[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

Vitamin B12 is a water-soluble vitamin and is generally well tolerated
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Soya products such as miso, tarami, and tempeh have been established to have no significant levels of B12
Phase 3 trials showed weight loss of up to 11.2% at the highest dose over 72 weeks
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