INVESTIGATIONS & DIAGNOSIS, TREATMENT PLAN
INVESTIGATIONS & DIAGNOSIS
Initial investigations:
- HbA1c
- Lipid profile
- Morning testosterone – If testosterone is low:
- LH
- FSH
- SHBG
- Prolactin
TREATMENT PLAN
Conservative:
- Lifestyle modifications: smoking cessation, reduce alcohol, weight reduction, exercise
Medical:
- PDE5 inhibitors (some can be purchased over-the-counter for example, 50 mg Viagra taken one hour before sexual intercourse)
- 6-8 week follow-up.
| Contraindications to PDE5 inhibitors: | |
| – Angina
– Unstable angina – Nitrate use (24-hour gap needed) – Hypotension – Recent MI – Heart failure |
– Uncontrolled hypertension
– Arrhythmia – Severe hepatic impairment – Renal impairment – Retinitis pigmentosa |
Referral criteria:
- Mental health: if impacting psychosocial relationships
- Cardiac: if high cardiovascular risk
- Endocrine: testosterone deficiency/hyperprolactinaemia
- Urology: failed trial of 2 different PDE5 inhibitors
- Urological emergency requiring admission: Priapism (erection >4 hours).