Clinical Research Directory

Inclusion Criteria: Men aged 30-65 years. Erectile dysfunction present for at least six months. International Index of Erectile Function-5 score of 21 or less. Metabolic syndrome diagnosed according to the International Diabetes Federation criteria. Sexually active participants in a stable sexual relationship. Willingness and ability to participate in the six-month lifestyle-modification program. Ability to provide written informed consent. Exclusion Criteria: Erectile dysfunction primarily attributable to neurogenic, psychogenic, hormonal, or postsurgical causes. Severe hypogonadism requiring immediate testosterone-replacement therapy. Use of phosphodiesterase type 5 inhibitors, intracavernosal injections, vacuum erection devices, or other erectile-dysfunction treatment that cannot be discontinued before baseline assessment. Significant penile anatomical abnormality that may interfere with penile duplex Doppler assessment, including Peyronie disease. Previous pelvic surgery or pelvic radiotherapy likely to affect erectile function. Severe or unstable cardiovascular disease that precludes sexual activity or participation in exercise-based lifestyle modification. Uncontrolled diabetes mellitus, defined in the protocol as HbA1c greater than 10%. Uncontrolled hypertension despite medical therapy. Severe renal or hepatic impairment. Active malignancy or life expectancy of less than one year. Major psychiatric illness, cognitive impairment, or inability to comply with study procedures or follow-up. Inability or refusal to provide written informed consent.