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In placebo group, 13 (27.66%) patients were affected by mild, 29 (61.7%) by mild–moderate and 5 (10.64%) by moderate ED, assessed by IIEF-6 questionnaire; moreover, 35 (74.47%) patients were affected by mild–moderate and 12 (25.53%) by severe vasculogenic ED, assessed at dynamic PDU (Fig. 1). No significant difference was found regarding serum total testosterone and prolactin levels, which were within the normal range in the totality of the patients. At baseline, in patients in l-ARG or placebo group, no significant difference was found regarding clinical and biochemical parameters. Moreover, patients are usually embarrassed about their erectile problems, and even in the cases where they would like to consult treating physicians about their sexual health, medical professionals are not willing to address this health problem . 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