Manus Solis
Erectile Dysfunction
A vascular and hormonal signal. Investigated thoroughly, treated at the cause.
Overview
Erectile dysfunction affects roughly 50% of men between ages 40 and 70, and its prevalence increases with age. While PDE5 inhibitors (sildenafil, tadalafil) address the symptom, they leave the underlying cause untreated. ED is frequently a manifestation of hormonal deficiency, insulin resistance, endothelial dysfunction, or cardiovascular disease, all conditions that respond to medical intervention when properly identified.
At Manus Solis, we evaluate erectile dysfunction as a systemic finding. Your Vis Viva Score captures the clinical picture across three domains: symptom burden (Sensus), metabolic and hormonal bloodwork (Pulsus), and cardiovascular and physical performance (Virtus). Treatment addresses the root physiology. When testosterone is low, we restore it. When metabolic dysfunction is present, we treat it. The goal is durable, lasting function.
Common Symptoms
- Difficulty achieving erection
- Difficulty maintaining erection
- Reduced rigidity
- Loss of morning erections
- Decreased libido
- Delayed or absent orgasm
- Fatigue
- Depressed mood
- Reduced exercise tolerance
What We Measure
- Total & free testosterone
- SHBG
- Estradiol (E2)
- Prolactin
- LH & FSH
- Fasting insulin & glucose
- HbA1c
- Lipid panel (advanced)
- hsCRP (inflammation)
- Thyroid panel
- CBC & hematocrit
- Liver & kidney function
- PSA
- Vitamin D
Hormones & Treatments
- Testosterone (cypionate, enanthate, cream)
- Anastrozole (estrogen management)
- HCG (testicular function)
- DHEA
- Thyroid (if concurrent deficiency)
- PDE5 inhibitors (tadalafil, sildenafil, adjunctive)
Custom-compounded by our Ontario pharmacy partner. Individually dosed. Physician-titrated.
Treatment
How We Treat This
We identify and treat the hormonal and metabolic drivers of erectile dysfunction. Testosterone replacement, estrogen modulation, insulin sensitization, and cardiovascular risk reduction form the therapeutic foundation. PDE5 inhibitors may be prescribed as adjunctive therapy while underlying causes are corrected. For men already on testosterone who still experience ED, we investigate estradiol balance, prolactin, thyroid function, and vascular health.
Men who want their erectile dysfunction evaluated beyond a prescription for sildenafil. Particularly relevant for men with concurrent fatigue, weight gain, or metabolic concerns, symptoms that often share a common hormonal or metabolic origin.
Questions
FAQ
Can low testosterone cause erectile dysfunction?
Yes. Testosterone supports nitric oxide synthesis in penile tissue, maintains smooth muscle integrity, and modulates libido centrally. Men with testosterone levels below the physiological range frequently report erectile difficulty that improves with appropriate replacement. Because ED is rarely caused by a single factor, we evaluate the full hormonal and metabolic picture.
Do I still need Viagra or Cialis if I start hormone therapy?
Many men find they can reduce or discontinue PDE5 inhibitors once testosterone and metabolic health are optimized. Others benefit from continued low-dose tadalafil for its combined erectile and cardiovascular effects. We make this decision together, guided by your response to treatment over the first 3–6 months.
Is erectile dysfunction a sign of heart disease?
It can be. The penile arteries are smaller than coronary arteries, so endothelial dysfunction often manifests as ED before any cardiac symptoms appear. Studies show ED precedes a cardiovascular event by 3-5 years in some men. We screen for metabolic syndrome, advanced lipid abnormalities, inflammatory markers, and insulin resistance as part of every ED evaluation.
What if I already take testosterone but still have ED?
This is common and usually means the evaluation was incomplete. Elevated estradiol from aromatization, suboptimal free testosterone due to high SHBG, thyroid dysfunction, insulin resistance, or inadequate dosing can all contribute. We review your current protocol, repeat a full panel, and adjust until the clinical response matches the lab data.
Ontario-Wide
Virtual consultations available to patients in Toronto, Mississauga, Brampton, Markham, Vaughan, Richmond Hill, Oakville, Burlington, Hamilton, Ottawa, London, and across Ontario. Bloodwork requisitions and prescriptions managed remotely. Compounds shipped directly from our Ontario pharmacy partner.
Begin
Book a Discovery Call
A confidential conversation with our physician and founder.
inquiries@manussolis.com · Yorkville, Toronto