From the Guidelines
A 34-year-old male with normal testosterone levels and erectile dysfunction symptoms should not be referred to an endocrinologist for evaluation of erectile dysfunction as a first step, as the primary evaluation and management of erectile dysfunction typically falls under the scope of a urologist or primary care physician.
Key Considerations
- The American Urological Association (AUA) guideline recommends a thorough medical, sexual, and psychosocial history, physical examination, and selective laboratory testing for men presenting with symptoms of erectile dysfunction 1.
- The guideline also recommends measuring morning serum total testosterone levels in all men with erectile dysfunction, but notes that testosterone therapy is not indicated for the treatment of erectile dysfunction in patients with normal serum testosterone levels 1.
- The Princeton III consensus recommendations suggest that all men with erectile dysfunction should have their cardiovascular risk assessed and that testosterone levels should be routinely measured, but this does not necessarily imply a need for referral to an endocrinologist 1.
Referral Criteria
Referral to an endocrinologist may be considered if:
- The patient has symptoms or signs of hormonal dysfunction, such as low libido or testicular atrophy, in addition to erectile dysfunction.
- The patient has a history of conditions that may affect hormone levels, such as pituitary or testicular disorders.
- The patient's erectile dysfunction is suspected to be related to a hormonal imbalance, despite having normal testosterone levels. In general, a referral to an endocrinologist would be considered on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and laboratory results.
Initial Evaluation
The initial evaluation and management of erectile dysfunction should focus on:
- Assessing the patient's medical, sexual, and psychosocial history.
- Performing a physical examination, including vital signs and genital examination.
- Selective laboratory testing, including measurement of morning serum total testosterone levels.
- Evaluating the patient's cardiovascular risk factors and providing lifestyle advice to reduce cardiovascular risk and improve erectile function 1.
From the Research
Evaluation of Erectile Dysfunction
A 34-year-old male with normal testosterone levels and erectile dysfunction symptoms may not necessarily require an immediate referral to an endocrinologist. However, the following factors should be considered:
- The presence of other underlying health conditions, such as diabetes mellitus, hypertension, or neurological disorders, which can contribute to erectile dysfunction 2, 3
- The role of other hormones, including LH, prolactin, TSH, and FT4, in sexual functioning, which may need to be investigated 2, 3
- The potential for endocrine diseases, such as hyperprolactinemia or thyroid hormone disorders, to cause erectile dysfunction 3
Referral to an Endocrinologist
Referral to an endocrinologist may be necessary if:
- The patient's erectile dysfunction symptoms persist despite treatment with phosphodiesterase type 5 inhibitors 2
- The patient has a history of decreased libido or testicular atrophy, which may indicate an underlying endocrinopathy 4
- The patient's testosterone levels are found to be low, which can be a marker of sexual and physical frailty 2, 5
- Other endocrine causes of erectile dysfunction, such as hypogonadism or hyperprolactinemia, are suspected 3, 6
Diagnostic Evaluation
A proper diagnostic evaluation of erectile dysfunction should include: