Let’s Talk About Erectile Dysfunction: What It Really Is and How to Treat It

Erectile dysfunction (ED) is one of the most common yet misunderstood conditions affecting men—especially in midlife and beyond. Despite how often it’s discussed in commercials, the reality of ED is far more nuanced than just “not being able to get it up.”

As Dr. Laura, I treat ED not as a one-size-fits-all diagnosis, but as a multifactorial condition with physical, hormonal, emotional, and neurological components. Let’s break down what’s really going on—and the best options to address it.

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What Is Erectile Dysfunction, Really?

ED is defined as the persistent or recurrent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. But it’s more than a bedroom issue—it’s often a signal of deeper health concerns.

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The Two Types of ED: Psychogenic vs. Physiologic

1. Psychogenic ED (Mind-Body Connection)

This form of ED originates primarily in the brain. It’s common in younger men and those with performance anxiety, stress, or a history of trauma.

Common Causes:

    •    Performance pressure

    •    Anxiety or depression

    •    Relationship strain

    •    Early experiences of shame, rejection, or guilt

Clues: Morning erections are usually intact. Symptoms may vary depending on the partner or situation.

2. Physiologic ED (Body-Based)

Here, the issue lies in blood flow, nerve function, or hormonal balance. It becomes more common with age and chronic illness.

Common Causes:

    •    Vascular disease (hypertension, diabetes)

    •    Low testosterone or DHEA

    •    Neurologic conditions

    •    Medication side effects (SSRIs, blood pressure meds)

    •    Pelvic trauma or surgery

Clues: Gradual onset, diminished morning erections, difficulty with arousal regardless of mood.

Most men have elements of both, which is why treatment must address the whole person.

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Core Treatment Approaches

🧬 Hormone Optimization

Low testosterone is a major contributor to ED and low libido.

I evaluate:

    •    Total and free testosterone

    •    Estradiol, SHBG, prolactin, DHEA

When needed, I use:

    •    Testosterone replacement therapy (TRT)

    •    Clomid or hCG for fertility-preserving options

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💊 Medication Options

1. Tadalafil (Cialis)

    •    Daily low-dose or as-needed use

    •    Supports blood flow, endothelial function, and nitric oxide

    •    May help with BPH symptoms and mood

2. Sildenafil (Viagra)

    •    Shorter-acting, works in 30–60 minutes

    •    Best for event-driven use

    •    Can cause flushing, headaches, or congestion in some patients

3. Apomorphine + Tadalafil (Compound)

    •    Combines dopamine agonist and PDE5i

    •    Enhances libido and erection initiation (psychogenic and physiologic)

    •    Sublingual or troche forms work fast

I often prescribe this blend when men have performance anxiety + mild vascular issues or when PDE5s alone aren’t enough.

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🧠 Mind-Body Interventions

    •    Psychosexual therapy or coaching

    •    EMDR or somatic therapy for trauma-based ED

    •    Stress management, mindfulness, parasympathetic activation

    •    Sleep and circadian rhythm support

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💉 Advanced and Adjunctive Therapies

    •    Peptides: PT-141 for libido and spontaneous arousal

    •    Shockwave therapy: Regenerates blood vessels (GAINSWave, etc.)

    •    PRP (P-Shot): Platelet-rich plasma to restore nerve and vascular function

    •    Vacuum devices and cock rings: Helpful when combined with other treatments

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The Dr. Laura Approach

Every man I work with gets a full evaluation—labs, lifestyle, relationship dynamics, and emotional health. Because ED isn’t just about the penis—it’s about the person.