A. Social or psychological factors should be evaluated. Medical conditions, medications, and history of prior pelvic surgical procedures should be sought. Physical examination should search for abnormalities of sexual characteristics or of the genitalia. Evidence of trauma, plaques, or testicular abnormalities should be assessed. A neurologic examination should be performed.
B. Laboratory work-up. Complete blood count and chemistries should be obtained. Serum testosterone measurement is recommended in all impotent patients over age 50. In patients younger than 50 years, serum testosterone determination is recommended only in cases of low sexual desire or abnormal physical findings. Serum prolactin should be measured in patients with low sexual desire, gynecomastia, and/or testosterone less than 4 ng/mL.
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