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Please note pre-referral criteria are applicable in this referral.
If referring for erectile dysfunction the patient must have tried the basic ED therapy and investigation unless contraindicated. Referrals submitted without this information will be returned. Please see the Referral Section.
1st line testing for all men to assess CVD risk and diabetes as underlying cause:
(There will be a prompt at request in the GP system to add on a PSA and/ or testosterone if clinically indicated from the history and examination)
Blood samples for testosterone must be taken BEFORE 11am (to avoid an artificially low result)
2nd line testing (if PDE-I failure):
If 2 low Testosterone results (under 8nmol/L): Test for causes of persistently low testosterone
*Test groups available on GP order comms test requesting software
If appropriate, interventions to help:
Following 1st line testing:
All PDE5 inhibitors have similar efficacy overall. (See Formulary section 7.4.5 drugs for erectile dysfunction)
With the exception of generic sildenafil, the other formulary drugs for the treatment of erectile dysfunction may only be prescribed on the NHS under certain circumstances; see Formulary Guidance on prescribing for erectile dysfunction for more information.
Side effects not common, similar in all three:
Although all are similar compounds, experience indicates that patients rarely get the same side effects with all three.
Where PDE5 inhibitors are successful subsequently titrate down.
If PDE5 inhibitor failure: 2nd line testing:
If low Testosterone(under 8nmol/L): Repeat Testosterone test at 4 weeks.
If 2 low Testosterone results (under 8nmol/L), test for possible causes:
Patients with persistently low testosterone under 8nmol/L reconsider if obesity could be lowering testosterone/ refer to endocrinology for consideration of testosterone replacement therapy/ further investigation.
There are specific NHS prescribing restrictions on GPs for the treatment of ED. This means that referral to access medication or other interventions will need to be considered earlier for some groups of patients than others.
*Added due to testing changes - patients with a low testosterone and no response to PDE5-I will be referred for low testosterone
If referring for erectile dysfunction the patient must have tried the basic ED therapy and investigation unless contraindicated. Referrals submitted without this information will be returned.
e-Referral service selection
Mr Richard Pearcy, Consultant Urologist, Andrologist at Derriford Hospital
This guideline has been signed off on behalf of NHS Devon.
Publication date: September 2015
Updated: March 2023
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