How should men with ED be evaluated prior to therapy?

Except in rare circumstances, the initial evaluation  of men does not impact what will be  offered for treatment. Rather, screening aims  to identify comorbid cardiovascular disease,  diabetes, hyperlipidemia, hypertension, hypogonadism,  and depression, all of which merit  intervention in their own right.  Because most men with ED have a disproportionate  burden of comorbidities, it is considered  appropriate to measure lipids and glucose  after an overnight fast, and to record blood  pressure to screen for treatable conditions.  SinceEDmay bemedication-induced, screening  for concomitant administration of possible causative  medicines (eg., thiazide diuretics, beta  blockers, serotonin-selective reuptake inhibitors  (SSRIs), alpha-reductase inhibitors, and  aldosterone antagonists) is important [3–8].  Hypogonadism is an uncommon cause of ED  (causative in less than 5% of ED cases). Testosterone  testing is of utility in men with low  libido. In such men initial screening with a  morning total testosterone is reasonable, to be  followed with a repeat morning total testosterone  and free testosterone if the initial screen is  below normal or in the low normal range. The  practice of measuring testosterone in men  with intact libido has been reported to not  be cost-effective .