In their extensive review, Bassil and coworkers summarise the benefits and risks, with benefits such as improvement of sexual function, bone density, muscle strength, cognition and overall improvement in quality of life. Among the risks that have been suggested include erythrocytosis, liver toxicity, worsening of sleep apnoea and cardiac function, possibly increasing symptoms of benign prostatic hyperplasia (BPH). They also note that although a possibility of stimulation of prostate cancer has been hypothesised, no scientific or clinical evidence exists to this possible risk.38
Older men (aged ≥65 years) have higher plasma concentrations of sildenafil compared with younger men (18–45 years), with mean maximum concentration (Cmax) 70% greater in older men and mean area under the curve (AUC) 84% higher compared with the younger age group. Due to age-differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40%. However, no differences in the safety of any dose of sildenafil were observed in older patients compared with younger men. Therefore, dosage adjustments are not required in elderly patients (Seftel 2003). Sildenafil significantly improves erectile function in elderly patients with erectile dysfunction of broad etiology although efficacy rates may be lower compared with younger men due to the normal aging process and age related risk factor accumulation mentioned before (Rendell et al 1999; Wagner et al 2001; Carson et al 2002).
You may be wondering why alprostadil can’t just be applied directly to the penis as a topical agent instead of directly injecting/inserting it. A study conducted in 2006 in 1732 patients using a topical formulation did demonstrate some efficacy (though less than Caverject or Muse). Common side effects were burning sensation (for both men and women) though this was relatively low, with only 2.7% of subjects stopping its use. Currently, drug manufacturer Apricus Biosciences is looking to bring this formulation, named Vitaros, to market in the US (it is available in Europe at this time) but progress with regulatory approval has been slow. When and if this formulation makes it to the US market, it may be preferred by men who cannot take PDE-5 inhibitors.
As we mentioned before, there are a lot of treatment options that you could use to treat a condition as erectile dysfunction. A lot of the men diagnosed with erectile dysfunction decide to try some of the natural remedies before they refer to some of the top men enhancement pills. Exercise is one of the most commonly recommended ways as a natural remedy for erectile dysfunction. We all know that exercising has a lot of different beneficial effects on our bodies so why not use it as a part of the treatment for this condition? 
Erectile dysfunction is the inability for men to initiate and maintain an erection [1]. Multiple co-morbidities can predispose patients to get erectile dysfunction. Some of the more common chronic conditions would be diseases like hypertension, cardiovascular disease, diabetes mellitus and various stress disorders like anxiety and depression [2]. In medicine, two types of therapy are typically used to treat this erectile dysfunction. Physicians could choose to target the chronic conditions and improve therapies to reduce secondary effects. Controlling blood sugar, blood pressure or helping patients manage stress are all potential avenues to lead to symptom resolution [3]. On the other hand, patients could also choose a quick-acting solution like taking a pharmaceutical supplement to help synthesize nitric oxide (NO) [4]. This compound is imperative in dilating blood vessels to allow blood to collect in the penis to sustain erections. The most common drug on the market for this goes by the trademark Viagra [5]. Unfortunately, this drug is not for everyone, and it has the potential to interfere with many other medications that a patient may already be taking. Some alternative options come by way of natural supplements for erectile dysfunction. Some of the more successful vitamins and dietary supplements for ED we covered included horny goat weed and how it can treat erectile dysfunction or how vitamin D can treat erectile dysfunction. Nevertheless, we have also found that some compounds are untested and potentially dangerous, so it is important to avoid them at all costs. Herbal Viagra can be one of these potentially dangerous remedies for erectile dysfunction. In this article, we will focus on another supplement for erectile dysfunction that has been linked to being a potential treatment for erectile dysfunction: zinc. The question is: do zinc supplements for erectile dysfunction work?  

What to Tell Your Friend: If our friend's penis was immune to the effects of booze, drugs, performance anxiety, fatigue, or simply not being in the mood for sex, the first thing to do would be to recommend that he go into porn because that's quite a skill set. Then we'd tell him to not waste the money he and his stunt cock earn by spending it on Viagra because he doesn't need it.

