Before starting Cenforce (a medication containing sildenafil citrate used to treat erectile dysfunction), several tests and evaluations should be performed to ensure it is safe and effective for the individual. A comprehensive cardiovascular assessment is essential, as sildenafil can affect blood pressure and is contraindicated in individuals taking nitrates or those with serious heart conditions. A thorough medical history and physical examination should be conducted, particularly focusing on cardiovascular, liver, and kidney function. Blood tests to assess liver and kidney health, blood pressure monitoring, and possibly an electrocardiogram (ECG) are advised. Hormonal tests, especially testosterone levels, may also be indicated to determine underlying causes of erectile dysfunction.