Do endocrinologists treat erectile dysfunction? Yes, endocrinologists play a vital role when erectile dysfunction (ED) stems from hormonal imbalances such as low testosterone, elevated prolactin, thyroid disorders, or diabetes. Whilst GPs and urologists manage most cases, endocrinologists provide specialist expertise in diagnosing and treating the hormonal causes that can significantly impair erectile function. Their involvement typically follows initial assessment by your GP, who may identify hormonal concerns through blood tests or clinical examination. Working as part of a multidisciplinary team, endocrinologists address the hormonal component whilst ensuring you receive comprehensive care for all contributing factors, optimising both sexual health and overall wellbeing.

What Role Do Endocrinologists Play in Erectile Dysfunction Treatment?

Endocrinologists are specialist physicians who diagnose and manage disorders of the endocrine system, which includes glands that produce hormones regulating numerous bodily functions. When erectile dysfunction (ED) has an underlying hormonal cause, endocrinologists play a crucial role in identifying and treating these imbalances.

Whilst many cases of erectile dysfunction are managed successfully by GPs or urologists, endocrinologists become particularly valuable when hormonal abnormalities are suspected or confirmed. They possess expertise in conditions such as hypogonadism (low testosterone), hyperprolactinaemia, thyroid disorders, and diabetes mellitus—all of which can significantly impact erectile function. Their specialist knowledge allows them to interpret complex hormone test results and develop targeted treatment strategies.

Endocrinologists work as part of a multidisciplinary team, often collaborating with urologists, diabetes specialists, and cardiovascular physicians. Their involvement typically follows initial assessment by a GP, who may identify hormonal concerns through blood tests or clinical examination. The endocrinologist's role extends beyond simply prescribing hormone replacement; they investigate the root cause of hormonal imbalances, which may include pituitary tumours, genetic conditions, or metabolic disorders.

It is important to recognise that erectile dysfunction frequently has multiple contributing factors, including vascular, neurological, psychological, and lifestyle elements. Endocrinologists address the hormonal component whilst ensuring patients receive comprehensive care for all relevant factors. This integrated approach, consistent with NICE Clinical Knowledge Summary (CKS) guidance on erectile dysfunction, optimises outcomes and addresses underlying health issues that may extend beyond erectile function alone.

Erectile dysfunction can be an early indicator of cardiovascular disease, as both conditions share common risk factors such as hypertension, diabetes, and dyslipidaemia. Cardiovascular risk assessment and risk factor modification should therefore form part of the overall management strategy. Psychosexual therapy and counselling are available through NHS pathways and may be recommended alongside medical treatments when psychological factors contribute to erectile difficulties.

When Should You See an Endocrinologist for Erectile Dysfunction?

Not every man experiencing erectile dysfunction requires endocrinological assessment. Your GP will typically conduct initial investigations, including a detailed medical history, physical examination, and baseline blood tests. Referral to an endocrinologist becomes appropriate when specific indicators suggest hormonal involvement.

Key referral triggers include:

• Confirmed hormonal abnormalities – Low testosterone levels detected on two separate early-morning (ideally fasting) blood samples, taken on different days. Testosterone should be interpreted against your local laboratory reference ranges. If sex hormone-binding globulin (SHBG) is abnormal, free or bioavailable testosterone should be calculated. Testing should be avoided during acute illness. Elevated prolactin (after repeat testing and exclusion of macroprolactin and drug causes) or thyroid dysfunction also warrant specialist review.

• Associated symptoms – Loss of libido, reduced energy, mood changes, gynaecomastia (breast tissue development), or symptoms of thyroid disease

• Suggestive clinical features in younger men – Whilst psychogenic and vascular causes are common at any age, men under 40 with erectile dysfunction accompanied by symptoms or signs of endocrine disease may benefit from specialist investigation

• Poor response to standard treatments – Failure to respond to phosphodiesterase-5 inhibitors (such as sildenafil) warrants broad re-evaluation, which may include endocrine, vascular, neurogenic, medication-related, and psychological factors

• Diabetes-related complications – Poorly controlled diabetes or multiple diabetic complications often benefit from endocrine review

• Suspected pituitary pathology – Headaches, visual disturbances, or other symptoms suggesting pituitary tumours. Severe headache with visual disturbance or eye movement problems requires urgent same-day assessment due to the possibility of pituitary apoplexy

Your GP may also consider endocrine referral if you have a history of testicular injury, chemotherapy, radiation therapy, or chronic conditions affecting hormone production. Men taking medications that influence hormone levels, such as opioids, antiandrogens, 5-alpha-reductase inhibitors, or corticosteroids, may similarly benefit from specialist assessment.

