Erectile Dysfunction (ED)

Erectile dysfunction (ED) is the ongoing difficulty achieving or maintaining an erection firm enough for sex. ED can be vascular, hormonal, neurologic, medication-related, or psychological—and it is often multifactorial. Because ED may be an early sign of cardiometabolic disease or a hormonal imbalance, lab testing helps you and your clinician identify drivers you can act on.

A proactive approach starts with morning total testosterone (with free testosterone/SHBG when indicated) and adds pituitary hormones (LH/FSH) and prolactin to clarify causes of low testosterone or libido changes. Pair endocrine testing with thyroid labs (TSH ± free T4), diabetes markers (fasting glucose, A1c), lipids (± ApoB, Lp(a)), and general health checks (CMPCBC). Results support screeningdiagnostic triage, and monitoring, but they do not replace a clinician’s exam, medication review, counseling, or imaging when needed.

Signs, Symptoms & Related Situations

  • Sexual/urogenital

    • Difficulty achieving or maintaining erections; reduced morning erections; low libido

    • Ejaculatory changes; penile curvature or pain (specialist evaluation may be needed)

  • Hormonal clues

    • Low energy, depressed mood, decreased muscle mass, increased body fat, hot flashes

  • Cardiometabolic context

    • High blood pressure, central weight gain, high triglycerides/low HDL, high blood sugar

  • Neurologic/medication factors

    • Neuropathy, spinal injury, pelvic surgery; medicines associated with ED (some BP, prostate, depression/anxiety drugs)

  • When to seek urgent care

    • Chest pain or severe shortness of breath during sexual activity; priapism (erection >4 hours); sudden testicular pain; new weakness, numbness, or vision changes

Symptoms and risk factors require evaluation by a qualified clinician.

Why These Tests Matter

What testing can do

  • Identify hormonal causes (low total or free testosterone; abnormal LH/FSH; elevated prolactin; thyroid dysfunction)

  • Uncover cardiometabolic risks linked to ED (diabetes, dyslipidemia, metabolic syndrome)

  • Establish baselines (CBC, CMP) that guide safe follow-up and broader evaluation

What testing cannot do

  • Diagnose ED by one value or determine psychological contributors

  • Replace a clinician’s exam, cardiovascular risk assessment, or medication review

  • Provide treatment or dosing guidance—use results to plan next steps with your clinician

What These Tests Measure (at a glance)

  • Total Testosterone (morning): primary screen for androgen status; repeat on a morning sample if low/borderline. Levels vary by lab and time of day; confirm on repeat.

  • Free Testosterone & SHBG: clarifies bioavailable testosterone, especially when total T is borderline or SHBG is abnormal (age, thyroid, liver, obesity).

  • LH & FSH: help distinguish primary testicular from central (pituitary/hypothalamic) causes when testosterone is low.

  • Prolactin: high values can suppress gonadal function and libido; persistent elevation needs clinician evaluation.

  • Thyroid (TSH ± Free T4): both hypo- and hyperthyroidism can affect libido, mood, and erectile function.

  • Diabetes markers (A1c, fasting glucose ± fasting insulin): hyperglycemia and insulin resistance damage blood vessels and nerves.

  • Lipid Panel (± ApoB, Lp(a)): vascular risk profiling; ED can be an early marker of atherosclerosis.

  • Comprehensive Metabolic Panel (CMP): liver/kidney function, electrolytes; overall safety context.

  • Complete Blood Count (CBC): anemia and some blood disorders can affect energy and sexual performance.

  • Estradiol: optional in select cases (e.g., gynecomastia, obesity, unexplained low T).

  • PSA (as directed): prostate context in age-appropriate men when clinically relevant.

Quick Build Guide

Clinical goal Start with Add if needed
First-line ED workup Morning total testosterone • TSH • A1c/fasting glucose • Lipid panel • CMP • CBC Free T/SHBG • LH/FSH • Prolactin
Low libido/fatigue with borderline T Repeat morning total T • Free T/SHBG LH/FSH • Prolactin • Estradiol
Cardiometabolic risk present A1c • Lipid panel • CMP ApoB • Lp(a) per clinician
Suspected pituitary/central cause Total/Free T • LH/FSH • Prolactin Thyroid panel; additional endocrine tests as directed
Medication contributors possible CMP • CBC • A1c • Lipid panel Review meds with clinician; add hormonal panel if symptoms fit
Normal hormones, persistent ED Cardiometabolic labs (A1c, lipids) • CMP • CBC Clinician-directed imaging or specialty evaluation

How the Testing Process Works

  1. Choose your starting set: many begin with morning total testosteroneTSHA1clipid panelCMP, and CBC.

  2. Collect correctly: schedule morning blood draw (typically 7–10 a.m.) for testosterone; fasting is needed only for certain lipid/glucose orders.

