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where to buy viagra buy viagra 200mg online Ultrasonography of testes may help in disclosing abnormalities in testes and epididymides. Transrectal ultrasonography can disclose abnormalities in the prostate and pelvis that may interfere with erectile function. Penile ultrasound to check for blood vessel or blood flow problems Some authors advocate measuring prolactin and free testosterone levels as part of the initial evaluation.4,5 The value of this routine testing is uncertain, however, because the incidence of endocrinopathy presenting as erectile dysfunction is reportedly only 2 percent.8 A reasonable strategy is to obtain a free testosterone level in all men aged 50 and older and in those younger than 50 who have symptoms or signs of hypogonadism such as decreased libido, bilateral testicular atrophy or a reduced amount of body hair.9 The prolactin level should be measured if the free testosterone level is low, the patient has a substantial loss of libido or a prolactinoma is suspected on the basis of a history of headache with visual field cuts.10 Measurement of luteinizing hormone levels can be reserved for use in distinguishing primary from secondary hypogonadism in men with low testosterone levels.9 If low testosterone is the only cause of a man's erectile dysfunction, it can be treated with testosterone replacement therapy.