Health Questions and Answers

Question: What are the six main categories of ED?


  • Hormonal: hypogonadism (primary or secondary), hyperprolactinemia (with resultant hypogonadism), hyperthyroidism or hypothyroidism, and diabetes. Less common: adrenal insufficiency and Cushing’s syndrome.
  • Pharmacologic: long list of implicated medications: antihypertensives (clonidine, beta blockers, vasodilators, thiazide diuretics, spironolactone); antidepressants (selective serotonin reuptake inhibitors [SSRIs], tetracyclic antidepressants), antipsychotics, anxiolytics, cimetidine, phenytoin, carbamazepine, ketoconazole, metoclopramide, digoxin. Alcohol is a major culprit. Illicit drugs include marijuana, cocaine, and heroin.
  • Systemic disease: any severe illness can cause ED and hypogonadotrophic hypogonadism.
  • Vascular: diabetes, peripheral vascular disease.
  • Neurologic: diabetes, spinal cord injury, neuropathy.
  • Psychogenic: uncommon in isolation, but contributes to most cases due to other etiologies. It is a diagnosis of exclusion.

Reference: Larson PR, et al: Williams Textbook of Endocrinology, 10th ed. Philadelphia, W.B. Saunders, 2003.

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