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You should contact your GP if you: Experience new or worsening erectile dysfunction Have ED accompanied by other symptoms such as reduced libido, fatigue, or mood changes Find that ED is affecting your mental health or relationships Are considering supplements but take regular medications Experience side effects from any supplement Seek urgent medical attention if you experience: Chest pain, breathlessness, or other cardiovascular symptoms (call 999 if acute) An erection lasting more than 4 hours (priapism) Sudden changes in vision or hearing Severe penile pain or new penile deformity Your GP can perform appropriate investigations, address modifiable risk factors, discuss evidence-based treatments, and refer to specialist services if needed

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Notably, while TMAO is associated with a higher prevalence of prediabetes, it does not appear to significantly influence insulin resistance or longitudinal changes in fasting plasma glucose [24, 61, 66, 67]

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