I am writing this in a different typeface to cut down on boredom. I have for many reasons become sort of an "expert" at this simply because necessity is the "mother" of invention.
When I was originally tested for ED in the interview one of the things that became obvious to me was that ED is in fact positional. Even without meds I have certain positions in which I can achieve at least a partial erection and in fact I even get weak morning wood if I am lying on my side when I wake up.
I think that the positional aspect is one of the most annoying parts of ED simply because you get going and then things head down and it all starts to go wrong with a simple position change. Again this is a marker that you do in fact have it and that it is not psychogenic in origin.
Psychogenic ED (created by stress, new sex partner etc.) is not sensitive to the position or as one might assume gravity.
Treating it is in some ways a multi-step approach and sadly most MD's do not treat it correctly. Even those that appear enlightened usually are not thorough enough.
In blood-work you need the following:
FSH
Serum Testosterone
Free Floating Testosterone
Estiadol
DHT
Prolactin
FSH is Follicle Stimulating Hormone, this is the hormone that your Pituitary sends to regulate testicular output of testosterone. If you have a high level of FSH and a low testosterone level then the testes are to blame. If you have a low FSH level with a low testosterone level then the problem is that the testicles are not being told by their regulatory system to produce.
Serum Testosterone is the most common test run, the problem is that it is not always a good guideline. They always want to get a serum level early in the morning because that is when it is at it's highest level. This is deceptive because if the level drops below accepted norms at any time you are still in trouble.
Free Floating Testosterone is what your body has available for use. Free Floating is a better guideline. If you are producing testosterone and your body is not converting it for use the Serum or blood level for testosterone is absolutely useless
Estiadol is the term for Estrogen. Males all have a small quantity of estrogen in their systems and this is normal. The problem is that Estiadol (Estrogen) competes for the same receptor sites as the testosterone. Thus it becomes a blocking agent preventing you from using the testosterone you are making. If that level is at all elevated above where it should be, a drug called an Estrogen "antagonist" is given and this prevents the estrogen (Estiadol) from getting to the receptor sites and opens the door for your testosterone to do the job. Estiadol often elevates as body fat percentages go up. This is why it is often elevated in older men.
DHT is Dihydrotestosterone. DHT is very important and has been in recent years demonized by a bunch of hustlers out to push medications that solve a problem in the wrong way. It is DHT that is responsible for all of your secondary sex characteristics, libido and genital function NOT the unconverted testosterone produced by the testes.
The last one that everybody overlooks in males is Prolactin. Prolactin in a female is used to induce the production of breast milk in nursing Mothers, men have it too, but in men it serves a very different purpose. In men it is used as a "control hormone". As you have intercourse and become increasingly excited working your way towards ejaculation your body prepares a bolus of prolactin at the moment of ejaculation this is released. This wilts the erection and causes the over sensitivity you feel in your penis right after having sex. If this level is even slightly elevated it can kill erectile function in a major way and often creates depression and libido issues as well. Most of the time as we age the level increase is idiopathic meaning it has no obvious cause. If one is overweight it tends to elevate too. It is prolactin in females that causes the depression and mood swings in many women during the time they are nursing. The solution is simple and that is a Prolactin antagonist. There are two different versions of this and in men when they are used if one does not work try the other one.
In order to treat ALL of ED one has to treat the entire person not just a single symptom. The sad fact is that most MD's are not well schooled in this and do not have the ability to do it well. If you have a really good MD who will forget the old and work into the future he needs the above blood panel and he needs to turn your blood panel into that of a 25 year old healthy male. Work with all the levels and get them into that range and if your ED is at all hormonal it will respond favorably. It may not go away simply because of a narrowing of the blood supply to the penis, but what it will do is make you feel a whole lot better, help you manage weight, and you do this while remaining healthy reversing some other conditions.
I had an MD in Orange County California who was doing this for me. I have only found one other doing this correctly and that is a Dr. John Chrisler in Flint, MI. I am certain that there are others, but I have not found them yet. MY own MD passed away suddenly of a stroke in 2010 and I am looking to get this fixed again too.
Also, if you have any male children make dead certain that they get records on their testosterone etc. levels as shown above. It is completely legal for an MD to prescribe testosterone replacement therapy and work the whole thing if medical records for a patient show that the levels were substantially different at a younger age.