What Are the Causes of ED?

If you are dealing with erectile dysfunction (ED), you are not alone, and you are not broken.

ED can feel personal, frustrating, and even embarrassing. But the truth is, it is usually a health signal, not a character flaw.

An erection depends on healthy blood flow, strong nerve signals, balanced hormones, and a calm nervous system. When one of those systems gets disrupted, erections can become weaker, less reliable, or harder to maintain.

Let’s break down the most common causes of ED in a way that actually makes sense, and more importantly, what you can do about it.

 

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ED Usually Has More Than One Cause

 

A lot of people look for one single reason their erections changed.

In reality, ED often develops from a combination of factors, like mild circulation issues mixed with stress, or hormones plus lifestyle changes.

That is why guessing rarely works, and why a proper assessment matters.

At Ottawa Men’s Health Clinic, we focus on identifying what is driving the problem for you, so treatment actually addresses the root cause.

 

The Most Common Causes of Erectile Dysfunction

 

1) Reduced Blood Flow (The #1 Physical Cause)

Most erections depend on strong circulation. If blood flow is limited, you may notice:

• Erections are softer than they used to be

• You can get an erection, but cannot maintain it

• Performance is inconsistent

• Morning erections become less frequent

Blood flow issues can be linked to things like high blood pressure, high cholesterol, early vascular changes, or being less active than before.

This is also why ED is sometimes considered an early warning sign for broader cardiovascular health.

The encouraging part is that blood flow can often be improved, especially with treatments designed to support circulation and tissue health.

 

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2) Stress, Anxiety, and Performance Pressure

Even if your body is physically capable, your nervous system needs to cooperate.

Stress shifts your body into “fight or flight” mode, which is the opposite of what your sexual function needs.

This can show up as:

• Trouble getting started

• Losing the erection midway

• Feeling stuck in your head

• Worrying it will happen again (and then it does)

This is extremely common, especially when ED first starts. One difficult experience can create a pattern where anticipation becomes the biggest obstacle.

This does not mean it is “all in your head.” It means your nervous system is doing what it is designed to do under pressure.

 

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3) Low Testosterone and Hormonal Changes

Low testosterone can affect:

• Sex drive

• Energy

• Mood

• Erections

• Recovery

Many men do not realize that hormone levels can impact sexual performance, even if they feel “fine” overall.

If you have noticed low motivation, lower confidence, fatigue, or reduced libido alongside ED, hormones are worth assessing.

 

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4) Medication Side Effects

This surprises a lot of men.

Some medications can interfere with sexual function, including certain treatments for:

• Blood pressure

• Depression and anxiety

• Sleep issues

• Prostate symptoms

You should never stop medication on your own, but you also should not assume you have to “live with it.” There are often options and supportive treatments that can help.

 

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5) Lifestyle Factors (Sleep, Alcohol, Smoking, and More)

Sometimes the cause is not one dramatic thing, but slow accumulation.

Common contributors include:

• Poor sleep and fatigue

• Excess alcohol

• Smoking or vaping

• High stress with no recovery

• Weight gain and reduced activity

• Nutrient and metabolic changes

This is not about judgment. It is about understanding what your body is responding to.

 

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6) Chronic Health Conditions

Certain conditions increase the likelihood of ED, including:

• Diabetes

• Heart disease

• High blood pressure

• Metabolic syndrome

• Neurological disorders

ED is common in men managing chronic health issues, because those conditions can affect blood flow, nerve function, or hormone balance.

If you have been told your ED is “just age,” but you also have one of these underlying issues, it may be time for a more targeted plan.

 

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7) Aging (But Not in the Way Most People Think)

Aging itself is not the cause. The changes that often come with aging can be.

As men get older, they are more likely to experience shifts in circulation, hormone levels, and recovery time. That can affect performance, even when desire is still there.

Also, ED can affect men at different stages of life. It is not limited to older men.