Cardiovascular evaluation:
(1) risk factors for atherosclerosis (hypertension, dyslipidemia, smoking, inactivity, etc)
(2) history of or evidence for ischemic heart disease
(3) evidence of an abdominal aortic aneurysm
(4) evidence of peripheral vascular disease
(5) evidence of carotid stenosis
(6) history of stroke or transient ischemic attack
Additional diagnostic considerations should include:
(1) diabetes mellitus
(2) pelvic surgery or trauma
(3) medications
(4) chronic ethanol abuse
(5) estrogen excess including gynecomastia
(6) hypogonadism
(7) chronic renal disease
(8) prostate disorders (prostatitis, benign prostatic hypertrophy, colon cancer)
(9) peripheral neuropathy
(10) mood disorders, especially depression
(11) conflict in relationships
Tests to supplement the clinical examination:
(1) ECG
(2) lipid studies
(3) fasting glucose with hemoglobin A1c
(4) liver function tests
(5) serum creatinine
(6) urinalysis
(7) free serum testosterone
(8) Doppler studies of arterial blood flow
(9) prostate specific antigen (PSA)
(10) appropriate evaluation for colonic neoplasia based on risk factors
