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Based on the information you have shared, this presentation is not uncommon and does not indicate a hormone deficiency or serious organic disease. Your testosterone level (7.06 ng/dL), prolactin, and blood sugar being normal means that the hormonal and metabolic causes of erectile dysfunction have been ruled out. When libido is low and PDE-5 inhibitors (like sildenafil/tadalafil) do not give benefit despite normal hormones, the most likely causes are psychogenic erectile dysfunction, performance anxiety, chronic stress, depression, excessive pornography/masturbation, sleep disturbance, or overactivation of the sympathetic nervous system. In such cases, the problem is not blood flow or testosterone, but impaired brain–sexual response coordination, which is why tablets alone do not work well. Low libido with normal testosterone is very commonly seen in men with anxiety, mental fatigue, relationship stress, fear of failure, or long-standing stress, even if erections were previously normal. PDE-5 inhibitors require proper sexual stimulation and mental readiness to work,without that, their effect is limited.

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Since your routine evaluation is normal, the cause is possibly psychological. You need to consult a psychologist or a sexologist.

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