  3. Review results: if testosterone is low or borderlinerepeat a morning sample and add free T/SHBG and LH/FSH.

  4. Clarify the picture: add prolactin and targeted tests based on symptoms.

  5. Plan next steps: discuss results with your clinician; they may recommend cardiovascular assessment, counseling, or specialty referral.

Interpreting Results (General Guidance)

  • Low total testosterone: confirm with a repeat morning test; consider free T/SHBG and LH/FSH to localize (primary vs central).

  • Normal testosterone with ED: look for vascular/metabolic drivers (A1c/lipids), thyroid issues, medication effects, or psychological factors.

  • High prolactin: may suppress testosterone—requires clinician evaluation and confirmation.

  • Abnormal TSH or Free T4: thyroid imbalance can impair libido and energy; address with your clinician.

  • A1c or lipids elevated: indicates cardiometabolic risk that often tracks with ED severity.
    Interpret labs with a qualified healthcare professional; patterns, timing, and symptoms matter more than any single value.

Choosing Panels vs. Individual Tests

  • Foundational ED panel: Morning total testosterone • TSH • A1c • Lipid panel • CMP • CBC

  • Hormone-focused add-ons: Free T/SHBG • LH/FSH • Prolactin • Estradiol (select cases)

  • Cardiometabolic risk refinement: ApoB • Lp(a) where available

  • Age-appropriate context: PSA as directed by your clinician

FAQs

Do I need to test testosterone in the morning?
Yes. Testosterone follows a daily rhythm; morning testing improves accuracy. Repeat a low result.

Can ED be an early sign of heart disease?
It can. ED often reflects vascular health, so A1c and lipid testing help assess risk.

If my testosterone is normal, why do I still have ED?
Many cases are vascular, neurologic, medication-related, or psychological. Labs guide the next steps but don’t tell the whole story.

Do I have to fast?
Only if your order includes fasting lipids or fasting glucose. Hormone tests typically don’t require fasting.

What does a high prolactin mean?
It can lower testosterone and libido. Mild elevations may need repeat confirmation and clinical evaluation.

Will these tests diagnose ED by themselves?
No. They clarify contributors. Diagnosis and care planning require a clinician’s evaluation.

Can medications cause ED?
Some can. Do not stop medicines on your own—review your list with your clinician.

Related Categories & Key Tests

  • Men’s Health Tests Hub

  • Testosterone & Men’s Hormone Tests • Thyroid Tests • Diabetes Health • Heart & Cardiovascular Risk • Prostate Health

  • Key Tests: Total Testosterone (AM) • Free Testosterone • SHBG • LH • FSH • Prolactin • TSH • Free T4 • Estradiol • A1c • Fasting Glucose • Lipid Panel (± ApoB, Lp[a]) • CMP • CBC • PSA (as directed)

References

  • American Urological Association. Guideline on the Management of Erectile Dysfunction.
  • American Urological Association. Testosterone Deficiency Guideline.
  • Endocrine Society. Testosterone Therapy in Men with Hypogonadism: Clinical Practice Guideline.
  • American Diabetes Association. Standards of Care—Cardiometabolic risk assessment.
  • American College of Cardiology/American Heart Association. Cholesterol guideline—risk assessment and treatment thresholds.
  • Clinical reviews on endocrine, vascular, and psychogenic contributors to ED and the role of laboratory testing.

Available Tests & Panels

Your Erectile Dysfunction (ED) Tests menu is pre-populated in the Ulta Lab Tests system. Start with morning total testosteroneTSHA1clipid panelCMP, and CBC. Use filters to add free T/SHBGLH/FSHprolactinestradiol, and risk-refining markers (ApoB, Lp[a]) as needed. Review results with your clinician to decide on next steps and monitoring.

