Assess. Diagnose. Treat. Follow.

You will not be asked to describe your symptoms over the phone. That conversation belongs in a consulting room with a physician, not with whoever answers the telephone.

What we do ask about is scheduling and discretion. Many men prefer an early or late appointment; some prefer we only ever contact them by text. Whatever you specify is entered into your record and followed exactly.

It begins with a conversation, and it is a long one. When the symptoms started, whether onset was sudden or gradual, whether morning erections still occur, what medications you take, how you sleep, what you drink, what has changed in your life. Each of those answers narrows the diagnosis.

The physical examination follows, then blood work: hormone panel, HbA1c, lipids, and a metabolic panel. Where the history suggests a vascular cause, we perform a penile duplex ultrasound to measure arterial inflow and check for venous leak directly.

You will also complete an IIEF-5 questionnaire. It takes two minutes and it matters, because it gives us a numerical baseline to measure against later rather than relying on how you happen to feel at a follow-up visit.

Once laboratory results return, your physician reviews the whole picture and writes your plan. You receive it in writing, and you review it together in person or by video.

The plan states the mechanism we believe is driving your symptoms, the treatment we recommend and why, what it costs, what the alternatives are, and what we expect to see and when. If something we found needs a cardiologist, an endocrinologist or a sleep study, that referral is in the plan too.

For most men this is a properly supervised medication trial — the right molecule, at a genuine therapeutic dose, with the timing explained. For others it is a procedural course, injection training, hormonal correction, or a combination.

Where a treatment involves technique — injection therapy, a vacuum device — you are trained in the clinic, in person, until you are confident. Nobody is handed a device and a leaflet.

First follow-up is typically at four to six weeks, then at three months, then at intervals appropriate to your treatment. We repeat the IIEF-5 each time, so improvement is a measurement rather than an impression.

This is also where honesty costs us money and we do it anyway. If a course of acoustic wave therapy has produced no measurable change at twelve weeks, we tell you, and we do not recommend a second course on the basis of hope.