Although penile prostheses remain one of the most effective treatments for all types of ED, non-surgical treatments have replaced prosthetic implants as the first choice for patients in the last decade. non-surgical treatments for ED are both specific and non-specific. Atopic treatments include psychotherapy, medication modification and hormone therapy; non-atopic treatments include sildenafil, vacuum reduction devices, transurethral therapy and cavernous body injections. Although non-specific treatments seem to be more effective for most ED, patients should also be made aware of specific therapies. 1, lifestyle changes It is now known that ED is closely associated with atherosclerotic coronary artery disease and peripheral vascular disease. Although it is difficult to prove whether it is beneficial for ED recovery, patients should also be encouraged to make lifestyle changes (regular exercise, healthy diet, smoking cessation and moderate alcohol consumption, etc.). Long-distance cycling is also a risk factor for ED that needs to be discussed. Changes in seat design and riding style may reduce the damaging effects of compression on the penile arteries. 2, adjust the medication If the patient is taking a certain medication after sexual dysfunction, it is important to determine whether the problem is decreased libido, erectile dysfunction, or rapid or delayed ejaculation. In most cases, changing the type of medication is a viable first step. Antihypertensives are theorized to lower blood pressure, and it is that effect that has been suggested as the mechanism for their adverse effect on erections. Adapting antihypertensive medications to adrenergic receptor antagonists, calcium channel blockers, or angiotensin-converting enzyme inhibitors may result in better ED in some patients. Patients taking antidepressants for sexual dysfunction may benefit from adjusting their medication to trazodone. 3, psychosexual treatment Sildenafil, vacuum narrowing device or cavernous injection may have a faster effect than patients using a long course of psychotherapy. However, once the underlying specific cause is eliminated, ED is likely to be cured, so patients with significant psychological disorders should be advised to seek psychotherapy or sex therapy. In addition, for patients with mixed psychological and organic causes of ED, psychotherapy may help to relieve their anxiety and eliminate unrealistic expectations associated with medical or surgical treatment. 4, hormone therapy Patients with thyroid, adrenal or hypothalamic dysfunction should undergo endocrine screening and treatment. Urologists should be aware that elderly ED patients with concurrent hypogonadism may exhibit the following symptoms: low libido, depression, mental retardation, decreased muscle mass, decreased bone salt density, decreased skin tone, changes in body hair distribution, changes in sleep patterns, and increased visceral fat. This section focuses on hypogonadism and hyperprolactinemia associated with ED. There is a case for initiating androgen therapy in patients with ED that has been clearly associated with hypogonadism. The long-acting preparations of testosterone, testosterone cypionate and testosterone enanthate, are the least expensive androgen replacement therapies and are effective in restoring normal serum testosterone levels. Both preparations are administered by deep intramuscular injection, and blood testosterone exceeds physiological levels within 72 hours, followed by a steady decline over 2-3 weeks. Testosterone cypionate and testosterone enanthate are usually injected at 200mg-400mg every 2-4 weeks. testosterone propionate has a shorter half-life and requires 1 injection every other day. If used early in the morning, testosterone transdermal patches can mimic normal blood testosterone cycling. Testosterone replacement therapy does not improve sexual function in patients with hyperprolactinemia, regardless of the presence or absence of hypogonadism. The primary goal of treatment for this disorder is to remove drugs of abuse such as estrogens, morphine, sedatives, or nerve agents. Bromocriptan is a dopamine agonist that reduces prolactin levels and normalizes testosterone levels. It has also been used to reduce the size of prolactinomas. Surgery is an option only if there is a poor response to medication or if the adenoma is squeezing the optic nerve and causing visual field changes.