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Most Popular

The Hemoglobin A1c (HbA1c) Test measures average blood glucose over 2–3 months by detecting sugar attached to hemoglobin in red blood cells. It is used to diagnose diabetes, identify prediabetes, and monitor long-term blood sugar control. Doctors rely on the HbA1c test to evaluate treatment effectiveness, guide adjustments, and assess risk for complications, making it essential for diabetes care and metabolic health screening.

Blood
Blood Draw
Also Known As: Hemoglobin A1c Test, HbA1c Test, Glycated Hemoglobin Test

Most Popular

The Hemoglobin A1c with eAG Test measures average blood sugar levels over the past 2–3 months and provides an estimated average glucose (eAG) value for easier understanding. It is widely used to screen, diagnose, and monitor diabetes and prediabetes. Doctors use this test to evaluate long-term glucose control, adjust treatment, and reduce the risk of complications such as neuropathy, kidney disease, and heart problems linked to poor blood sugar management.

Blood
Blood Draw
Also Known As: Hemoglobin A1c with eAG Test, HbA1c with eAG Test, Glycated Hemoglobin with estimated Average Glucose Test

The Hepatic Function Panel Test measures liver enzymes, proteins, and bilirubin to assess liver health and function. It includes ALT, AST, ALP, albumin, total protein, and bilirubin levels. Abnormal results may indicate hepatitis, cirrhosis, fatty liver, or bile duct problems. Doctors use this test to investigate jaundice, nausea, abdominal pain, or fatigue and to monitor liver disease, alcohol use, or medication side effects affecting liver function.

Blood
Blood Draw
Also Known As: Liver Function Panel Test, LFT

The Liver Function Panel, also known as a Hepatic Function Panel, measures proteins, enzymes, and bilirubin to assess liver health and function. It helps detect liver disease, monitor liver conditions, and evaluate the effects of medications or other factors on liver performance.

Blood
Blood Draw
Also Known As: Hepatic Function Panel Test, HFP Test

Most Popular

The IGF-1 Test measures insulin-like growth factor 1, a hormone regulated by growth hormone (GH), to assess growth and endocrine function. Abnormal levels may indicate growth disorders, acromegaly, gigantism, or GH deficiency. Doctors order this test to evaluate delayed growth, short stature, excessive growth, or pituitary disease and to monitor GH therapy. Results provide valuable insight into hormone balance, metabolism, and overall endocrine health.

Blood
Blood Draw
Also Known As: Insulin-like Growth Factor 1 Test, Somatomedin-C Test, IGF-I Test

The Iron Total and Total Iron Binding Capacity (TIBC) Test measures iron levels in blood along with the blood’s ability to transport iron. It helps diagnose iron deficiency anemia, iron overload (hemochromatosis), and monitor nutritional or chronic health conditions. Low iron or high TIBC may indicate anemia, while high iron or low TIBC can suggest overload. Doctors use this test to evaluate fatigue, weakness, or other symptoms linked to iron and metabolic health.

Blood
Blood Draw
Also Known As: Serum Iron Test, Total Iron Binding Capacity Test, TIBC Test, UIBC Test

The Iron Micronutrient Test measures blood iron levels to evaluate nutritional status and detect deficiencies or excess. Iron is essential for hemoglobin production, oxygen transport, energy metabolism, and immune function. This test helps identify anemia, iron overload, absorption issues, or dietary imbalances, supporting diagnosis and management of overall health and vital body functions.

Patient must be 18 years of age or older.
Blood
Blood Draw
Also Known As: Serum Iron Test, Serum Fe Test

Most Popular

The Iron Total Test measures iron levels in blood to evaluate nutritional status, red blood cell production, and overall metabolic health. Abnormal levels may indicate iron deficiency anemia, chronic blood loss, or poor absorption, while high levels may suggest hemochromatosis, liver disease, or iron overload. Doctors use this test to investigate fatigue, weakness, or pallor and to monitor treatment. Results provide key insight into anemia and iron balance.

Blood
Blood Draw
Also Known As: Serum Iron Test, Serum Fe Test

The Mineral Micronutrients Test Panel measures minerals: Calcium, Chromium, Copper, Iron, Magnesium RBC, Manganese, Molybdenum, Selenium, and Zinc to assess nutritional balance and overall health. These minerals are essential for bone strength, metabolism, energy production, antioxidant defense, and immune function. The panel helps detect deficiencies, excesses, or absorption issues, guiding health management.