For raised prolactin levels, your GP will typically arrange a repeat measurement and exclude macroprolactin before considering pituitary MRI, as certain medications (including some antipsychotics and antidepressants) can elevate prolactin. Very high prolactin levels may require consideration of the 'hook effect', a laboratory artefact that can occur with some assays.

The referral pathway typically follows NHS protocols, with waiting times varying by region. Private endocrine consultations are available for those seeking more rapid assessment. Regardless of the route, bringing a list of all medications, previous test results, and a symptom diary can facilitate a more productive initial consultation.

How Hormonal Imbalances Contribute to Erectile Dysfunction

Hormonal regulation is fundamental to normal erectile function, with testosterone playing a central role. Testosterone influences libido, supports the physiological mechanisms of erection, and maintains the health of penile tissues. When testosterone levels fall below the normal range, erectile dysfunction commonly develops, though the relationship is complex and not always linear. It is important to understand that low testosterone is neither necessary nor sufficient to cause erectile dysfunction, and multiple aetiologies often coexist.

Testosterone deficiency (hypogonadism) affects an estimated 2–4% of men, with prevalence increasing with age, though estimates vary depending on definition and population studied. Low testosterone reduces sexual desire and can impair the nitric oxide pathway essential for smooth muscle relaxation in penile blood vessels. This hormonal deficit may result from testicular failure (primary hypogonadism) or problems with the pituitary gland or hypothalamus (secondary hypogonadism). Conditions such as Klinefelter syndrome, mumps orchitis, or pituitary tumours can cause significant testosterone deficiency. Obesity, metabolic syndrome, and obstructive sleep apnoea are also important contributors to androgen deficiency and erectile dysfunction.

Hyperprolactinaemia, characterised by elevated prolactin levels, suppresses testosterone production and directly reduces libido. Prolactin-secreting pituitary tumours (prolactinomas) are a common cause, though certain medications, including some antipsychotics and antidepressants, can also raise prolactin levels. Men with hyperprolactinaemia often experience both reduced sexual desire and erectile difficulties.

Thyroid disorders affect erectile function through multiple mechanisms. Hypothyroidism (underactive thyroid) can reduce libido and cause fatigue, whilst hyperthyroidism (overactive thyroid) may lead to anxiety and hormonal imbalances. Both conditions are readily treatable once identified.

Diabetes mellitus represents a particularly important endocrine cause of ED. Studies suggest that up to 50% of men with diabetes experience erectile dysfunction, though prevalence varies. Chronic hyperglycaemia damages blood vessels and nerves, whilst also affecting testosterone production. The combination of vascular, neurological, and hormonal factors makes diabetes-related ED especially challenging, requiring comprehensive endocrine management alongside glycaemic control.

Because erectile dysfunction is commonly multifactorial, correcting hormonal issues often needs to be combined with interventions addressing vascular health, psychological factors, and lifestyle modifications for optimal outcomes.

What Tests and Treatments Do Endocrinologists Offer?

Endocrinologists employ a systematic approach to investigating erectile dysfunction, beginning with comprehensive hormonal assessment. Initial blood tests typically include total testosterone (measured on two separate occasions on different days, ideally between 8–10 am when levels peak and preferably fasting), sex hormone-binding globulin (SHBG), luteinising hormone (LH), follicle-stimulating hormone (FSH), and prolactin. If SHBG is abnormal, free or bioavailable testosterone should be calculated using albumin levels. These tests help distinguish between primary and secondary hypogonadism and identify other hormonal abnormalities.

For elevated prolactin, a repeat measurement is arranged to confirm the finding, and macroprolactin is excluded, as this form does not cause symptoms. Medication history is reviewed to identify drugs that may raise prolactin. With very high prolactin levels, laboratories may need to consider the 'hook effect', a technical artefact that can occur with certain assays.

Additional investigations may include thyroid function tests (TSH, free T4), HbA1c or glucose tolerance testing for diabetes screening, and lipid profiles to assess cardiovascular risk. If a pituitary tumour is suspected based on persistently elevated prolactin or low gonadotrophin levels, magnetic resonance imaging (MRI) of the pituitary gland and visual field testing will be arranged.