Saying zinc is essential for our physiology is an understatement due to the numerous processes this element has involvement in. It is believed that zinc plays a crucial role in the activation of over 300 enzymes in the human body and unfortunately, deficiencies in this element are quite common [6]. It is currently estimated that about 17.2 percent of the global population is at risk for insufficient zinc intake [7]. When zinc is deficient, patients at younger ages are more sensitive to physiological alterations. Young patients still in puberty can expect to see slower growth in gonadal organs (sex organs) and have stunned growth, which can reduce sex hormones overall and predispose patients to sexual dysfunction. As adults, there seems to be a link between low zinc levels and sexual dysfunction. Zinc is also essential in our immune system and any deficiency essentially shuts off half of our only protection against pathogens. These patients will contract sicknesses easily and have some chronic conditions that could also cause erectile dysfunction. [8] Thankfully, most staple foods in the Western diet have naturally high levels of zinc. Some of the most robust foods include low-fat beef, ground beef, dark meat in poultry, egg yolks and some types of cheeses [9]. 
Physical and emotional stress — whether over-exercising, under-sleeping or just dealing with everyday stressors like work and a busy schedule — causes an increase in “stress hormones,” including cortisol and adrenaline. Stress can lower desire for sex. This is because stress can contribute to fatigue or preoccupation with other tasks. It can also significantly affect blood flow by increasing inflammation.
Intracavernosal injections remain an excellent treatment option with proven efficacy and safety over time. Baniel and colleagues (2001) treated sildenafil non-responders after radical prostatectomy with intracavernosal injections of vasoactive drugs with 85% success rate. Shabsigh and colleagues (2000) were able to salvage sildenafil non responders with intracavernosal injections of alprostadil. More than 85% improvement in Q3 and Q4 of the IIEF was recorded (Shabsigh et al 2000). The tri-mix combination (papaverine, phentolamine, alprostadil) is certainly the more efficacious drug treatment for erectile dysfunction and can be used in severe cases of erectile dysfunction when intravernous alprostadil fails or it is not preferable due to side effects.
Wistar rats (From Medical Research Institute, Colombo) were obtained and kept in a well ventilated animal house under natural dark light cycle (temperature 28-30°C, humidity; 50-55%). Animals were housed in groups (four per group) until they reached sexual maturity (150-200 g). They were provided with pelleted food and water. Male rats were permitted access to receptive females on three separate occasions and then screened for sexual proficiency. Male rats who displayed consistently vigorous sexual activity were selected for the study.
Although the term ‘treatment failure’ to oral drugs is widely used, there is no precise definition of what exactly means. Treatment failure may be due to medication, clinician and patient issues (Table ​(Table3).3). Based on these issues a definition of a non-responder to oral pharmacotherapy is proposed: “an inadequate erectile response after at least 4 attempts of the highest tolerated drug dose in accordance with manufacturer’s guidelines with respect to timing relative to meals, alcohol ingestion, use of concomitant medications, and adequate sexual stimulation/arousal” (Carson et al 2004).
So what’s the problem? Well, if you really listen to the advertisements on television for erectile dysfunction (ED) medications, ignoring the blue tinted jazz from Viagra or the bathtubs in the sunset from Cialis, you may have heard the line “Do not take if you take nitrates for chest pain, as it may cause an unsafe drop in blood pressure.” You see Viagra, Cialis, and Levitra belong to the same drug class called Phosphodiesterase 5 Inhibitors (abbreviated as PDE-5 inhibitors), and they all share the same interaction with nitrates. Many patients wonder how bad can a ‘drop in blood pressure’ be. The answer, as we learned after Viagra came out, is this reaction could lead to heart attack in patients and potentially cause death, leading to a black box warning for the whole class of drugs like Viagra.

Samadi, who was not involved in the research, warned that a prescription is not as good as a fundamental lifestyle change. "Long-term, medication is not the answer unless you take care of the high blood pressure or high cholesterol or diabetes," he said. "Medication works well for those who cannot make the necessary changes, but drugs should not be the first line of treatment."
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