Patient must be 18 years of age or older.

Most Popular

The Lipid Panel Test checks six key blood lipids: total cholesterol, HDL cholesterol, LDL cholesterol, non-HDL cholesterol, triglycerides, and the Chol/HDL ratio. This panel assesses risk for cardiovascular disease, heart attack, and stroke by evaluating cholesterol balance and fat levels in the blood. Doctors use lipid panel results for routine screening, treatment monitoring, and guiding lifestyle or medication adjustments.

Also Known As:  Lipid Profile Test, Cholesterol Panel Test, Lipids Blood Test 

The Lipid Panel with Ratios Test measures seven key markers: total cholesterol, HDL, LDL, non-HDL cholesterol, triglycerides, Chol/HDL ratio, and LDL/HDL ratio. This advanced panel evaluates cardiovascular risk by assessing cholesterol balance and fat metabolism. Doctors use it to detect high cholesterol, atherosclerosis risk, and heart disease, and to monitor treatment. Often part of routine exams, it provides insight into long-term heart and metabolic health.

Also Known As: Lipid Profile Test, Cholesterol Panel Test, Lipid Blood Test

The Phosphate (as Phosphorus) Test measures phosphorus levels in blood to evaluate bone strength, energy metabolism, and kidney health. Abnormal levels may indicate kidney disease, vitamin D imbalance, parathyroid disorders, or malnutrition. Doctors order this test to investigate fatigue, muscle weakness, or bone problems and to monitor conditions like chronic kidney disease. It provides key insight into metabolic, endocrine, and bone health.

Blood
Blood Draw
Also Known As: Phosphate Test, Phosphorus Test, PO4 Test

Most Popular

The Pregnenolone Test measures pregnenolone levels in blood, a precursor hormone used to make cortisol, DHEA, estrogen, progesterone, and testosterone. Abnormal levels may indicate adrenal disorders, congenital adrenal hyperplasia, or pituitary problems. Doctors order this test to evaluate unexplained fatigue, infertility, or hormone imbalance and to monitor adrenal health. Results provide vital insight into endocrine function, steroid production, and overall hormonal balance.

Blood
Blood Draw
Also Known As: Pregnenolone Blood Test

Most Popular

The Prolactin Test measures prolactin, a hormone produced by the pituitary gland, to assess reproductive and endocrine health. High prolactin (hyperprolactinemia) may cause infertility, irregular periods, or milk production in women and low testosterone, erectile dysfunction, or infertility in men. Doctors use this test to evaluate pituitary tumors, hormonal imbalance, or unexplained symptoms such as headaches, vision changes, or abnormal lactation.

Blood
Blood Draw
Also Known As: PRL Test

Most Popular

The PSA Total Test measures prostate-specific antigen levels in blood to evaluate prostate health. Elevated PSA may indicate prostate cancer, benign prostatic hyperplasia (BPH), or prostatitis. Doctors use this test for early detection of prostate cancer, monitoring treatment, or assessing recurrence risk. Commonly recommended for men over 50 or those at higher risk, the PSA test supports diagnosis, prevention, and long-term prostate care.

Blood
Blood Draw
Also Known As: Prostate Specific Antigen Test, PSA Test, Prostate Test

The Sex Hormone Binding Globulin (SHBG) Test measures SHBG, a protein that binds testosterone and estrogen, to assess how much active hormone is available in the body. Abnormal levels may indicate PCOS, infertility, low testosterone, liver disease, or thyroid disorders. Doctors order this test to investigate symptoms like low libido, irregular periods, acne, or hair loss and to evaluate hormone balance, endocrine function, and metabolic health in men and women.

Blood
Blood Draw
Also Known As: SHBG Test, TeBG Test, Testosterone-Estrogen Binding Globulin Test

Most Popular

The T3 Free Test measures free triiodothyronine (T3), the active thyroid hormone not bound to proteins, to assess thyroid function. It helps diagnose hyperthyroidism, hypothyroidism, goiter, and pituitary disorders. Doctors order this test to evaluate symptoms like fatigue, weight changes, anxiety, or irregular heartbeat and to monitor thyroid replacement or antithyroid therapy. The Free T3 Test provides key insight into metabolism, energy regulation, and overall endocrine health.

