Three ads, three doors. Book the GP you have seen twice in a decade, tap the online ED service that keeps following you around the internet, or go straight to a specialist and skip the queue in the middle.
None of them is a wrong choice, and that is part of what makes the decision awkward. Registered Australian doctors work across all three, and any of them can finish with a script in your hand.
The thing that actually separates them has nothing to do with convenience. It is whether anyone, at any point, works out why your erections have changed. This article sets out what each option can and cannot do, and when seeing an erectile dysfunction specialist in Sydney is worth the extra step. Dr Phillip Katelaris is a urologist consulting at Hornsby, Castle Hill and St Leonards.
What each option actually does
Each of the three pathways solves a different problem, and the differences are structural rather than a matter of quality.
Your GP
For most men the GP is the sensible first stop. A GP has the time to take a full history, examine you, order blood tests, check whether something you are already taking is behind the change, prescribe first-line treatment and write a referral when one is needed.
There is a practical reason as well. Medicare pays a rebate on a specialist consultation only if you hold a referral, so skipping the GP costs you that rebate. A standard GP referral runs for 12 months from your first appointment with the specialist, unless the referring doctor writes a different period on it.
Online and telehealth ED services
Online ED services are legal, and for some men they work well. The better ones use AHPRA-registered doctors, run an actual consultation by phone or video, then send an eScript to your pharmacy. Privacy and convenience count for something here. Plenty of men would never have raised the subject at all if the only route to it was a waiting room.
The limitation is just as real. No remote consultation can include a physical examination, and how much assessment happens before a script goes out varies a great deal from one service to the next.
That is not simply an opinion. The Medical Board of Australia’s telehealth guidelines say that prescribing through questionnaire-based, asynchronous web tools, with no real-time consultation between doctor and patient, is not good practice. Ahpra repeated that position in updated guidance released in October 2025. So a fair test is whether you actually spoke with the doctor.
Some services run a proper telehealth consultation and some do not, and the website will not always tell you which one you are dealing with.
A urologist (ED specialist)
A urologist is a surgically trained specialist in the urinary tract and the male reproductive system, and is the doctor most often responsible for managing erectile dysfunction that has not resolved with first-line treatment. Training runs well beyond a medical degree, through surgical fellowship and years of supervised practice.
The practical difference is range. A urologist can examine you, order and interpret specialist imaging such as a penile duplex Doppler ultrasound, and deliver treatments no other pathway offers, including injection therapy, linear shockwave therapy and penile prosthetic surgery. Our guide on what an erectile dysfunction specialist does goes through this in more detail.
The question that decides it: has anyone found out why?
Erectile dysfunction is a symptom, not a diagnosis, and that single distinction settles most of this debate.
Difficulty with erections is often the first visible sign of something else: narrowing arteries, undiagnosed or poorly controlled diabetes, low testosterone, untreated sleep apnoea, or a medication doing exactly what it was never meant to do. The small arteries supplying the penis are affected by vascular disease earlier than the larger arteries supplying the heart, which is why ED can appear several years before any cardiac symptom.
Tablets can quiet the symptom while the cause of it carries on unnoticed. That is a gap in the process rather than a problem with the medication.
None of this is an argument against convenience. It is an argument for making sure at least one thorough assessment happens somewhere in the process, whether that is with your GP, a telehealth doctor who does the job properly, or a urologist. Convenience and thoroughness are not opposites, but they are not the same thing either, and only one of them finds a cardiovascular problem.
When a specialist is the right call
Book an assessment with a urologist if any of the following apply:
- Tablets have been tried properly and failed. Around one in three men do not get an adequate response from PDE5 inhibitors, and there are established second-line options.
- ED followed prostate, bladder, bowel or pelvic surgery. Nerve injury needs a different approach to standard prescribing.
- You have diabetes or known heart disease. Both change what is likely to work and what needs monitoring.
- The onset was sudden. A sudden change warrants investigation rather than a script.
- There is penile curvature, pain or a palpable lump. These may indicate Peyronie’s disease, which has its own treatment pathway.
- You are under 40. ED in younger men is less common and more likely to signal something worth finding.
- A procedure is on the table. Injection therapy, shockwave therapy and implant surgery all require specialist assessment first.
- The problem is causing real distress. Relationship strain and low mood are legitimate reasons to escalate, not soft ones.
When you probably don’t need a specialist yet
Plenty of men do not need a urologist, at least not yet, and it is worth saying so.
Occasional difficulty that lines up with a rough fortnight at work, a heavy weekend or a stretch of poor sleep is a common pattern, and it often settles on its own. A first episode in an otherwise healthy man with no warning signs belongs with your GP. And if you were given tablets but never really trialled them at an adequate dose, the next conversation is about dosing rather than a referral.
The men who do badly are generally not the ones who started with a GP. They are the ones who never went back after the first attempt did not work.
