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CPD: Key questions on erectile dysfunction

Dr Noshi Narouz on underlying causes, the role of low testosterone and management of patients with CVD

Learning Objectives

This module will update you on helping patients with erectile dysfunction, including:

  • What investigations to undertake
  • The role of low testosterone
  • The link between ED and diabetes
  • Prosthetic options

Author

Dr Noshi Narouz is a consultant in sexual health and HIV medicine at Crawley Hospital and the Spire Gatwick Park Hospital. He is the lead consultant of the psychosexual service and sexual dysfunction in West Sussex.

What investigations should we undertake in men presenting with erectile dysfunction (ED)?

According to current guidelines,1-4 basic investigations should include fasting blood glucose or HbA1c, lipid profile and fasting serum testosterone (testosterone levels should be measured between 8am and 11am).

Other tests (such as thyroid function tests, prolactin and PSA) will be directed by the history and examination. If serum total testosterone (TT) is low (less than 8nmol/l) or borderline (8-12nmol/l) repeat with serum FSH, LH and prolactin. If indicated, measure free testosterone (FT) to confirm TT measurements. Most patients do not need further investigations unless specifically indicated.

Specialised diagnostic tests include nocturnal penile tumescence and rigidity, vascular testing, intracavernosal injection test, colour Doppler ultrasound and neurological tests – patients may require referral to specialist centres for these tests. These are usually indicated in patients with expected arterial or venous abnormality, those who have a history of trauma or surgery, and those with an abnormality of the penis or testes, or considered for surgical intervention. However, in most cases, these specialised diagnostic tests have little impact on the selection of therapeutic options.

Weight, BMI, blood pressure, heart rate and waist circumference, although not investigations, are important baseline measures, and are worth noting.

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