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[7] [8] When to contact your GP: Persistent difficulty achieving or maintaining erections sufficient for sexual activity ED that causes distress or affects your relationship ED accompanied by other symptoms (chest pain, shortness of breath, extreme fatigue) Sudden onset of ED, particularly in younger men When to seek emergency care: Erections lasting longer than 4 hours (priapism) call 999 or go to A&E New severe chest pain during sexual activity call 999 Your GP will conduct a thorough assessment, which typically includes: Medical history exploring cardiovascular risk factors, diabetes, neurological conditions, hormonal issues, and psychological factors Medication review identifying drugs that may contribute to ED Physical examination assessing cardiovascular health, genital examination if indicated Blood tests HbA1c or fasting glucose, fasting lipids, morning (7-11 am) total testosterone with repeat if low/borderline, and consideration of LH/prolactin if hypogonadism is suspected This assessment is crucial because ED can be an early warning sign of cardiovascular disease

[6] [13] Proton pump inhibitors (PPIs) and H2-receptor antagonists , used for acid reflux, reduce stomach acid production and may affect B12 release from food proteins

Regular Follow-Up Treatments Depending on your personal health needs and goals, you may need regular B12 injections to maintain optimal energy levels