Mechanistic and clinical data suggest heterogeneous treatment effects: GLP-1 receptor agonists and SGLT2 inhibitors show promising vascular benefits with mixed erectile outcomes, whereas ARBs and finerenone appear favorable compared with older agents associated with sexual adverse effects.<h4>Conclusion</h4>ED in T2DM should be regarded as a clinically relevant marker of systemic vascular disease. Here, SLC5A2 is linked to type 2 diabetes mellitus.