Investigations

The choice of investigations depends on the individual circumstances of the patient.

Choice of investigations includes:

• serum lipids, fasting plasma glucose, and HbA1c should be measured in all patients (if not assessed in the previous 12 months)
• serum testosterone measured on a blood sample taken in the morning between 08.00 and 11.00 (1)
• LFTs, GGT
• U+Es
• prostate-specific antigen (PSA) - for detection, or suspicion, of prostate cancer
  • note that NICE suggest that you should consider checking the PSA in all men presenting with ED (2)

Additional laboratory tests may be considered in selected patients:

• prolactin
• LH, sex hormone binding globulin - when low testosterone levels are detected
• TFTs
• FBC

Most patients do not need further investigations unless specifically indicated. However, some patients wish to know the aetiology of their ED and should be investigated appropriately. Other indications for specialist investigations include:

• young patients who have always had difficulty in obtaining and/or sustaining an erection
• patients with a history of trauma
• where an abnormality of the testes or penis is found on examination
• patients unresponsive to medical therapies that may desire surgical treatment for ED (1)

Reference:

• (1) British Society for Sexual Medicine (BSSM) 2013. Guidelines on the management of erectile dysfunction
• (2) NICE (June 2015). Suspected cancer: recognition and referral.