What does the history part of an ED visit cover?
The history is the most important test, and it costs nothing but time. The AUA erectile dysfunction guideline asks clinicians to take a thorough medical, sexual and psychosocial history from every man who reports erection problems.
Expect questions like these:
- When did the change start, and was it sudden or gradual?
- Do you still get morning or nighttime erections?
- Is the problem getting an erection, keeping it, or both?
- Has your desire changed, or only the physical response?
- Which medicines, supplements and recreational substances do you use?
- Do you have high blood pressure, diabetes, heart disease or a history of pelvic surgery?
The answers sort men into broad groups fast. A sudden change with normal morning erections points one way; a slow fade alongside rising blood pressure points another. The NIDDK guide to diagnosing ED adds a mental health history, because stress, anxiety and depression can cause or worsen ED. If you suspect nerves play a part, our answer on whether ED can be psychological goes further.
What is the five-question IIEF score?
The IIEF-5 is a short questionnaire that turns your symptoms into a number from 5 to 25. The AUA recommends validated questionnaires like it to gauge how severe ED is, and the score gives you and your provider a baseline to measure treatment against.
The study that created the IIEF-5 pulled five questions from the longer 15-item International Index of Erectile Function, focused on erectile function and satisfaction with intercourse. In 1,152 men, a cutoff score of 21 separated men with and without ED with a sensitivity of 0.98 and specificity of 0.88.
| IIEF-5 score | What the original study classed it as |
|---|---|
| 22 to 25 | No ED |
| 21 or below | ED present, graded into severity bands |
| 5 to 7 | Severe ED, the lowest band |
Answer honestly rather than generously. A score that reflects your real experience is far more useful than one that looks good on paper. Our guide on how to prepare for an ED consultation suggests tracking a few weeks of symptoms first.
The blood tests behind an ED diagnosis
Three blood tests do most of the work: a morning total testosterone, an A1c or fasting glucose, and a lipid panel. The AUA recommends measuring morning total testosterone in men with ED and lists fasting lipids and a fasting glucose or hemoglobin A1c as basic studies appropriate in some men.
Each one answers a different question. Testosterone shows whether low hormone levels are blunting desire or the response to ED medicine. The A1c looks for prediabetes or diabetes, which the NIDDK defines as an A1c of 5.7% to 6.4% and 6.5% or higher, respectively. The lipid panel shows the cholesterol picture behind the artery narrowing that drives most physical ED.
Thyroid and prostate tests join the list for some men, as the NIDDK notes. Our page on blood tests for erectile dysfunction covers each marker in detail.
When is a Doppler ultrasound added?
A penile duplex Doppler ultrasound is a specialist test for a minority of men, not a first step. The AUA calls it the gold standard for checking blood flow in the penis and describes it as useful for separating psychological from physical causes, assessing arterial function in men who may need a cardiology review, finding severe venous leak that is unlikely to respond to medicine, and identifying young men who might be candidates for surgery to restore blood flow.
The scan usually involves an injection that produces an erection, then an ultrasound that shows blood moving through the penis. Penile Doppler is not part of the Ultimate Male service menu, so when it is warranted the next step is a referral to a urologist. Our page on vascular erectile dysfunction explains what the scan looks for.
Related question: can ED be the first sign of diabetes?
It can. High blood sugar damages the small vessels and nerves erections depend on, sometimes before a man has any other symptom. That is why the A1c belongs in the first round of labs, and our answer on whether ED can be an early sign of diabetes walks through the link.
How Ultimate Male evaluates ED
At Ultimate Male, the evaluation runs in the order the guideline suggests: history and symptom score, then labs, then a plan. Blood is drawn on site in San Gabriel or Downey, results usually return in 24 to 48 hours, and a PA-C or MD reviews them with you privately.
If the results point to a hormone, blood sugar or cholesterol problem, that gets addressed alongside the erection itself. Treatment choices, from oral medicines to injectables, are covered on our erectile dysfunction treatment page, and the full lab menu is on the preventative blood testing page. Chest pain during sex, or an erection lasting more than four hours, is an emergency: call 911 or go to the nearest ER.
