Urologist or Andrologist for Erectile Dysfunction in London?
- Prof Fabio Castiglione, MD, PhD, FECSM, FEBU
- Mar 10, 2021
- 5 min read
Updated: 2 days ago
If erection problems keep happening, a GP or sexual health clinic can provide an initial assessment. A consultant urologist with focused experience in andrology or sexual medicine is particularly appropriate when symptoms are persistent, the cause is uncertain, first-line treatment has not worked, or specialist tests and procedures may be needed. The right pathway depends on your symptoms, general health and treatment history.
What is erectile dysfunction?
Erectile dysfunction (ED) means being unable to get or keep an erection firm enough for satisfactory sexual activity. Occasional difficulty can occur with stress, tiredness or alcohol. The NHS advises seeking medical help when erection problems keep happening because ED can have physical, psychological or mixed causes and may be associated with a treatable health condition.
Should you see a GP, urologist or andrologist?
GP or sexual health clinic
For many men, primary care is the correct starting point. A GP or sexual health clinician can review medicines and lifestyle factors, check blood pressure, arrange appropriate blood tests and discuss first-line treatment. They can refer to a specialist when the presentation is complex or treatment is unsuccessful.
Consultant urologist
A urologist is trained in urinary tract and male reproductive conditions. Urology input may be particularly useful when ED occurs with urinary symptoms, prostate disease, penile or testicular findings, previous pelvic surgery, trauma or a possible need for procedural treatment.
Urologist-andrologist or sexual medicine specialist
Andrology focuses on male sexual and reproductive health. A consultant urologist with andrology or sexual medicine expertise can provide specialist assessment of ED, consider vascular, hormonal, neurological, medication-related and psychosexual factors, and discuss the full range of non-surgical and surgical options. Other specialists may be involved when cardiovascular, endocrine, fertility or psychological factors need separate expertise.
When is specialist assessment particularly useful?
erection problems are persistent or worsening
PDE5 inhibitor treatment has not worked despite correct use
tablets are unsuitable because of medicines or health conditions
ED began after prostate, pelvic or spinal surgery
there is penile curvature, pain, shortening or a suspected Peyronie’s plaque
low sexual desire or symptoms of testosterone deficiency are present
there is pelvic trauma, neurological disease or a complex medical history
you are considering injections, vacuum therapy, shockwave treatment or a penile prosthesis
the problem is causing significant personal or relationship distress
Why erectile dysfunction deserves a health assessment
ED is not always an isolated sexual symptom. It may be associated with high blood pressure, high cholesterol, diabetes, obesity, smoking, hormonal problems, depression, anxiety or medication effects. European urology guidance highlights the relationship between ED and cardiovascular risk. Assessment is therefore an opportunity to address both sexual function and wider health rather than simply prescribe a treatment for erections.
What happens during an erectile dysfunction consultation?
A proper assessment usually includes a medical and sexual history, review of current medicines, cardiovascular and metabolic risk factors, relationship or psychological context and previous treatments. A focused examination may be recommended. Current European guidance supports checking glucose or HbA1c, lipid profile and an early-morning testosterone level when these have not been assessed recently, with additional tests selected according to the individual presentation.
Specialist tests such as penile Doppler ultrasound are not required for every patient. They may be considered when the result could clarify the cause or influence a treatment decision.
Treatment options should follow the diagnosis
ED treatment is personalised according to cause, safety, effectiveness, invasiveness, cost and patient preference. Options may include:
lifestyle change and management of cardiovascular or metabolic risk factors
review of medicines that may contribute to ED
psychosexual counselling or therapy when relevant
PDE5 inhibitor medicines such as sildenafil or tadalafil when safe and appropriate
vacuum erection devices
topical, intra-urethral or penile injection treatments
low-intensity shockwave therapy for selected patients after assessment
penile prosthesis surgery when other options are unsuitable or unsuccessful
PDE5 inhibitors must not be combined with nitrate medicines or nitric oxide donors such as recreational nitrites. Treatment should be discussed with a qualified clinician who knows your medical history. The NHS also warns that medicines bought from unregulated websites may be fake, unsuitable or unsafe.
Is shockwave therapy suitable for every man with ED?
No. Low-intensity shockwave therapy is not a universal treatment for every cause of erectile dysfunction. Candidacy depends on the likely mechanism of ED, severity, previous treatment response and wider health. It should be considered within a complete assessment and balanced discussion of evidence, expected benefit, limitations, alternatives and cost. Read more about the consultant-led shockwave assessment in London.
Private erectile dysfunction assessment in London
Prof Fabio Castiglione provides consultant urology and andrology assessment for erectile dysfunction in London. The aim of the first consultation is to understand the likely causes, identify relevant health factors and agree an evidence-led plan rather than assume that one treatment suits every patient.
View the erectile dysfunction information page · Read how to choose an andrologist in London · Book a consultation
Frequently asked questions
Can a GP treat erectile dysfunction?
Yes. A GP can assess common causes, arrange basic health checks and discuss first-line treatment. Referral to urology, andrology, cardiology, endocrinology or psychosexual services may be appropriate depending on the findings and response.
Is an andrologist always better than a urologist for ED?
Not necessarily. The important issue is relevant experience. Many andrologists are consultant urologists with additional focus on sexual and reproductive health. A general urologist may also manage ED, while complex cases may benefit from a clinician whose regular practice includes sexual medicine and advanced ED treatment.
What blood tests may be considered?
Depending on recent results and individual risk, assessment may include glucose or HbA1c, cholesterol and an early-morning testosterone level. Additional hormone or other tests are selected according to symptoms and clinical findings.
Can erectile dysfunction be a sign of heart disease?
ED and cardiovascular disease share several risk factors, and ED can sometimes precede recognised cardiovascular symptoms. This does not mean that every man with ED has heart disease, but blood pressure, diabetes, cholesterol, smoking and overall cardiovascular risk should not be ignored.
Does having morning erections rule out a physical cause?
No single feature proves the cause. Morning or spontaneous erections can provide useful context, but physical and psychological factors often overlap. Diagnosis should be based on the full history, health assessment and relevant examination or tests.
Can treatment be guaranteed to work?
No. Outcomes vary with the underlying cause, severity, general health, correct use of treatment and individual response. A clinician should discuss realistic expectations, uncertainty, risks and alternatives.
Sources
About the author
Prof Fabio Castiglione, MD, PhD, FECSM, FEBU, Urologist (ITA). Consultant Urologist and Andrologist — King’s College Hospital NHS Foundation Trust; Hon. Reader, King’s College London, UK; Academic Lead of Urology; GMC 7542824; Director and Founder of Holistic Andrology.
Authored by Prof Fabio Castiglione. Editorial update: 17 August 2026. Clinical information was checked against current NHS, BAUS and European urology guidance.
Medical disclaimer: This article provides general information and is not a diagnosis or a substitute for personalised medical advice.
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