How to Tell If Your ED Is Vascular, Psychological, or Hormonal
When you start experiencing erection problems, it’s natural to assume it’s all in your head - or that it’s just part of getting older.
But erectile dysfunction (ED) isn’t one single condition. It’s a symptom, and understanding the cause is the key to fixing it.
Most cases fall into one (or a mix) of three main categories:
Vascular (blood flow)
Psychological (mind and stress-related)
Hormonal (testosterone and endocrine issues)
Let’s break down how to spot which one might be affecting you, what patterns to look for, and when it’s time to get blood tests or seek expert help.
1. Vascular ED: When It’s a Circulation Problem
Vascular erectile dysfunction is the most common type, especially in men over 40.
To get and maintain an erection, you need strong blood flow into the penis and healthy vessels to keep it there. When those vessels are narrowed, stiff, or damaged (a process known as endothelial dysfunction), the pressure drops, and so does your confidence.
Common signs of vascular ED:
Erections are weaker or don’t last as long as before.
You can still get morning or spontaneous erections, but they’re not as firm.
You might notice reduced sensitivity or slower arousal.
You have risk factors like high blood pressure, high cholesterol, diabetes, or you smoke.
Why it matters:
Vascular ED can actually be an early warning sign of heart disease. The blood vessels in the penis are smaller than those around the heart, so they often show signs of damage first.
What to do:
Book a check-up with your GP or a men’s health practitioner.
Ask for blood pressure, cholesterol, and glucose tests.
Consider a treatment like focused shockwave therapy (ESWT) if poor blood flow is confirmed, it helps regenerate blood vessels and restore natural function.
2. Psychological ED: When the Mind Interferes
Performance anxiety, stress, relationship issues, or even fear of “failing” again can all interrupt the brain-body connection needed for an erection.
Psychological ED often affects younger men, or men who’ve had one bad experience that creates a lasting mental block.
Common signs of psychological ED:
You still get normal morning or solo erections (e.g. during masturbation).
The problem only happens with a partner or in certain situations.
It fluctuates, some days are fine, others not.
You’re under stress, feeling anxious, or overthinking sex.
Why it matters:
Even when ED starts as a physical issue, it can quickly develop a psychological layer, where fear and worry keep the problem going.
What to do:
Address stress, sleep, and lifestyle factors first.
Avoid excessive porn or unrealistic performance expectations.
Consider therapy or coaching to rebuild sexual confidence.
Combine mind-based work with physical treatments if needed, body and brain often need to recover together.
3. Hormonal ED: When Testosterone (or Other Hormones) Are Off
Testosterone plays a huge role in libido, energy, mood, and erection quality.
When it’s low, you may not feel mentally or physically “switched on” - which can affect both desire and performance.
Common signs of hormonal ED:
Low sex drive or lack of motivation.
Fatigue, low mood, or reduced muscle mass.
Erections are weak and desire is low.
Weight gain, especially around the belly.
Sometimes, erectile function improves with testosterone optimisation.
What to do:
Ask your GP or practitioner for a blood test including:
Total and free testosterone
SHBG (sex hormone binding globulin)
LH, FSH, and prolactin
Thyroid function (if fatigue or weight issues are present)
If levels are low, investigate why, not just replace hormones.
Poor sleep, excess alcohol, obesity, and certain medications can all suppress testosterone.
4. When It’s a Mix of Causes
Many men don’t fit neatly into one category.
For example:
Long-term stress increases cortisol, which lowers testosterone and worsens vascular function.
Poor circulation can make you anxious, creating a mental block.
That’s why the best approach is a full assessment - physical, hormonal, and psychological, so nothing is missed.
When to Get Blood Tests or a Medical Check-Up
If your erections have been weaker for more than 3 months, or you’ve lost morning erections entirely, it’s time to get tested.
Ask for:
Blood pressure and cholesterol (for vascular health)
HbA1c or fasting glucose (for diabetes)
Total and free testosterone
Thyroid, prolactin, and liver function (if fatigue or low libido present)
These results give a clear picture of where the problem lies, and what kind of treatment will actually fix it.
The Takeaway: Knowledge Beats Guesswork
ED isn’t a one-size-fits-all issue.
The man who needs vascular regeneration therapy isn’t the same as the man who needs stress support or hormone optimisation.
The most effective path forward starts with understanding what’s really happening in your body.
Once you know whether your ED is vascular, psychological, or hormonal, you can choose treatments that actually restore confidence, not just cover up symptoms.
Download our free ED info pack here.