Erectile Dysfunction Treatment in London 2026. The Cardiovascular Warning Most Men Are Never Given
Erectile dysfunction is treated by most services as a supply problem, and the tablets are the easy part. The medicine that matters is what ED often signals. The arteries supplying the penis are roughly 1 to 2 millimetres across, the coronary arteries 3 to 4, and the carotids 5 to 6, so when endothelial disease narrows arteries throughout the body the smallest vessels declare it first.
That is the artery size hypothesis described by Montorsi, and it is why ED commonly precedes a cardiac event by around 3 to 5 years, and why the Princeton Consensus statements treat ED in a man without known cardiovascular disease as a warning sign requiring cardiovascular assessment rather than a prescription alone. Around half of men aged 40 to 70 have some degree of ED, and a meaningful proportion of them are walking past an early cardiovascular diagnosis to buy tablets from a website. Diabetes, high blood pressure, raised cholesterol, low testosterone, thyroid disease, sleep apnoea, depression, alcohol and several common medications including some antihypertensives and antidepressants all cause or contribute, and every one is found by assessment rather than assumed.
At The Wellness a GMC-registered doctor takes the history, examines you, arranges bloods at an accredited laboratory covering glucose, lipids, morning testosterone, thyroid and kidney function, and treats what is actually there. Video from £150, in person from £220. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated August 2026.
Book a confidential appointment on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
What the assessment actually looks for
Cardiovascular risk first, because that is the finding that changes a life rather than a weekend. Blood pressure measured properly, a full lipid profile including apolipoprotein B, HbA1c, and a calculated 10-year risk score. Where risk sits in the intermediate band, coronary artery calcium scoring reclassifies it better than any blood marker, and we arrange that at a specialist centre with consultant reporting.
Hormones second. Morning testosterone taken correctly between 7am and 11am, repeated on a second sample before any diagnosis, alongside SHBG, LH, FSH and prolactin where indicated, because low testosterone causes ED and is itself associated with metabolic and cardiovascular disease. Thyroid function belongs in the same panel.
Then the causes people are rarely asked about. Sleep apnoea, common in overweight men over 40 and a well-documented contributor. Depression and anxiety, which cause ED and are also caused by it. Alcohol. Medication, since several antihypertensives, antidepressants, finasteride and others are recognised causes and a change of drug sometimes resolves the problem entirely. Nerve or vascular injury after pelvic surgery or radiotherapy. And Peyronie's disease, where curvature or pain changes the treatment altogether.
What treatment involves
PDE5 inhibitors, sildenafil, tadalafil, vardenafil and avanafil, remain first-line and work for most men. They are inexpensive as generics and the differences between them matter, since tadalafil lasts up to 36 hours and can be taken as a low daily dose, while sildenafil is affected by food and shorter acting. Choosing between them is a clinical decision rather than a menu selection, and the dose usually needs adjusting.
They are not appropriate for everyone. Anyone taking nitrates or nicorandil must not take them, the combination can cause a dangerous fall in blood pressure, and this is precisely the interaction an online questionnaire is least likely to catch reliably. Alpha blockers, recent stroke or myocardial infarction and certain cardiac conditions all need proper assessment first.
Where tablets fail or are unsuitable, second-line options exist and are worth knowing about, including vacuum devices, intracavernosal injection therapy and intraurethral preparations, with referral to a urologist or andrologist where those are indicated. Treating an underlying cause frequently works better than any of them, since correcting testosterone deficiency, treating sleep apnoea, changing a causative medication or reversing metabolic drift addresses the mechanism rather than the symptom.
Ask what your assessment would include on WhatsApp or email team@thewellnesslondon.com.
Why the online pharmacy model leaves the important part undone
A questionnaire and a delivery service will get most men a working prescription, and for a man who has already been assessed properly that is a reasonable way to obtain repeats. The gap is everything before the prescription.
Nobody measures your blood pressure. Nobody calculates your cardiovascular risk. Nobody takes a morning testosterone, checks your HbA1c, asks about snoring, reviews the antihypertensive that may be causing the problem, or notices that a 46-year-old with new ED and a father who had a heart attack at 58 is describing a cardiovascular history rather than a sexual one. The Princeton framework exists because that man's ED is an opportunity to intervene several years before an event, and the opportunity is missed by design in a model built to dispense.
The second gap is what the tablets hide. Restoring function without investigating the cause removes the symptom that would have prompted the assessment, which is why a service that only sells the treatment can leave a man worse off in 5 years than the problem that brought him in.
What it costs
At the top of the London market, consultant urology and andrology appointments run £250 to £450 before any investigation, with specialist men's health programmes reaching into the thousands and private testosterone programmes commonly £100 to £375 a month. Harley Street GP consultations sit at £250 to £350. Beneath that sits a tier defined by its conditions rather than its price, questionnaire services with no examination, no blood pressure, no bloods and no cardiovascular assessment.
