What questions will you be asked?
Expect questions about three things: your erections, your health and your life. The AUA guideline says every man with ED should have a thorough medical, sexual and psychosocial history, and NIDDK describes the same: questions about erections, ejaculation, orgasm and desire, plus mental health and how the relationship is going.
Typical questions include:
- When did it start, and did it come on suddenly or gradually?
- Do you still wake with erections?
- Is the trouble getting firm, staying firm, or both?
- Is your interest in sex the same as before?
- Which medicines and supplements do you take, especially nitrates for chest pain or “poppers”?
- What have you already tried, at what dose, and how did it go?
- Do you smoke, drink or use cannabis or other drugs?
Many providers also use the five-question IIEF-5 score to rate severity. Our page on tests used to diagnose ED explains how it works.
Is a physical exam needed?
Some examination is part of a full ED evaluation, though how much depends on your symptoms. NIDDK notes that clinicians perform a physical exam to look for blood vessel and nerve problems, hormonal signs and physical problems with the penis. The Princeton III consensus adds blood pressure, waist size and body mass index, because ED is a marker of heart risk.
A genital exam matters most when there is a curve, a lump, pain, a change in the testicles, or when injections are being considered, since the AUA asks that any existing plaque or curvature be documented before injection therapy begins. When the history points to a straightforward cause, the exam may be brief. You can ask what is being checked and why before anything starts, and you can pause at any point.
Which labs are drawn?
A small set of blood tests does most of the work:
| Test | Why it is checked |
|---|---|
| Morning total testosterone | The AUA recommends it for every man with ED; low testosterone can blunt pills and lower desire |
| Fasting glucose or A1c | ED can be an early sign of diabetes |
| Lipid panel | Cholesterol problems share a root with vascular ED |
| Others as needed | Thyroid, prolactin or a blood count when the history points that way |
Princeton III specifies that testosterone be drawn before 11 a.m. At Ultimate Male, draws are done on site at both clinics, with results in 24 to 48 hours. If you have recent labs from another doctor, bring them. The blood tests for erectile dysfunction page goes marker by marker.
How is a first treatment chosen?
The choice follows from what the history and labs show, and a few factors carry the most weight:
- Nitrates. If you take them, PDE5 pills such as sildenafil and tadalafil are ruled out.
- Heart risk. The AUA says low-risk men can be treated without extra cardiac testing, while men at higher risk should see a cardiologist first.
- Your schedule. Sildenafil suits planned occasions; tadalafil’s longer window suits men who prefer spontaneity.
- What already failed. Men who had a fair trial of pills may move to injections, which the AUA says should start with an in-office test dose.
- Lab results. Low testosterone or undiagnosed diabetes changes the plan.
Whether you leave with a treatment the same day depends on these factors. A man with no red flags and recent normal labs may get a starting plan right away, while a man with chest symptoms, new diabetes signs or a curve in the penis needs results or referrals first.
Related question: should you bring your partner?
It is your choice. NIDDK notes that clinicians may ask partners how ED affects the relationship, and the AUA suggests counseling when relationship issues get in the way of treatment. Some men prefer the first visit alone and involve a partner later; our guide to talking with your partner about ED can help either way.
How Ultimate Male runs the first ED visit
The path at our San Gabriel and Downey clinics is simple: a free 10-minute phone call, on-site labs, then a one-on-one consultation with a PA-C or MD that ends with a plan and scheduled follow-up. Visits are paid one at a time with no membership.
To get the most from the visit, see our guide on how to prepare for an ED consultation, and if privacy is on your mind, read whether ED treatment is confidential. Learn more about erectile dysfunction treatment, or book your ED consultation when you are ready.
