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Tucker J, Salas J, Secrest S, Scherrer JF. Erectile dysfunction associated with undiagnosed prediabetes and type 2 diabetes in young adult males: A retrospective cohort study. Prev Med. 2023 Sep;174:107646.
[ii] Miner M, Parish SJ, Billups KL, Paulos M et al. Erectile Dysfunction and Subclinical Cardiovascular Disease. Sex Med Rev. 2019 Jul;7(3):455-463.
[iii] Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017 May 23;357:j2099.