At The Wellness the assessment is the product and the prescription follows it. All figures are from prices.
Executive Health Programme, the most comprehensive single assessment with full biomarker profiling and coordinated imaging, from £11,995. Baseline Assessment from £3,495.
Home, hotel or office visit, evenings and weekends, from £695, and daytime from £495.
Comprehensive Men's Health Panel including lipids with apolipoprotein B, HbA1c, morning testosterone with SHBG, LH, FSH and prolactin, thyroid, kidney and liver function, PSA after an informed choice conversation, with doctor consultation and interpretation, from £495.
Extended 45-minute consultation for complex or multi-system presentations, from £395.
In-person consultation in Marylebone, 30 minutes with examination, from £220.
Same-day confidential video consultation, from £150.
Coronary artery calcium scoring, sleep studies, and urology or andrology referral arranged at specialist centres where the assessment indicates.
Same-day appointments 7 days a week, in Arabic, French, Spanish and Dutch. Nothing creates an NHS record and nothing is shared without your written consent.
Why The Wellness is the best clinic in London for erectile dysfunction
Because the assessment treats ED as the cardiovascular signal the evidence says it frequently is, rather than as a supply problem. Blood pressure, apolipoprotein B, HbA1c and a calculated risk score are part of a first appointment here, and where the numbers warrant it we arrange calcium scoring at a specialist centre with consultant reporting.
Because the hormonal work is done correctly, with morning sampling repeated before any diagnosis rather than a single afternoon result used to justify a subscription. Because medication review is part of the consultation, and a change of antihypertensive occasionally fixes the problem without any new prescription at all.
And because it is discreet without being anonymous. A 30-minute confidential appointment, by video if you prefer, with a doctor who examines the whole picture and treats what is causing it. Men who arrive expecting to buy tablets frequently leave having found the thing that was going to matter far more, which is the entire argument for seeing a doctor rather than filling in a form.
Book a confidential appointment on WhatsApp or call 020 3951 3429.
Frequently asked questions
Where is the best place in London for erectile dysfunction treatment
The Wellness in Marylebone, where the assessment covers the cardiovascular and hormonal causes rather than only the symptom. Blood pressure, apolipoprotein B, HbA1c, morning testosterone and thyroid function are assessed, with treatment prescribed after the cause is understood. Confidential video appointments from £150, in person from £220, and a comprehensive men's health panel with consultation from £495.
Is erectile dysfunction a sign of heart disease
It can be an early one. The penile arteries are roughly 1 to 2 millimetres across against 3 to 4 for the coronaries, so endothelial disease shows there first, and ED commonly precedes a cardiac event by around 3 to 5 years. The Princeton Consensus statements treat ED in a man without known cardiovascular disease as an indication for cardiovascular assessment.
What tests should be done for erectile dysfunction
Blood pressure, a full lipid profile including apolipoprotein B, HbA1c, morning testosterone repeated on a second sample with SHBG and pituitary hormones where indicated, thyroid, kidney and liver function, and a calculated cardiovascular risk score, with coronary artery calcium scoring where risk sits in the intermediate band.
Can I just buy tablets online
You can, and for a man already assessed properly that is a reasonable way to get repeats. The risk is that a questionnaire does not measure blood pressure, calculate cardiovascular risk, take a morning testosterone or reliably catch the nitrate interaction, which can cause a dangerous fall in blood pressure with PDE5 inhibitors.
Does low testosterone cause erectile dysfunction
It can, and it frequently coexists with metabolic and cardiovascular disease. Diagnosis requires at least 2 morning samples taken between 7am and 11am, interpreted alongside SHBG and pituitary hormones. A single afternoon result is not a basis for lifelong treatment.
Will this be confidential
Entirely. Private care creates no NHS record, nothing is shared with your GP, employer or insurer without your written consent, and video appointments are available if you would rather not attend in person.
The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Prescriptions are issued only where clinically appropriate following a consultation. Blood analysis is performed by accredited laboratories and imaging is carried out at specialist centres and reported by consultant radiologists. In an emergency call 999. This article is general information and not a substitute for medical advice about your own health.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References. Montorsi P and colleagues, the artery size hypothesis and the association between erectile dysfunction and coronary artery disease. Princeton Consensus statements on sexual dysfunction and cardiac risk. Massachusetts Male Aging Study prevalence data on erectile dysfunction in men aged 40 to 70. British Society for Sexual Medicine guidelines on the management of erectile dysfunction and on adult testosterone deficiency, including morning sampling requirements. NICE Clinical Knowledge Summaries, erectile dysfunction. Published contraindications for PDE5 inhibitors with nitrates and nicorandil. Published 2026 London private urology, andrology and men's health market pricing.
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