Most men with erectile dysfunction do one of two things: nothing, or buy a tablet online. Both skip the step that matters most. This is a structured order of actions — what to do first, what to do next, and what to expect at each stage.
Short answer: Week one, see a doctor for a cardiovascular and metabolic check — ED is frequently the earliest sign of vascular disease. Weeks one to four, review your medications and start the lifestyle changes with real evidence. Weeks two to twelve, begin treatment if appropriate and give it several proper attempts. Month three onward, review what worked and address anything still outstanding.
Step 1 — Establish What Kind of Problem It Is
Before anything else, one observation narrows the field considerably.
- Do you still wake with erections?
- Can you achieve one alone but not with a partner?
- Did it appear suddenly, or fade gradually over months?
Morning erections and function when alone suggest the mechanism is intact and a psychological component is likely. A gradual decline in every situation points to a physical cause. Sudden onset after starting a new medicine points at the medicine.
This costs nothing and changes what happens next.
Step 2 — See a Doctor (Week One)
Not primarily for a prescription. Erectile dysfunction is an independent predictor of cardiovascular disease — the penile arteries are narrower than the coronary arteries, so atherosclerosis restricts them earlier, sometimes years before cardiac symptoms.
A reasonable assessment covers:
- Blood pressure
- Blood glucose or HbA1c
- Cholesterol profile
- Morning testosterone, if desire is also reduced
- Thyroid function, where indicated
- A review of every medicine you take
If nothing else on this list happens, do this. Our guide to the causes of erectile dysfunction covers what an assessment involves, and the NIDDK overview sets out the standard pathway.
Step 3 — Review Your Medications (Week One)
The most commonly missed reversible cause. Frequent contributors include antidepressants — particularly SSRIs — older beta-blockers, thiazide diuretics, antipsychotics and anti-androgens such as finasteride.
Never stop a prescribed medicine yourself. Ask about alternatives; a change of drug or dose often resolves the problem entirely.
Step 4 — Start What Actually Works (Weeks 1–4)
These have the strongest evidence and, unlike tablets, address the cause:
- Stop smoking — damages the small vessels an erection depends on. Improvement often within months
- Aerobic exercise — improves endothelial function, the same mechanism ED medicines act on
- Lose excess weight — trials show measurable improvement, with some men regaining normal function
- Reduce alcohol
- Fix sleep — testosterone is produced largely during sleep, and untreated sleep apnoea is strongly associated with ED
Expect months rather than weeks. Start them now so they are working while other steps proceed.
Step 5 — Treatment, If Appropriate (Weeks 2–12)
If a PDE5 inhibitor is prescribed:
- Take it correctly — 30–60 minutes before, without a heavy meal or significant alcohol, with genuine arousal
- Give it several separate attempts. Many men need three or four occasions before it works reliably
- Do not increase the dose yourself
- If one drug does not suit, another may — non-response to sildenafil does not predict non-response to tadalafil or avanafil
Options are compared in our guide to ED medicines, and taking them correctly is covered in how to take sildenafil. Products sit under Erectile Dysfunction.
Step 6 — Address the Psychological Side (Ongoing)
Performance anxiety is self-reinforcing: one difficult episode creates the anxiety that causes the next. Medication often breaks that loop by restoring confidence, but where anxiety, depression or relationship factors are central, psychosexual therapy is genuinely effective — and works best alongside treatment rather than after it has failed.
If a partner is involved, our guide on supporting a partner with erectile dysfunction may help the conversation.
Step 7 — Review (Month 3)
Go back to your doctor if:
- Treatment has not worked after several proper attempts
- Side effects are troublesome
- New symptoms have appeared
- Test results indicated something needing follow-up
Persistent non-response across drugs usually points to an unaddressed cause rather than a need for a higher dose.
What to Avoid Throughout
- Buying prescription medicine without an assessment — it skips the cardiovascular check and the nitrate interaction check
- Unregulated herbal ED products — repeatedly found adulterated with undeclared sildenafil or tadalafil, dangerous for anyone on nitrates
- Testosterone without confirmed deficiency — no benefit, and it suppresses your own production
- Escalating the dose on your own
- Waiting. Most causes are treatable, and some are markers of conditions that progress
Frequently Asked Questions
What should I do first about erectile dysfunction?
See a doctor — primarily for a cardiovascular and metabolic check, since ED is frequently an early marker of vascular disease.
How long before I see improvement?
Medication can work the same day, though several attempts are often needed. Lifestyle changes take weeks to months. Treating an underlying cause varies.
Do I have to take medication?
Not necessarily. Where the cause is reversible — medication side effects, smoking, excess weight, anxiety — correcting it can restore function without ongoing treatment.
Can I skip the doctor and just buy tablets?
You would skip the check for nitrate interactions and for the cardiovascular disease ED may be signalling. That is the part with real consequences.
How do I know if it is psychological?
Morning erections, or function when alone but not with a partner, suggest a psychological component. Only a doctor can confirm it.
What if the first medicine does not work?
Review with your doctor. The dose may need adjusting, another drug may suit better, or an untreated cause may be involved.
Should my partner be involved?
Often it helps considerably. Erectile dysfunction affects both people, and avoidance from either side tends to entrench it.
Is it ever too late to address?
No. Most causes remain treatable, and treatment improves function at any age.
Health and Medical Disclaimer
This article is general information, not medical advice, and does not replace consultation with a qualified healthcare professional. Erectile dysfunction medicines are prescription-only and must never be taken with nitrate medicines for chest pain. Do not start or stop any prescribed medicine without medical advice. Persistent erectile dysfunction should be medically assessed, as it may be an early sign of cardiovascular disease or diabetes.
