European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Hypogonadism, Erectile Dysfunction, Premature Ejaculation, and Peyronie's Disease.

Late-onset hypogonadism (LOH) is defined as a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action.

• The guidelines emphasize appropriate indications and subsequent follow-up for testosterone therapy in patients with LOH.
• LOH is specifically contextualized as a condition of the ageing male, distinguishing it from other forms of hypogonadism.
• The guidelines provide both basic and advanced diagnostic approaches for LOH.
• Recommendation strength was evaluated based on trade-offs between benefits and drawbacks, quality and reliability of evidence, and diverse patient preferences and values.

Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, and its treatment algorithm aims to support personalized care.

• The decision-making algorithm for treating ED is tailored to individual patients according to invasiveness, tolerability, and effectiveness of different therapeutic options.
• Patient expectations are explicitly incorporated into the treatment decision framework.
• Patients should be 'fully counselled with respect to all available treatment modalities.'
• The systematic review covered new research published between 2021 and 2024 from Medline, EMBASE, and Cochrane Libraries.

Pharmacotherapy is recommended as first-line treatment for lifelong premature ejaculation (PE), while treating the underlying cause is the initial goal for acquired PE.

• The EAU guidelines adopted the definition of PE developed by the International Society for Sexual Medicine.
• The guidelines require that the subtype of PE (lifelong vs. acquired) be defined before treatment is initiated.
• Patient expectations should be discussed thoroughly after PE subtype classification.
• The distinction between lifelong and acquired PE drives fundamentally different treatment pathways.

Surgical treatment for Peyronie's disease (PD) should be offered to patients with penile deformity that negatively impacts sexual function, with penile prosthesis implantation recommended for those with concomitant erectile dysfunction.

• Accurate baseline assessment of PD patients should differentiate between acute and stable phases of the disorder.
• Penile prosthesis implantation is specifically recommended for PD patients who also have concomitant ED.
• Surgical intervention is indicated based on functional impact (negative effect on sexual function) rather than deformity alone.
• The guidelines provide both basic and advanced diagnostic frameworks for PD.

The 2025 EAU guidelines update was based on a systematic review of research published from 2021 to 2024 across multiple major databases.

• The panel searched Medline, EMBASE, and Cochrane Libraries for new research published in 2021–2024.
• Each recommendation's strength was evaluated based on three factors: trade-offs between benefits and drawbacks, quality and reliability of available evidence, and diverse patient preferences and values.
• The guidelines focus on key clinical decisions that would impact patient care most.
• The panel comprised 17 authors from multiple European institutions with specializations in urology and sexual medicine.

The guidelines provide detailed basic and advanced diagnostic approaches for all four conditions covered: LOH, ED, PE, and Peyronie's disease.

• Each condition has its own diagnostic framework at both basic and advanced levels.
• Clinical workup recommendations focus on diagnosis, treatment, and follow-up for each condition.
• The guidelines are intended to provide 'practical recommendations on the clinical workup.'
• The overview is described as offering 'valuable insights into the diagnosis, treatment, and follow-up' of all four conditions.