The things men ask before they book.

No. You can book directly. If you would like us to coordinate with your primary care physician we are glad to, but nothing about your care here requires their involvement or their permission.

Ninety minutes, most of it conversation. A full medical and sexual history, a validated IIEF-5 questionnaire, a physical examination, blood work, and — where indicated — a penile duplex ultrasound. You leave with a written plan, not a prescription pushed across a desk.

Less than you expect. This is the only thing we do. Every man in the waiting room is there for the same reason, every member of staff has had this conversation thousands of times, and nobody here finds any part of it remarkable.

Yes. Your care is confidential and protected under HIPAA. We will never contact anyone about your treatment without your written authorization, and you control how we communicate with you — including whether we leave voicemails or send text reminders.

New patient consultations are typically available within five to seven business days. If you have had a sudden onset of symptoms, or symptoms following an injury, tell us when you book and we will bring you in sooner.

Most often it is vascular: the same processes that narrow coronary arteries also narrow the much smaller penile arteries, which is why ED frequently appears first. Other contributors include diabetes, low testosterone, medication side effects, nerve injury, obstructive sleep apnea, alcohol, smoking, depression and anxiety. In most men more than one factor is at work, which is why single-cause explanations tend to be wrong.

It can be an important one. Because penile arteries are considerably narrower than coronary arteries, the same degree of atherosclerosis becomes symptomatic there first — often years earlier. This is one of the main reasons we insist on cardiovascular screening rather than simply writing a prescription. Some men come here about their sex life and leave having caught something more serious in time.

No. Roughly a quarter of men presenting with new erectile dysfunction are under forty. Younger men are more likely to have a hormonal, psychological, or medication-related cause than a vascular one, and those causes are frequently very treatable.

Usually both, in a ratio that changes over time. A physical problem produces a failure, the failure produces anxiety, and the anxiety produces further failures. Untangling which came first is less useful than treating both, which is why we have a psychosexual specialist on staff rather than on speed dial.

In the great majority of cases, yes — something on the ladder will work. Between oral medication, injection therapy, devices, hormonal correction and, ultimately, surgical options, erectile dysfunction is one of the more consistently treatable conditions in medicine. The relevant question is usually which treatment, not whether any will.

As a category, no. Independent laboratory analyses of seized products repeatedly find undeclared prescription PDE5 inhibitors at unpredictable doses — which is dangerous if you take nitrates and merely wasteful otherwise. If a supplement genuinely works, it is because it contains a drug that should have been prescribed to you by someone who reviewed your medications first.

We are out of network by design, which keeps appointment lengths clinical rather than actuarial. We provide a superbill for every visit so you can submit for out-of-network reimbursement, and diagnostic laboratory work and imaging ordered by us are frequently covered directly by your carrier. Prescriptions are usually billed through your pharmacy benefit as normal.

The initial consultation and full diagnostic workup is a single flat fee, published on our pricing page along with the cost of every procedure we offer. You will never receive a quote from us that you have not already seen in writing.

Yes. Records are protected under HIPAA and stored in an encrypted, access-audited electronic record. We do not sell data, we do not run advertising trackers that transmit health information, and we do not disclose anything to employers, insurers or family members without your written authorization.

For follow-ups, medication adjustments and results reviews, yes. The initial consultation must be in person: the physical examination and duplex imaging cannot be done over video, and a clinic that offers to diagnose you entirely by questionnaire is selling you a prescription, not making a diagnosis.

Give us twenty-four hours' notice and there is no charge. We hold long appointment slots that are difficult to refill at short notice, so late cancellations incur a fee — which we waive without argument in genuine emergencies.

Through the licensed pharmacy of your choice, or via a compounding pharmacy we work with for injectable formulations. We do not operate an in-house dispensary, because we do not want any financial incentive attached to what we prescribe.