Treatment approaches depend on the underlying diagnosis:

• Testosterone replacement therapy (TRT) – Available as gels, injections, or patches for confirmed organic hypogonadism. The MHRA emphasises that TRT should only be used in men with confirmed hypogonadism and requires careful patient selection and monitoring. TRT is contraindicated in men with known or suspected prostate cancer or male breast cancer. It should be used with caution in severe cardiac, hepatic, or renal disease due to the risk of fluid retention and oedema. Regular monitoring is essential and includes:
• Haematocrit and haemoglobin at baseline, 3–6 months, then annually (dose reduction or cessation if haematocrit exceeds 54%)
• Prostate-specific antigen (PSA) and digital rectal examination (DRE) according to local protocols
• Assessment for possible worsening of obstructive sleep apnoea
• Symptom review and testosterone level monitoring

Important: Testosterone replacement therapy suppresses spermatogenesis and may impair fertility. If you are planning to conceive, alternative treatments such as human chorionic gonadotrophin (hCG) or selective oestrogen receptor modulators (SERMs) may be more appropriate, and referral to an andrology specialist should be considered.

• Dopamine agonists – Medications such as cabergoline effectively treat hyperprolactinaemia, often restoring normal testosterone levels and erectile function. At the doses used for endocrine conditions, the risk of cardiac valve problems is very low, though echocardiography may be considered if high cumulative doses are used or symptoms develop, according to local policy.

• Thyroid hormone replacement – Levothyroxine corrects hypothyroidism, with erectile function typically improving as thyroid status normalises.

• Diabetes management optimisation – Improved glycaemic control, appropriate medication adjustments, and management of diabetic complications.

Endocrinologists monitor treatment response through repeat hormone testing, symptom questionnaires, and assessment of potential adverse effects. Treatment is individualised, with regular review ensuring optimal outcomes whilst minimising risks. Patients are advised to report any suspected side effects via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk.

Working with Your GP and Specialist Team for Erectile Dysfunction

Effective management of erectile dysfunction requires coordinated care between your GP, endocrinologist, and potentially other specialists. Your GP serves as the central coordinator, initiating investigations, managing common contributing factors, and facilitating specialist referrals when appropriate. This integrated approach, consistent with NICE Clinical Knowledge Summary guidance on erectile dysfunction, ensures comprehensive assessment of all potential causes.

Your GP's role includes addressing modifiable risk factors such as smoking, obesity, alcohol consumption, and physical inactivity—all of which significantly impact erectile function. Cardiovascular risk assessment using tools such as QRISK should be undertaken, with appropriate management of blood pressure, lipids, and diabetes. Your GP will review your medications, as numerous drugs (including some antihypertensives, antidepressants, and antihistamines) can contribute to ED.

Your GP can also prescribe phosphodiesterase-5 inhibitors (PDE5 inhibitors) such as sildenafil, tadalafil, or vardenafil, which remain first-line treatment for most men with erectile dysfunction. However, these medications are contraindicated in men taking nitrates (for angina) or riociguat (for pulmonary hypertension) due to the risk of severe hypotension. Caution is required when used alongside alpha-blockers. Before prescribing PDE5 inhibitors, your GP will assess your cardiovascular fitness for sexual activity and defer use in unstable cardiovascular disease. Sildenafil 50 mg (Viagra Connect) is also available over the counter from pharmacies in the UK following pharmacist assessment, with the same nitrate contraindication applying.

When hormonal abnormalities are identified, collaboration between your GP and endocrinologist ensures seamless care. The endocrinologist provides specialist assessment and initiates hormone-specific treatments, whilst your GP continues managing other health conditions and monitoring overall wellbeing. Regular communication between healthcare professionals prevents duplication of tests and ensures treatment plans are coordinated.

Additional specialists may join your care team depending on underlying conditions. Urologists address structural or vascular penile problems; cardiologists manage cardiovascular disease (which shares risk factors with ED and may require input for high or unstable cardiovascular risk); and diabetes specialist nurses support optimal glycaemic control. Psychological support through counselling or psychosexual therapy benefits many men, particularly when anxiety or relationship factors contribute to erectile difficulties, and is available through NHS referral pathways.

When to contact your GP urgently:

• Sudden onset of erectile dysfunction, especially if accompanied by chest pain or breathlessness

• Persistent painful erection (priapism) lasting more than 4 hours—this requires emergency treatment

• Sudden loss of vision or hearing after taking a PDE5 inhibitor

• Severe headache with visual disturbance or eye movement problems (possible pituitary apoplexy)

• New symptoms suggesting serious illness (unexplained weight loss, severe fatigue)

• Concerning side effects from prescribed treatments

Maintaining open communication with your healthcare team, attending scheduled follow-up appointments, and reporting treatment responses honestly optimises outcomes. Erectile dysfunction often signals broader health concerns, particularly cardiovascular disease, making comprehensive medical assessment valuable beyond addressing sexual function alone.

Frequently Asked Questions