What urologists wish men knew earlier

This is not a collection of quotes. It is a plain-English summary of advice that appears consistently in urology guidelines and that men commonly hear in clinic, often later than would have been ideal.

Can erectile dysfunction be a sign of heart disease?

It can. Erections depend on healthy blood vessels, and the arteries in the penis are narrow, so problems with blood flow can show up there early. A widely cited study in JAMA found that men who developed erectile dysfunction were more likely to have a cardiovascular event in the following years. That is an association rather than proof of cause, but it is why European guidelines recommend checking cardiovascular risk factors in men with ED.

In practical terms, persistent erection problems are a good reason to have your blood pressure, blood sugar and cholesterol checked, not just to ask for a tablet. Our feature on erectile dysfunction as an early health warning explains the link in more detail.

Is blood in the urine serious if it only happens once?

It should always be checked, even if it happens once, even if it does not hurt, and even if it clears up by itself. Visible blood in the urine often has a harmless explanation, such as infection, but it can also be the first sign of a problem in the bladder or kidney that is easier to treat when found early.

Are urinary problems just part of getting older?

They are common with age, but that does not mean you have to live with them. A weak stream, waking at night to pass urine and a sudden urge to go can often be improved with simple changes, medicines or, when needed, procedures. Guidelines put the emphasis on how much the symptoms bother you. If they do, it is worth asking.

Should every man have a PSA test?

Not automatically. The PSA blood test can help find prostate cancer earlier, but it can also lead to extra tests and to treatment of cancers that would never have caused harm. The US Preventive Services Task Force advises that men aged 55 to 69 make an individual decision after discussing the benefits and harms, and recommends against routine screening from age 70. Men with a family history or other risk factors may be advised to have that conversation earlier.

Is low testosterone the reason I feel tired?

Possibly, but less often than advertising implies. In the European Male Ageing Study, the symptoms most closely linked to low testosterone were sexual: fewer morning erections, low desire and erectile dysfunction. Late-onset hypogonadism defined by those symptoms plus a low blood level was uncommon, affecting about 2% of men aged 40 to 79. Tiredness has many causes, including poor sleep, low mood, weight gain and other medical conditions, and they deserve looking at too.

What should I do if I find a lump in my testicle?

Get it checked promptly. Most lumps are not cancer, but a new lump, swelling or a change in the feel of a testicle should be examined, usually with a quick ultrasound scan. A sudden, severe pain in a testicle is an emergency and needs same-day care.

Why does raising problems early matter?

A recurring theme in clinics is that men wait. Sexual and urinary problems are often easier to manage when they are raised early, and starting the conversation takes little more than putting up with a moment of awkwardness. Bringing a written list of symptoms, medicines and questions makes that conversation shorter and more useful.

What to take away

• Treat erection problems as a health signal, not only a bedroom issue.
• Never ignore blood in the urine or a new testicular lump.
• Raise urinary symptoms if they bother you, and discuss PSA before deciding.
• Ask for testosterone to be tested properly rather than assumed.

If erection problems are your main concern, our erectile dysfunction guide explains how they are assessed.

Questions men also ask

Should I see a GP or a urologist first?

In many health systems a GP or family doctor is the first step and can arrange initial tests. In others you can book a urologist directly. Either way, the important thing is to raise the symptom.

Do I need a check-up if I feel fine?

Routine checks such as blood pressure, blood sugar and cholesterol are sensible from middle age even without symptoms. Whether to have a PSA test is a separate decision to discuss with a doctor.

Sources & further reading

1. JAMA Erectile dysfunction and subsequent cardiovascular disease (opens in a new tab) (2005) Thompson IM, et al.
2. EAU EAU Guidelines on Management of Non-neurogenic Male Lower Urinary Tract Symptoms (LUTS) (opens in a new tab) (2024) European Association of Urology
3. JAMA Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement (opens in a new tab) (2018) US Preventive Services Task Force
4. New England Journal of Medicine Identification of late-onset hypogonadism in middle-aged and elderly men (opens in a new tab) (2010) Wu FCW, et al.
5. European Urology European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction (opens in a new tab) (2021) Salonia A, et al.

This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.