1. The script — what to say in the appointment
Read this aloud or paraphrase. The point is the structure: you are asking for a proper work-up before any prescription, not arguing with anyone.
"I am here about erectile dysfunction. I understand UK sexual medicine guidance recommends that newly presenting patients have a fasting glucose and/or HbA1c, a lipid profile, and a morning total testosterone measured. I would like that work-up before we discuss medication, please."
"I would also like you to ask me about my sleep, my alcohol use, any recreational drug use, and any other medications I am taking that might be relevant."
"If those tests are normal and the problem persists, I would like a referral to a urologist with an interest in andrology."
2. If you are pushed back
Sometimes a tablet is offered first and the work-up is skipped. This follow-up keeps the conversation open without making it adversarial.
"I understand sildenafil is often offered first and that is reasonable, but I would like the underlying work-up as well, because guidance says that for a man my age erectile dysfunction can be a sentinel symptom of cardiovascular or metabolic disease that we shouldn't miss."
3. Why each test matters
Fasting glucose / HbA1c
Checks for early type 2 diabetes. Diabetes affects the small blood vessels and nerves an erection depends on. HbA1c reflects the previous two to three months of blood sugar control.
Lipid profile
Checks for early cardiovascular risk. Erection problems can be one of the first signs of arterial disease, especially in younger men.
Morning total testosterone
Testosterone naturally varies through the day, so the sample must be early morning. A single low result is not a diagnosis — it should be repeated.
4. What a complete first appointment includes
- A full sexual and medical history — when the problem started, what pattern it follows, what makes it better or worse.
- A focused physical examination — blood pressure, body weight and waist, examination of the testicles and penis, peripheral pulses.
- A short validated questionnaire (usually the IIEF-5).
- The basic bloods: fasting glucose and/or HbA1c, lipid profile, and an early-morning total testosterone (drawn between 7 and 11 am).
- If the testosterone comes back low or borderline, a repeat morning sample with SHBG, free testosterone, LH, FSH and prolactin where relevant.
- An honest conversation about lifestyle contributors — sleep, alcohol, recreational drugs, prescription medications.
- A clear plan for what happens if the basic work-up is normal and the problem persists.
5. If the basic work-up is not offered
It is reasonable to ask why. It is reasonable to ask for a referral to a urologist with an interest in andrology, or for a second clinical opinion. The work-up is not optional — it protects against missing a metabolic, cardiovascular or hormonal cause that may be treatable now and harder to treat later.