Laboratory testing must be tailored to the patient complaints and risk factors. All patients must undergo a fasting glucose and lipid profile if not assessed in the previous 12 months. Hormonal tests must include morning sample of total testosterone (bio-available or calculated-free testosterone is more reliable to establish the presence of hypogonadism). These tests, if available, are preferable to total testosterone.
Additional laboratory tests must be considered only in selected patients (e.g. prostate-specific antigen (PSA) for detection of prostate cancer).
Additional hormonal tests (e.g. prolactin, follicle-stimulating hormone (FSH), luteinizing hormone [LH]) must be carried out when low testosterone levels are detected. If any abnormality is observed, further investigation by referral to another specialist may be necessary1,2. The minimal diagnostic evaluation (basic work-up) in patients with erectile dysfunction is presented in Figure 1.
Figure 1: Minimal diagnostic evaluation (basic work-up) in patients with erectile dysfunction.3
1. Morales A, Heaton JP. Hormonal erectile dysfunction. Evaluation and management. Urol Clin North Am 2001;28:279-288.
2. Lue TF, Giuliano F, Montorsi F, Rosen RC, Andersson K-E, Althof S et al. Summary of the Recommendations on Sexual Dysfunctions in Men. J Sexual Medicine 2004;1:6-23.
3. European Association of Urology - Guidelines on Erectile Dysfunction 2005