Areas of care
Andrology and Men's Health
Andrology is the part of urology that deals with male sexual and reproductive health. It covers difficulty with erections, problems with ejaculation, low testosterone, male infertility and conditions affecting the testes and penis. These problems are common, they are medical rather than personal, and most of them respond well to treatment once someone actually looks at them properly.
What this covers
- Erectile difficulty
- Trouble getting or keeping an erection firm enough for sex. Very common with age, and frequently linked to blood vessel health, diabetes, medication or psychological factors rather than any single cause.
- Ejaculation problems
- Ejaculating much sooner than wished, much later, or not at all. Each has different causes and different treatments, so the distinction matters.
- Male infertility
- Difficulty conceiving where the male factor is involved, which is the case in around half of couples having trouble. Assessment of both partners in parallel saves considerable time.
- Low testosterone
- Persistently low hormone levels causing tiredness, low mood, reduced libido and loss of muscle. Diagnosis needs a morning blood test repeated for confirmation rather than a single result.
- Varicocele
- Enlarged veins draining the testis, present in a meaningful share of men with fertility problems. Treatment is considered where it is causing pain or affecting semen quality.
- Curvature and scarring of the penis
- A firm plaque that causes bending, pain or shortening. It has an active phase and a stable phase, and treatment differs considerably between the two.
Why erectile difficulty is worth taking seriously
The arteries that supply the penis are narrower than the coronary arteries. When blood vessel disease begins developing, those smaller vessels are affected first, which means erectile difficulty can appear several years before any heart symptoms.
It is one of the few symptoms that gives an early, actionable warning of cardiovascular disease and undiagnosed diabetes. That is why proper assessment includes blood pressure, blood sugar and cholesterol, and not simply a prescription.
How assessment works
It starts with a conversation about what is actually happening, for how long, and in what circumstances, followed by an examination.
Blood tests cover blood sugar, cholesterol and hormone levels, taken in the morning where testosterone is being measured. Where fertility is the concern, a semen analysis is the central test and is usually repeated, since results vary considerably between samples. A scrotal ultrasound is added where an abnormality is felt, and specialised blood flow studies of the penis are used in selected cases.
Treatment approaches
- Treating what is underneath
- Controlling diabetes, blood pressure and cholesterol, reviewing medications that contribute, stopping smoking, losing weight and improving sleep all improve sexual function directly. This is the least glamorous part of treatment and often the most effective.
- Oral medication
- Well established tablets improve blood flow and work for a large proportion of men. They need to be taken correctly to judge properly, and many people conclude they do not work when in fact they were not used as intended.
- Hormone treatment
- Testosterone replacement is appropriate where levels are genuinely low and symptoms fit, and it is monitored. It is not a general tonic, and it can suppress fertility, which matters if children are planned.
- Procedures and surgery
- Options include treatment of a varicocele, correction of penile curvature once stable, surgical retrieval of sperm where none are present in the ejaculate, and implants for erectile dysfunction that has not responded to other treatment.
- Fertility pathways
- Where natural conception is unlikely, assisted reproduction is coordinated with the fertility team, including planning any surgical sperm retrieval alongside the treatment cycle.
On privacy
These consultations are confidential, and they are routine here rather than unusual. Men frequently wait years before raising any of this, often long after it started affecting their relationship or their confidence.
There is no need to arrive with the vocabulary for it. Describing the problem in ordinary words is entirely sufficient.
Common questions
Questions patients ask
- Is erectile dysfunction just a normal part of getting older?
- It becomes more common with age, but it is not something that has to be accepted. It is often the first visible sign of a treatable condition such as diabetes or vascular disease, which is a good reason to have it assessed rather than ignored.
- Can a low sperm count be treated?
- Often yes, depending on the cause. Hormonal problems, varicocele, infection and certain medications are all addressable. Where numbers cannot be improved enough, assisted reproduction using retrieved sperm is frequently still an option.
- What is a varicocele and does it always need treating?
- It is a collection of enlarged veins around the testis. Many cause no trouble at all and need nothing. Treatment is considered when there is persistent ache, when the testis is not growing normally in a younger patient, or when semen quality is affected and fertility is being pursued.
- Should I take testosterone if I feel tired and low?
- Only if blood tests actually show low testosterone on more than one morning sample and the picture fits. Tiredness has many causes, and taking testosterone without a proper diagnosis carries real downsides, including suppressing your own production and your fertility.
- Are these consultations private?
- Yes. Consultations are confidential, and this is standard urological work rather than anything remarkable.
This page is general information and is not a substitute for a consultation. Your own situation may differ.
Appointments
Discuss this with a urologist
If any of the above sounds familiar, a consultation is the way to find out what is actually going on. Appointments are booked in advance.