What a specialist consultation involves in practice
A urology consultation for erectile dysfunction is less confronting than most men expect, and it follows a predictable shape.
It starts with history: when the change began, whether it came on gradually or suddenly, whether morning erections still occur, every medication you take including anything bought online, and what has already been tried. Examination follows, covering the genitals, a check for penile curvature or plaque, and blood pressure.
Blood tests usually include morning testosterone, fasting glucose or HbA1c, and lipids. Imaging is not needed for everyone, though a penile duplex Doppler ultrasound may be arranged where a vascular cause is suspected or where surgery is being considered. From there, a treatment plan is matched to what the assessment actually found.
Dr Katelaris consults at three locations across Sydney and the North Shore: Hornsby, Castle Hill and St Leonards. Our guide to preparing for an appointment is worth reading beforehand, and the broader erectile dysfunction page covers causes and treatments in full.
Why choose Dr Katelaris as your erectile dysfunction specialist in Sydney & North Shore
Dr Phillip Katelaris has practised as a specialist urologist and urological surgeon for more than 35 years. He holds Fellowship of the Royal Australasian College of Surgeons (FRACS), is a member of the Urological Society of Australia and New Zealand (USANZ), completed postgraduate surgical training in Germany and robotic surgery training in the United States, and performs procedures at Sydney Adventist Hospital.
His work in erectile dysfunction spans the full range of options, from medical management and dose optimisation through injection therapy and linear shockwave therapy to penile prosthetic surgery. He has performed penile prosthetic surgery in Sydney for many years, and performed the first vasectomy reversal in Australia using the ROBOTICSCOPE platform.
What tends to matter more to patients is the order things happen in. Assessment comes before prescribing, treatment is matched to the cause that assessment identifies, and options are explained properly with time set aside for questions. Written informed financial consent is provided before any procedure, so costs are confirmed in advance rather than discovered afterwards.
Consultations are held at:
- Hornsby: Level 1, 51 Palmerton Road, Hornsby NSW 2077
- Castle Hill: 60 Cecil Avenue, Castle Hill NSW 2077
- St Leonards: Level 3, Suite 11, North Shore Private Hospital, Westbourne Street, St Leonards NSW 2065
You can confirm Dr Katelaris’s registration and credentials on any of these independent profiles:
Further background is on the about Dr Phillip Katelaris page, and our post on choosing the right urological surgeon covers what to look for generally.
Frequently asked questions
Is erectile dysfunction treated by a urologist?
Yes. A urologist is the specialist most commonly responsible for diagnosing and treating erectile dysfunction, because ED involves the male reproductive and urinary systems. Urologists can also perform procedures such as injection therapy, linear shockwave therapy and penile implant surgery, which other pathways cannot offer.
Who is the best doctor to see for erectile dysfunction?
Start with your GP, who can assess you, arrange blood tests and prescribe first-line treatment. See a urologist if tablets have not worked, if you have diabetes or heart disease, if ED followed pelvic surgery, or if a procedure is being considered.
Are online erectile dysfunction services safe?
Reputable Australian telehealth services use AHPRA-registered doctors and are legal and legitimate. The limitation is that a remote consultation cannot include a physical examination, so underlying causes such as cardiovascular disease or low testosterone may go undetected if no assessment is arranged. The Medical Board of Australia does not support prescribing based on an online questionnaire alone.
Do I need a referral to see an erectile dysfunction specialist in Sydney?
Yes, you need a referral from your GP to claim a Medicare rebate on a specialist consultation. Your GP can arrange initial blood tests at the same time, which makes the specialist appointment more productive. A standard GP referral runs for 12 months from your first specialist visit.
How much does it cost to see an ED specialist in Sydney?
With a valid GP referral, a Medicare rebate applies to the specialist consultation fee, and the out-of-pocket gap left over differs from practice to practice. Katelaris Urology provides written informed financial consent before any procedure, so you know the cost before going ahead.
Book a consultation
If you have been quietly working through this decision for a while, the useful next step is an assessment rather than another script. Contact Katelaris Urology on (02) 9477 7904 to arrange a consultation at Hornsby, Castle Hill or St Leonards.
Further reading
- Is a Urologist the Right Doctor for Erectile Dysfunction (ED)?
- What Does an Erectile Dysfunction Specialist Do? A Patient’s Guide
- Erectile Dysfunction: Symptoms, Causes and Treatment
- How to Choose the Right Urological Surgeon
Medical references
- Medical Board of Australia. Guidelines: Telehealth consultations with patients
- Ahpra. Updated telehealth guidance, October 2025
- Services Australia. Referrals for specialist treatment
- Healthdirect Australia. Erectile dysfunction
- Healthy Male (Australian Government funded). Erectile dysfunction: causes, diagnosis and treatment
- Cleveland Clinic. Erectile dysfunction: causes, diagnosis and treatment
Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. This article is general information and is not a substitute for individual medical advice.
Dr Phillip Katelaris MED0001030858
