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[7] [8] When to contact your GP: Persistent difficulty achieving or maintaining erections sufficient for sexual activity ED that causes distress or affects your relationship ED accompanied by other symptoms (chest pain, shortness of breath, extreme fatigue) Sudden onset of ED, particularly in younger men When to seek emergency care: Erections lasting longer than 4 hours (priapism) call 999 or go to A&E New severe chest pain during sexual activity call 999 Your GP will conduct a thorough assessment, which typically includes: Medical history exploring cardiovascular risk factors, diabetes, neurological conditions, hormonal issues, and psychological factors Medication review identifying drugs that may contribute to ED Physical examination assessing cardiovascular health, genital examination if indicated Blood tests HbA1c or fasting glucose, fasting lipids, morning (7-11 am) total testosterone with repeat if low/borderline, and consideration of LH/prolactin if hypogonadism is suspected This assessment is crucial because ED can be an early warning sign of cardiovascular disease

This is an extreme scenario that proper dosing and monitoring makes virtually impossible

Research has examined NNMT inhibition and its downstream effects on cellular NAD+ salvage, methylation balance and adipocyte energy metabolism, with preclinical work exploring roles in lipid handling and metabolic regulation

doi: 10.1093/ajcn/77.1.189 Gao, F., Yao, C., Gao, E., Mo, Q., Yan, W., & McLaughlin, R

Tirzepatide is a 39-amino-acid dual GIP/GLP-1 receptor agonist