Blood
Blood Draw
Also Known As: Free T3 Test, Free Triiodothyronine Test, FT3 Test, T3F Test, Unbound T3 Test

Most Popular

The T4 Free Test measures the level of free thyroxine (T4) in blood, the active thyroid hormone not bound to proteins. It helps diagnose thyroid disorders such as hypothyroidism, hyperthyroidism, and goiter, as well as pituitary conditions affecting hormone regulation. Doctors use this test to evaluate symptoms like fatigue, weight changes, hair loss, or irregular heartbeat and to monitor thyroid replacement or antithyroid therapy, providing insight into metabolic and endocrine health.

Blood
Blood Draw
Also Known As: Free T4 Test, Free Thyroxine Test, FT4 Test, T4F Test, Unbound T4 Test

The Testosterone Free and Total Test measures total testosterone and free, bioavailable testosterone in blood for both men and women. It helps diagnose hormone imbalance, infertility, low libido, erectile dysfunction in men, irregular periods, or PCOS in women. Doctors also order it to assess fatigue, mood changes, or muscle weakness and to monitor hormone therapy. This test provides key insight into reproductive, endocrine, and overall metabolic health.

Blood
Blood Draw
Also Known As: Bound and Unbound Testosterone, Uncapped Testosterone Test

The Testosterone Free and Total and Sex Hormone Binding Globulin (SHBG) Test measures total testosterone, free testosterone, and SHBG to assess hormone balance in men and women. It helps diagnose infertility, erectile dysfunction, low libido, irregular periods, PCOS, and abnormal puberty. Doctors also use it to evaluate fatigue, muscle weakness, or mood changes and to monitor hormone therapy. This test provides a comprehensive view of reproductive, endocrine, and metabolic health.

Also Known As: Bound and Unbound Testosterone with SHBG Test, Uncapped Testosterone Test

The Testosterone Total Male Test measures testosterone levels in men to assess reproductive, sexual, and hormonal health. It helps diagnose low testosterone (hypogonadism), infertility, and erectile dysfunction. Doctors use it to evaluate fatigue, muscle loss, or low libido and to monitor testosterone therapy, hormonal balance, bone health, and overall metabolism.

Patient must be male and 18 years of age or older.
Blood
Blood Draw
Also Known As: Total Male Testosterone Test

The Thyroid Panel Test measures Free T4 Index (T7), T3 Uptake, and Total T4 to evaluate thyroid hormone production and overall thyroid function. Abnormal results may indicate hypothyroidism, hyperthyroidism, or other endocrine disorders. Doctors use this test to investigate symptoms such as fatigue, weight changes, or irregular heartbeat and to monitor thyroid therapy. Results provide key insight into metabolism, energy balance, and endocrine health.

Blood
Blood Draw
Also Known As: Thyroid Test, Thyroid Function Test

Most Popular

The Thyroid Stimulating Hormone (TSH) Test measures TSH levels in blood to assess thyroid function and diagnose hypothyroidism or hyperthyroidism. It evaluates how the thyroid controls metabolism, energy, weight, and heart rate. Doctors use the TSH test to investigate symptoms such as fatigue, hair loss, or mood changes. Frequently included in routine health exams, it is also key for monitoring thyroid disease treatment and overall endocrine balance.

Blood
Blood Draw
Also Known As: Thyroid Stimulating Hormone Test, Thyrotropin Test

The Urinalysis Complete Test evaluates urine for physical, chemical, and microscopic properties to assess kidney health, urinary tract infections, diabetes, and metabolic disorders. It measures appearance, concentration, pH, protein, glucose, ketones, blood, bilirubin, nitrites, leukocyte esterase, and microscopic cells or crystals. Doctors use this test in routine exams, to diagnose urinary symptoms, and to monitor chronic kidney or metabolic disease.

Urine
Urine Collection
Also Known As: Urine Analysis Test, UA Test, Complete Urinalysis Test

Erectile dysfunction (ED) is an issue that plagues far too many men in the United States. In fact, more than 30 million men are currently struggling with ED.

Beyond its physical implications, ED puts a significant mental burden on men. It can also lead to marital strife as ED hinders a couple’s sex life.

The good news is that there are erectile dysfunction tests to help identify the issue. With a solid diagnosis, doctors can prescribe the proper ED treatments to solve the issue.

