How an appointment actually works

One appointment, not three referrals

A sexual difficulty can be almost entirely medical, almost entirely psychological, or some of each, and working out which it is in your case is the whole job. A man with erectile dysfunction may have early vascular disease, or performance anxiety, or both. The usual route is a GP for the first, a specialist for a second opinion, and a therapist months later for the part nobody asked about.

I am a GP, a sexual medicine specialist and a registered psychosexual therapist, so the assessment covers all of it in the same room: blood pressure and blood tests alongside a conversation about what is actually happening in your life. Not because the second is a consolation prize when the first comes back normal, but because there is no way to tell which it is without looking at both.

How I decide what to recommend

A private clinic can sell you a great deal you do not need, and much of this field runs on exactly that. My job is to work out with you what is likely to help and what is not, and where your energy and your money are best spent.

Tests and scans

I arrange an investigation when the result will change something, and not otherwise. I frequently see men who have spent thousands on screening packages and did not get the tests that would have told them anything, because they were offered what suited a clinic’s model. The principle is the right test for the right man at the right time. Nothing is arranged without my explaining the reasoning first, and I receive no financial benefit from any investigation I recommend.

Medication

I do not recommend anything I would not suggest to a member of my own family. A prescription can be appropriate and useful and is rarely the whole answer: where nobody has assessed what is driving the difficulty, medication alone often works less well than expected, or stops working. I take no margin on anything I prescribe, and the medication prices on the fees page are what the pharmacy charges.

Where the standards come from

Where there is a recognised standard, I follow it rather than my own preference. Testosterone deficiency is the clearest example and the one where men are most often misled. Diagnosis and treatment follow the international, European and British guidelines. In practice that means at least two morning blood tests rather than one, free testosterone and SHBG as well as the total, and symptoms weighed alongside the number. A good many men arrive having been told by an online clinic that their testosterone is low when it is normal.

The therapy I actually do

Where the work turns out to be psychological, it is not one method applied to everybody. I use Acceptance and Commitment Therapy, which is about changing your relationship to a difficult thought rather than arguing with it; Compassion Focused Therapy, developed specifically for shame and self-criticism, which is a great deal of what arrives here; EMDR, where an earlier experience is still anchoring a present difficulty in a way that talking about it does not reach; and the Developmental Model of Couples Therapy, where the difficulty has become part of how a relationship works. In practice these get combined. The work is shaped by what is actually going on, not by a fixed protocol.

Practical things worth knowing

You do not need a GP referral

You can book directly. If you would like me to write to your GP afterwards I will, and if you would rather I did not, that is equally fine and needs no explanation.

Appointments can be remote

Video appointments are available for first consultations as well as follow-ups. In person is better where you can manage it, since I can examine you and bloods can be taken the same day, but there is no requirement to come in, and a great deal does not need it.

Nothing is written down that does not need to be

Clinical records are kept securely and confidentially, and what goes in them is what is clinically relevant. You can ask at any point what I am recording and why. I use an AI scribe to help write up consultations and will ask your consent before using it. If you would rather I did not, I will write the notes myself and nothing else changes.

Partners are welcome, and optional

Some people come on their own, some with a partner, some with partners, and some start alone and change their mind later. All of those work, and none of them needs arranging in advance.