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Visit 1

A 56-year-old white male electrical engineer who underwent radical prostatectomy in 2001 presents with symptoms of low libido and malaise. The patient also mentions experiencing erectile dysfunction (ED).

Medical history: Prostate-specific antigen (PSA) level at diagnosis of prostate cancer was 4.4 ng/mL; Gleason score was 7, and margins were negative. Other laboratory data were PSA <0.1 ng/mL and total testosterone 51 ng/mL (normal range, 241-827 ng/mL).

Biweekly injection therapy (intracavernosal bimix [papaverine plus phentolamine]) was initiated post-prostatectomy as part of a penile rehabilitation program to optimize erectile function. At that time, the patient reported the return of spontaneous nocturnal erections. However, he discontinued injection therapy because the treatment effect was below expectations, and more importantly, because he perceived his wife had become less interested in sex.

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