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For monotherapy (as a supplement for those who want to avoid medical therapy), its effects are marginal at best

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[18] This should be initiated and monitored by specialists, with regular checks of PSA and haematocrit In cases where ED is refractory to medical management, specialist referral may be appropriateto urology for consideration of penile prosthesis implantation, or to endocrinology/andrology if hormonal causes are suspected