Is My ED Mental or Physical?
11 Nov 2025 · 12 min
Dr. Anne Truong explains that about 90% of ED is physical, not psychological. Excessive alcohol is the top cause, followed by aging, smoking, high blood pressure, and diabetes. If you get morning erections, it's likely psychological; if it's been gradual decline, it's probably physical.
Questions this episode answers
About 90% physical and 10% psychological.
Excessive alcohol consumption.
About 30–40% do not respond to Viagra.
About seven hours of sleep (ideally earlier, e.g., sleeping between 10:00 pm and 6:00 am).
June 23, 2022.
Chapters
This podcast is for you. The modern man. I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthformenpodcast.com for more information and resources from the show.
See you on the inside. Hi Modern Man. In this episode, you ever wonder whether you have erection that is either psychological or physical and how do you tell the difference? Because oftentimes when, when a man has ed, he first think that it may be a little bit mental. But I'm going to show you ways to tell the difference and how, how does one get physical ED versus psychological ed? So stay tuned. Okay, so in this episode we're going to talk about the difference between psychological ED and physical ED. And as you know, most ED cases, 90% are actually physical and only about 10% is psychological. And usually when psychological, those men usually have some form of anxiety, PTSD and depression or other mental health disorder that may play a role into that. And that may be when they're young or as they get older.
And you know, this is a great topic because I've literally have spoken to thousands of men that have, that have called into your office and one of the, you know, most commonality about the ED, the story I'm getting is, you know, first of all, I have ED and I think it's psychological because of my work, the stress and that I just can't seem to get an erection or maintain an erection. And also the relationship that I have with my partner, am I now getting too familiar with my partner? Am I not turned on? Am I not aroused by her anymore? And it's a serious problem with these men that I talk to because now they feel like their manhood has been shrunken down and they're not the way that they used to be. And on top of that their relationship is hurt because now they're not able to perform. And then there are other men that, that would, I've talked to, have said that it's a physical problem that I just can't get an erection. Sometimes I do, sometimes I don't. But I'm not sure is it physical or psychological. And you know, and if you can explain to the audience the difference between the two, I think that will help the men out there in general to determine is it psychological and physical? And the end Point is really to restore manhood and please their significant other.
Right, right. And. And that's a good question. So like I said, 90% is due to physical. And it is the physical part. The number one thing is the number one cause of ED is actually excessive alcohol consumption. And then the second is age. If you start to notice Ed, probably around like, even as early as late 30s to. And then around probably middle 40s, because that's when testosterone levels start to dip. And if you are a smoker, you'll start to have physical causes. High blood pressure, high cholesterol and obesity. And then the other factors are, you know, if you have prostate surgery or you have diabetes as well, those are the main causes. And if you having it, that is gradual. So if the ED is gradual and it starts out okay, you're not getting firm enough, and then. But then you get firm, and then, you know, once in a while you lose it. But then most of the time you're working. So is it a gradual progression, like over years is more physical? And as we know, blood flow is a major part of blood flow. Dysfunction is a major part of. Now contrast that.
So, so let me interrupt. So when it's physical, then that will affect the mind, and now you think that there's something wrong, but really, in actuality, it's more physical than mental, right?
Absolutely. So 90% of the time is physical. But it may be very subtle that you don't notice because, you know, how often does a man go to the doctors you don't know you have high blood pressure or not or high cholester. You may even have diabetes. And, you know, we talked in the previous episode, we talk about how alcohol can contribute to ED and after. Actually, alcohol is the number one cause, actually, of. So is it a gradual process? Now, the danger part, if you take like, med ED medicine, like Viagra or Cialis, it will give you a sense of reassurance that there's nothing anything physical. Could you take that? Did you go, oh, yeah, my erection's working well, I'm fine.
But it actually gives you a false.
Sense of security because it helped you give you a firmer erection. But when you need to be looking at is, why am I not getting a firmer erection? What's going on? Do I have one of these conditions that I just mentioned? Maybe I need to go see the doctor, get some blood work. If I'm in my 40s, let's get my testosterone level checked, get your blood pressure checked, your cholesterol level checked, and make sure you're not a diabetic. Maybe looking at your diet, you know, a Mediterranean diet. It's a good, it's a good diet to increase your testosterone level as well as help your erection. But the number one fact is that if you take too eat too much sugar or carbohydrate, your penis is very sensitive to a lot of sugar. So when you eat a lot of sugar, and I'm not talking about just sweet, but carbohydrate, like bread, pasta, then that and pastry, you become insulin resistant, meaning the insulin in your body doesn't bring down the sugar anymore. And that actually will affect your penis first, because per gram of muscle or tissue, the penis has the most blood vessels in the body compared to any other organ.