Read on to learn all about ED tests. Explore how an ED lab test can confirm the existence of an issue and lead to its resolution.

What Is Erectile Dysfunction?

Before diving into the various ED tests, it is important to define this medical condition. With ED, a male cannot get or maintain an erection. ED has a significant impact on sexual intercourse as the male now has difficulty satisfying his partner.

Some patients with ED cannot get an erection at all. Others get an erection initially, but it goes away during sexual intercourse, causing issues for their partner. Another group of men get an erection sometimes, but other times are unable to.

Patients with ED often schedule an appointment with their primary care physician. A urologist is another doctor that treats men with ED.

These doctors prescribe an ED lab test to verify the presence of an issue. A separate issue may cause a patient's ED, and the doctors will investigate all possibilities.

What Are the Causes of Erectile Dysfunction?

Many people associate ED with older men. They think that this is a common issue with aging men.

However, the truth is that ED is not a normal part of the aging process. In fact, ED can plague men in any age group.

Taking certain medications or other supplements can lead to ED. Your doctor will certainly assess your current medication to determine if there is a link to ED.

Particular behaviors are also known to cause ED. Obesity and smoking tobacco are two known causes of ED.

There are various medical conditions and diseases that lead to ED. Your doctor will ask about your medical history to look for potential causes. Even psychological or emotional conditions can directly cause ED.

The end result is not good for patients with ED. The effects go well beyond having a positive sex life.

Patients with ED suffer from low self-esteem and depression resulting from their condition. Naturally, ED patients have fertility issues and it often causes emotional duress when a couple cannot get pregnant.

How Is Erectile Dysfunction Diagnosed?

As stated earlier, the doctor is going to ask about your medical history. They are interested in what medicines you take, prior surgeries, and conditions you are dealing with. Additionally, your doctor will ask about your family history to see if there is a potential genetic linkage.

The doctor is certainly going to inquire about your sex life. This is a time to embrace honesty so that the doctor can figure out what is going on.

A physical examination by the doctor follows. Of course, examination of the testicles and penis is part of this process. The doctor also looks for hair loss and breast size. The latter two signs may indicate a hormonal imbalance.

Checking your pulse at the wrists is a common part of the physical examination. The doctor wants to make sure that blood is flowing properly to your extremities.

Listening to your heartbeat for any abnormalities and checking blood pressure are also important steps. Any cardiovascular issues may be the root cause behind ED.

Lab tests of your blood and urine are on deck. These lab tests yield clues to what is causing ED.

For example, your lab results may indicate issues like heart disease or diabetes. These conditions, along with kidney disease, are common root causes of ED. Your doctor also looks for hormonal imbalances that may trigger ED.

Thyroid operation is another possibility that the doctors check for using blood work. The thyroid is critical for the flow of sex hormones. If it is not working properly, it may be difficult to get an erection.

What Are Some Other Erectile Dysfunction Tests?

The doctor may want to run some additional tests. There are several different tests to confirm the presence of ED.

Men get several erections per night when they are sleeping. Your doctor may ask to perform an overnight erection test. This involves wearing a device that measures the strength and frequency of your nightly erections. If you are still getting erections at night, it suggests your ED issues are rooted in mental or emotional issues.

The doctor may call for an intracavernosal test. This is where the doctor injects medicine into the base of the penis to check for an erection. Failure to get an erection means there is a blood flow issue. Lastly, the doctor may want to do an ultrasound, which is another proven method to check for blood flow.

What Are the Benefits of Lab Tests for Erectile Dysfunction?

There are many benefits to going for erectile dysfunction lab tests. For starters, the results are secure and confidential. No one, not even your partner, has access to the results unless you grant it.

At our lab, you do not even need a doctor’s prescription or referral. You can get ED lab results directly if you do not want to involve your primary care physician.

Another benefit to our testing is that you do not need health insurance. The testing is affordable and 100% satisfaction is guaranteed. The results are available to the patient in no more than 48 hours.

How Can ED Tests Get You Back on Track Today?

ED tests are the most effective way to get your personal life back on track. Here, you can confirm the issue and determine what the root cause is. Whether it is a medical condition or mentally induced, knowing the root cause is key to fixing it.

If you are interested in getting erectile dysfunction tests, we offer a selection of Erectile Dysfunction (ED) panels that include lab tests and biomarkers to evaluate if they are out of balance.