Background: This is an update of the 2008 British Society for Sexual Medicine (BSSM) guidelines.
Aim: To provide up-to-date guidance for U.K. (and international) health care professionals managing male
Methods: Source information was obtained from peer-reviewed articles, meetings, and presentations. A search of
Embase, MEDLINE, and Cochrane Reviews was performed, covering the search terms “hypogonadism,”
“eugonadal or hypogonadism or hypogonadal or gonadal,” and “low or lower testosterone,” starting from 2009
with a cut-off date of September 2017.
Outcomes: We offer evidence-based statements and recommendations for clinicians.
Results: Expert guidance for health care professionals managing male sexual dysfunction is included.
Clinical Translation: Current U.K. management has been largely influenced by non-evidence guidance from
National Health Service departments, largely based on providing access to care limited by resources. The 2008
BSSM guidelines to date have been widely quoted in U.K. policy decision making.
Conclusions: There is now overwhelming evidence that erectile dysfunction is strongly associated with cardiovascular
disease, such that newly presenting patients should be thoroughly evaluated for cardiovascular and
endocrine risk factors, which should be managed accordingly. Measurement of fasting serum glucose, lipid
profile, and morning total testosterone should be considered mandatory in all newly presenting patients. Patients
attending their primary care physician with chronic cardiovascular disease should be asked about erectile
problems. There can no longer be an excuse for avoiding discussions about sexual activity due to embarrassment.
Hackett G, Kirby M, Wylie K, et al. British Society for Sexual Medicine Guidelines on the Management of
Erectile Dysfunction in Men—2017. J Sex Med 2018;XX:XXXeXXX.