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NICE-aligned management typically involves: Addressing modifiable risk factors (smoking cessation, weight loss, increased physical activity, alcohol reduction) Optimising management of underlying conditions (diabetes, hypertension, depression) Trial of PDE5 inhibitor therapy Referral to specialist services (urology/andrology) if first-line treatments fail or where structural/neurological/endocrine causes are suspected Consideration of psychosexual therapy where appropriate Men should be reassured that ED is a medical condition with effective treatments, and seeking help through proper channels ensures safety, appropriate investigation of underlying causes, and access to evidence-based therapies

New England Journal of Medicine, 375(19), 1834-1844

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Foods that are rich in vitamin B12 include: Fish (salmon, trout, tuna, and sardines) Shellfish (clams) Organ meat (liver and kidneys) Beef Milk Yogurt Cheese Eggs Fortified cereal A balanced meal plan can provide the nutrients clients need to support a healthy weight loss journey

But it was far too sudden and really started getting worse after Covid