From the Guidelines
For a 38-year-old male with weak erections for 6 months, the appropriate workup should begin with a comprehensive history and physical examination, including a thorough medical, sexual, and psychosocial history, as well as selective laboratory testing, as recommended by the American Urological Association guideline on erectile dysfunction 1. The history should focus on potential underlying causes including cardiovascular disease, diabetes, hypertension, obesity, smoking, alcohol use, medication side effects (particularly antidepressants, antihypertensives, and antiandrogens), psychological factors like stress or depression, and sleep disorders.
- Key aspects of the history include:
- Identifying the onset of symptoms, symptom severity, and degree of bother
- Specification of whether the problem involves attaining and/or maintaining an erection
- Situational factors, such as occurring only in specific contexts or with specific partners
- The presence of nocturnal and/or morning erections, which may suggest a psychogenic component to ED symptoms Physical examination should include:
- Vital signs, including pulse and resting blood pressure
- Genital examination, including assessment of penile skin lesions and placement/configuration of the urethral meatus
- Examination of the penis for occult deformities or plaque lesions Laboratory testing should include:
- Morning serum total testosterone levels, as recommended by the American Urological Association guideline on erectile dysfunction 1
- Fasting glucose or HbA1c, lipid profile, complete blood count, and comprehensive metabolic panel, as these tests can help identify underlying conditions that may be contributing to ED If testosterone is low (<300 ng/dL), additional hormonal testing including luteinizing hormone, follicle-stimulating hormone, and prolactin is warranted, as recommended by the Princeton III consensus recommendations for the management of erectile dysfunction and cardiovascular disease 1. Specialized tests, such as nocturnal penile tumescence testing or vascular assessment with penile Doppler ultrasound, may be considered if vascular insufficiency is suspected or if the patient's symptoms suggest a psychological component to their ED. This comprehensive approach is necessary because erectile dysfunction often serves as an early warning sign of underlying systemic conditions, particularly cardiovascular disease, and addressing these factors can both improve erectile function and prevent more serious health complications, as highlighted by the American College of Physicians' clinical practice guideline on hormonal testing and pharmacologic treatment of erectile dysfunction 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Evaluation
The initial evaluation of a 38-year-old male presenting with weak erections for the past 6 months should include:
- A comprehensive medical and sexual history, as outlined in 2
- A focused clinical examination
- Laboratory tests, such as:
Laboratory Tests
Laboratory tests can help identify underlying conditions that may be contributing to erectile dysfunction. According to 5, common laboratory abnormalities in men with erectile dysfunction include:
- Low testosterone (18.7%)
- Increased prolactin (4.6%)
- Abnormal luteinizing hormone (14.6%)
- Increased thyroid-stimulating hormone (4.0%)
- Increased prostate-specific antigen (8.3%)
- Anemia (26.5%)
- Renal insufficiency (11.9%)
Additional Considerations
Additional considerations in the evaluation and management of erectile dysfunction include:
- Screening for cardiovascular risk factors, as recommended in 3 and 4
- Assessment of lifestyle factors, such as obesity, sedentary lifestyle, and smoking, which can increase the risk of erectile dysfunction, as noted in 3 and 4
- Consideration of the patient's overall health and well-being, including immunizations and screening for other health conditions, as outlined in 6