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Viagra, Cialis, Levitra & Co - When Willy Does not Work

▶ General Information

Please Note:  I do not recommend self-diagnosis or treatment.  What's here presented is strictly for general information purposes only.  Sometimes a little knowlege can be deadly.  Don't rely on the internet.  See a real-life doctor.

▶ Overview
Erection is a dance between the nervous, endocrine and vascular system.  The easiest way to remember the nervous involvement is "Point (parasympathetic) and Shoot (sympathetic)". Erectile dysfunction (ED) is the inability to obtain or maintain an erection during sex. You can break it down into two categories:  Organic (75% of cases) or Psychogenic (25% of cases). Guys with organic problems do not get or have abnormal nocturnal or early morning erections.  The do not have a rigid erection under any circumstances. On the other hand,  those with psychogenic etiology have normal nocturnal and early morning erection.  Their erection difficulty is confined to sex.

▶ Testing
The way to verify the diagnosis is with a little blood pressure cuff around your penis and measuring what's called the Penile/Brachial index.  It's a measurement comparing the two BP.  If your ratio is less than 0.6 you most likely have an organic problem.  This is covered under many insurances as part of ED workup. I'm going to focus on organic causes because they're in the majority and most of the articles on ED seem to focus on the psychogenic causes.

▶ Organic Causes
There are four major causes of Organic ED.All of these are diagnosed by blood tests.  In addition to testosterone other tests (depending on history, age, etc) may include;  prolactin, FSH/LH (*follicular stimulating hormone,  leutenizing hormone) and thyroid.

  • Hypogonadism: There are many different causes, but in the aging male the most common is low testosterone.  Normal testosterone levels are 300-1200 so you can see there's quite a range.  If you have ED accompanied by gynecomastia (male breast enlargement). Hormonal causes (like hyperprolactinemia) can also manifest as decreased libido and infertility. (hormonal based problem) 
  • Vascular. This includes atherosclerosis (fat in the arteries), smoking, hypertension and diabetes.  If you have any of these underlying conditions contributing to ED; this is one reason to treat them.
  • Neurogenic. Number one cause is diabetes although anything that has a widespread effect on the nervous system can affect erections.  The other one for our group is vitamin deficiency due to alcoholism!  Malnutrition, malabsorption can lead to autonomic nervous dysfunction affecting a lot of things (balance, fine motor) and erections.
  • Drugs.  There are a lot of common drugs that can cause ED. I can't tell you how many times someone has been on one of these common medications and presents with ED.  There are alternatives to these medications so talk to your doc about a change (if you don't satisfy any of the above causes).
  • Beta Blockers - widely prescribed for high blood pressure (hypertension) and heart disease.  These include (but not all)  Atenolol, metoprolol and propranolol.
  • Anti-Depressants -  Many can cause dysfunction on a continuum of sexual delay (sometimes beneficial in premature ejaculation) to impotence.  Buproprion (in the 'atypical depressant' class) has the least reported sexual dysfunction side effects (although I've seen cause mania on a few occasions, personally I don't like antidepressants in general).
  • Anabolic steroids - much has been written about this.  
  • Alcohol can cause temporary impotence but more importantly chronic alcohol use can lead to a relative increase in estrogen.  Tobacco is worth a mention again.
  • Opiod class medication (vicodin, oxycodone, etc).

I can't stress enough how quitting smoking, exercising, controlling your blood pressure and controlling other causes can help ED.  Drugs like Viagra can band-aid the problem but there's so many health benefits besides being able to get hard it's worth looking at. Remember - ED should be correctly diagnosed before treating!

  • Treating the underlying cause!  Once again, many causes of organic ED have an underlying cause that should be treated in conjunction with any short term (Viagra-type) therapy.
  • Testosterone patch or intramuscular injection for deficiency.
  • Phosphodiesterase-5 inhibitors:  These drugs include viagra (Slidenafil), Levitra (Vardenfil) and Cialis (Tadalafil).  They decrease breakdown of PD-5 which contributes to arterial dilation.

▶ Psychologic
Psychologic causes including premature ejaculation respond well to behavioral therapy.  Depression can lead to ED and if you loss of sexual desire is the primary symptoms you might look at this.


▶ Buying Viagra, Ciallis and Levitra within Thailand

Viagra, Cialis, Levitra and other generic products such as Kamagra Gel, Apcalis etc.. are available at any pharmacy in Bangkok and Pattaya (don't buy any fake products on street markets please) Original products have a hologram on the package are available at licenses pharmacies and the average price is as follows: Viagra - 4 Tablets THB 1000.00 | Levitra 4 x 20gr Tablets THB 2000.00 | Cialis - 4 Tablets THB 800.00 | Kamagra Gel THB 200.00

Sunday, February 28, 2021