Routine laboratory tests

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These should include a blood sugar and a fasting lipid profile in all men with ED without a diagnosis of diabetes mellitus or dyslipidemia, respectively. A PSA should be determined in the case of abnormal findings during palpation of the prostate, or as per the physicians' PSA screening protocol. A urinalysis is also helpful to look for glucose, ketones and protein-uria, as well as blood and white blood cells.

Blood pressure, weight and waist circumference should be measured as a part of the ED evaluation, as ED has been linked to the metabolic syndrome.

Free testosterone, testosterone, prolactin and dehydroepiandrosterone sulfate (DHEAS) are the specific hormones that may be part of the ED evaluation. These hormones have been associated with sexual desire. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SHBG) are determined for further differential diagnosis in the case of low testosterone values, to ascertain primary or secondary hypo-gonadism. Estradiol, growth hormone or, better, insulin-like growth factor 1 (IGF-1) and thyroid parameters are determined in individual cases to diagnose further hormonal deficits.

It is recognized that serum testosterone levels decrease below the eugonadal range in some men with advancing age. Restoration of testosterone levels to the eugonadal range (300-1000 ng/dL) appear to correct many of the clinical abnormalities (impaired sexual function, negative changes in body composition, etc.) commonly associated with hypogonadism [24]. With respect to hypogonadal males, a number of studies have demonstrated that testosterone replacement therapy can significantly affect a number of the fundamental indicators of apposite sexual functioning, including intensity of libido, frequency of nocturnal erections, and frequency of sexual activity [25,26]. Furthermore, additional research in which an acute hypogonadal state was induced (in experimental animals and eugonadal males), not only confirmed the importance of physiologic levels of testosterone in maintaining normal sexual behavior, but also highlighted the dose-response relationships between testosterone levels and the various androgen-dependent processes, including sexual function.

Other data suggests that hypogonadism may affect the ability of the erectogenic agents to fully restore erectile function. Shabisgh et al. [27] have shown that the addition of testosterone to hypogonadal men with testosterone deficiency, who additionally have had a suboptimal response to PDE-5 inhibitors, was highly beneficial. Thus, a total and or free morning serum testosterone level may be indicated as a blood test for men with ED.

Confirmatory testing for a more comprehensive understanding of the etiology of the ED is optional, but should be available to the patient when appropriate. Such testing may include nocturnal penile tumescence (NPT) testing, penile duplex ultrasonography with color Doppler, cavernosom-etry, cavernosography, neurophysiologic testing, office intracavernosal injection of a vasoactive agent, such as prostaglandin E1 (PGE1). All or some of these tests should be available to the patient as directed by the physician. Controversy exists as to the usefulness, relative value, and the indications for these tests. In general, the tests are relegated to the domain of the urologist, who will offer a variety of tests as per specific patient indications.

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