From the Guidelines
Erectile dysfunction laboratory tests should include HbA1c, fasting blood glucose, and lipid profile, with total testosterone measurement considered in patients who do not respond to PDE5-Is 1. When evaluating erectile dysfunction, a comprehensive history and physical examination are crucial to establish the nature of the problem and distinguish it from other forms of sexual difficulty.
- Key diagnostic procedures include: + Comprehensive history (sexual, medical, drug use, risk factor assessment, and psychosocial factors) + Routine laboratory tests: HbA1c, fasting blood glucose, and lipid profile + Total testosterone measurement (if available: bio-available or free testosterone instead of total) in patients who do not respond to PDE5-Is
- The use of validated questionnaires, such as the International Index of Erectile Function and the Sexual Encounter Profile, is the most appropriate method to characterize frequency and severity of erectile dysfunction symptoms 1.
- Other explorations that may be useful in patients who do not respond to PDE5-Is include evaluations of nocturnal penile tumescence, penile Doppler ultrasound, and psychological evaluation.
- Cardiac risk factors should be evaluated and managed in all erectile dysfunction patients, with individualized risk stratification guiding treatment decisions 1.
From the Research
Erectile Dysfunction Labs
- The initial step in the management of erectile dysfunction (ED) is to assess erectile function in patients with risk factors for ED 2.
- A detailed sexual, medical, and social history, including a review of medications used, is the most important aspect of a patient's assessment 2.
- Laboratory tests for ED may include: + Fasting glucose and blood lipid profile, which should be performed in every man with ED 2, 3, 4. + Free testosterone levels in men older than 50 y or if hypogonadism is suspected 2, 4. + Thyroid-stimulating hormone test 4. + Prostate-specific antigen test in select cases 3.
- The evaluation of men with ED requires a full medical and personally and culturally sensitive sexual history, a focused clinical examination 3.
- Serum total testosterone (TT) level may be evaluated in men with type 2 diabetes, either with or without erectile dysfunction (ED) 5.
- A cut-off value of 403.5 ng/dl of TT blood levels may be used as an indicator for initiation of testosterone replacement therapy in diabetic men with ED 5.
Diagnostic Tests
- There is no preferred, first-line diagnostic test for ED, and history and physical examination are sufficient to make a diagnosis of ED in most cases 4.
- Penile hemodynamics may be assessed using intracavernosal injection and penile duplex study 5.
- Diagnostic tests are optional and should be requested on an individualized basis 2.
Treatment
- Therapeutic intervention should be patient-oriented and based on the expectations and wishes of the patient and his partner 2.
- First-line therapy for ED consists of lifestyle changes, modifying drug therapy that may cause ED, and pharmacotherapy with phosphodiesterase type 5 inhibitors 4.
- Treatment of ED requires lifestyle modification, reduction of comorbid vascular risk factors, and treatment of organic or psychosexual dysfunction with either pharmacotherapy alone or in combination with psychosexual therapy 3.