So stay away from sodas.
Yeah, stay away from sweet sodas, desserts and dessert. But you know, everything in moderation, you know.
So how does all this tie into the psychological ed?
Right? So the psychological ed, sometimes it occur abruptly. Abruptly. Like one day you're doing great, you have no problem getting firm erection. Things are going well and within a week or within a month, boom, you can't get an erection anymore. It doesn't happen anymore. Even with foreplay, even, even, even taking Viagra. Also know that 30 to 40% of men do not respond to Viagra. Not because, but doesn't mean that you have a psychological ed, you just don't respond to it. So if the ED is abrupt, then it's more psychological because it wouldn't be that abrupt. Is it a physical thing? It would be over years. So what I see is that if a man tells me that, you know, one week or a month ago, it thinks he was 100% fine and then he, then he's not, then I would ask him, well, do you have a morning erection or nighttime erection? If he still has morning erection, nighttime erection, then physically he's actually okay. It's just that he need to clear some of the stuff that's going on in his head. A lot of time is clutter. A lot of time. If a man, you know, one nights not going well, or maybe several nights not going well, he's not performing as he should, he starts to question himself.
Issue at work or work related.
Right, right.
Give you stress.
Well, he start to question himself and the performance and then he start questioning his performance and then it start to be affect his confidence and that start to have the negative real that goes on in his head, that create more negativity and that just, you know, create what I call clutter. And when you have Clutter. The stimulation from your brain going down to your penis is being impaired because of the clutter.
So going back to psychological versus physical, you can have both. Right. One affects the other.
That's right. Right, absolutely. So when physically you can get an erection, you start, it start to affect your confidence and you start having performance anxiety. And that increases the physical part because you start to feel more stress and you start to feel more depressed. And you may take medication incidentally medication for depression. Anxiety actually affect ed so it's not good for your erection to take a depression or anxiety medication. So it almost kind of interplay with one another. But one thing you can tell is that is it a physical causes of ed? Usually a man doesn't get morning erection as frequent as he used to. Is it psychological? He will get nighttime or morning erection because he's normally.
Because he's not under pressure?
Yes.
He said he's at rest and there's not a lot of thinking going on.
Right, right, right.
He's more relaxed.
Right. Well, speaking of that, you know, like sleep when you're asleep, when you're asleep, your brain is relaxed and that and you, you normally will get an erection during REM sleep or REM sleep. And getting optimal sleep is also good for your erection as well. Optimally you should get about seven hours of sleep. If you or, or, and, or sleep between 10:00pm and 6:00am I, I know that you're the worst at that because you go to bed around like midnight or 1am sometime and sometime, you know, get up and like early. And if you do that frequently, it is what it does is that it lowers your testosterone.
No, I, I can, I can, you know, testify with that. I mean it's, it's true. The days that I don't have a lot of sleep, it does affect the performance. And that's why she's always telling me to go to bed early folks out there. So she has definitely interest in making sure I'm well taken care of.
Well, he's very well taken care of. He's all testosterone up with testosterone pellets. And his diet is very strict on the Mediterranean diet. And he exercises at least three to five times a week. We just got to work on to sleep. Yeah, right.
Yeah.
Yeah. You got to stop watching your action movie late at night.
That's the only time I'm allowed to watch it, folks. Otherwise I'll be watching, you know, chick flicks.
Jane Austen is my favorite and he know all the Jane Austen movie. So having said that, I hope that this has been useful for you to think of ED as 90% is physical and 10% is psychological and but the bottom line is that ED can be treated whether it's physical or even psychological. But find out the cause of the problem. Don't try to take a medication to cover up and band aid the symptoms because I equate ED medication is like taking pain medicine, like opioids for your pain. It's only a band aid and the cause of why you got ED is going to be worsen if you just delay the treatment.
And also you depend, you become dependent on it and you can't be spontaneous. So exactly who wants that? Right?
Right. I can tell you thousands of men come and see me because they come dependent upon ED medication and after about three to five years it doesn't work.
Anymore or even less.
And then what happens? Their ED condition gets worse as well. As in anything, it's easier to treat a problem when it's at the beginning rather than waiting for it to get severe and then it's become more complex and sometimes doesn't respond at all. So we're here to help. Put your comment below if you have any questions or any topic you'd like us to talk about. We'd love to hear from you. So see you next episode Modern man.
Thank you for joining us. See you next time.
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