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Vascular Cardiovascular risk factors (eg, hypertension, smoking, diabetes) Abnormal vascular examination (eg, bruits, decreased pulses) Neurologic Neurologic comorbidity (eg, diabetic neuropathy, multiple sclerosis, spinal injury/surgery) Gradual onset, loss of bulbocavernosus reflex Psychogenic Sudden onset Situational (eg, ED with partner, normal erection during masturbation) Normal nonsexual nocturnal erections Endocrine Additional symptoms due to underlying disorder Abnormal hormone levels (eg, TSH, prolactin) Medications Onset related to starting medication Antihypertensives, SSRIs, antiandrogenic medications Hypogonadism Gradual onset Decreased libido, gynecomastia, testicular atrophy Low serum testosterone

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