What Erectile Dysfunction Pill is right for you?

Having trouble getting and maintaining an erection? The most popular treatment for erectile dysfunction are medications like Viagra, Cialis and Levitra. These medications are formally called phosphodiesterase type 5 inhibitors or PDE5’s for short. With several options on the market, men often ask what’s the difference and which will give them more bang for the buck?  Instead of making a selection based on the most repetitive commercial, let’s dive into which option is the right choice for you! 

What is sildenafil (Viagra)?

Also known as the “little blue pill,” sildenafil is the chemical name and active ingredient in Viagra. The FDA approved Viagra in March of 1998 for treatment of ED and has since been used in over 20 million men annually. 

How long does sildenafil take to work?

The amount of time required for sildenafil to start working can depend on several factors, from the specific response you have to the drug, to the amount of food eaten. Fat in a meal can delay the effects of Sildenafil and also decrease the amount absorbed (unless you are taking the rapid dissolve chewable which we will get to soon).

Sildenafil is a short acting medication with a rapid onset. It should be taken 20-30 minutes before sexual activity, and it reaches peak blood levels in 60 minutes on average. 

How long does sildenafil last? 

Sildenafil packs a punch in a short amount of time with a 4-6-hour half-life. The half-life determines how long the body will take to process the medication and be gone from the body in healthy individuals. The time it takes to eliminate may be prolonged in older people and people with liver or kidney disease. 

What is Vardenafil (Levitra)?

Vardenafil works, similar to sildenafil with a quick onset and short half-life. In August of 2003, Levitra became the second FDA approved medication for ED. Although similar to Viagra, neither medication is better than the other. What works best for you might not work best for your buddy. The best drug should be based on medical history and overall health. 

How long does vardenafil take to work?

Vardenafil is a short acting drug with a typical onset between 15-30 minutes and peak levels after 60 minutes. Clinical trials showed side to side, Levitra kicked in about 4 minutes faster than Viagra. Although that may seem insignificant…4 minutes is 4 minutes!  Several studies also showed that Levitra can be taken with food or drink. 

How long does vardenfil last?

Vardenafil has a half-life of 4-6 hours. 

What is tadalafil (Cialis)?

Tadalafil is often times referred to as the “weekend warrior,” as it has a much longer half-life than its counter parts Viagra and Levitra. If you prefer to be more spontaneous and less preplanned with your sex life, Cialis can be a great option. Cialis is FDA approved for ED and Benign Prostatic Hyperplasia (BPH).

How long does tadalafil take to work?

Tadalafil should be taken 30-60 minutes before sex. Cialis is also FDA approved for a 5mg daily use, creating a steady amount of the medication in the blood and eliminates the need to plan for sex. Daily Cialis can become part of your daily routine. The low dose daily has also been found to decrease symptoms of waking up frequently to urinate, straining to urinate, or frequency and urgency of urination.  Also, a plethora of biohackers consider a daily Cialis one of the best anti-aging medications on the market.

How long does tadalafil last?

Tadalafil has a 36-hour half-life or duration of action, compared to Levitra and Viagra at 4-6 hours. Many men find the longer duration more appealing because there is less pre-planning and can have multiple erections within the timeframe. 

Oral or Dissolve?

Most commercially available PDE5’s come in an encapsulated pill or tablet form with an outside film coating. This film acts as a barrier of absorption so the medication can be broken down in the digestive track. Once the body breaks down the coating and medication, less of the ingredients are active in the blood stream. 

Rapid dissolve tablets are now compounded for better results and avoiding the hassle of taking on an empty stomach. Let’s be honest, when are you not eating or drinking when sex is involved? Absorption across the mucus membrane in the mouth bypasses the gut and sends the medication directly into circulation. More of the drug in circulation equals an improved response and more rapid onset. A study published in 2003 found patients preferred the dissolvable PD5’s because of the higher bio-availability, discrete intake, inability to swallow a pill and faster response times. 

Research shows PDE5’s are a great first line treatment for erectile dysfunction and effective in about 80% of men. However, not all men have the desired response with oral medications. Other erectile dysfunction treatments include shockwave therapy, trimix, and platelet rich plasma. To discuss which PDE5 is right for you or other treatment options call 618-632-9000 (O’Fallon, Illinois) or 314-833-9000 (Town and Country, Missouri) to speak with a medical professional.  

There’s no arguing that a healthy diet is beneficial for your overall health. While it’s true you are more likely to experience ED with age, it is not age itself that is the culprit. When it comes to erections it’s all about the blood flow. Diseases and conditions like high blood pressure, type 2 diabetes and heart disease can wreak havoc on your vascular system directly effecting the quality of your erections. What you eat can directly prevent common health conditions and keep your BFF down there happy and healthy.

The star of the show: Nitric Oxide

If you missed our post on this miracle molecule, be sure to read up! Nitric Oxide (NO) is a critical molecule for the health of your penis. NO dilates blood vessels which in turn can increase blood flow to the penis. The key to getting and maintaining erections revolves around continuous activation of NO. Our bodies make NO on their own, but as we age, natural production decreases. In short, if there’s no NO, you lose your “pump.”  There are a few ways to get your NO levels up (supplementation, exercise, etc.) and in this post we’ll be focusing on the dietary approach. Why? Because whole foods will provide more nitrates than your body can naturally produce on its own. 

Eat your phytonutrients!!

Phytonutrients are chemical compounds produced by plants and have been researched in relation to NO. Flavonoids, a category of phytonutrients, can increase production of NO or keep NO from being destroyed in addition to:

• Improving blood vessel health
• Protecting blood vessels from damage due to consuming high-fat meals
• Preventing toxic cell-damaging chemicals from forming
• Lowering blood pressure in people with high blood pressure (high blood pressure directly effects the penis muscle necessary to stretch out and expand with blood)

5 Colors of Phytonutrients

Color	Benefits	Sources
Red	Supports prostate, urinary tract and DNA health. Protects against cancer and heart disease.	Pomegranate, cherry, tomato, raspberry, beets
Purple	Good for heart, brain, bone, arteries, and cognitive health. Fights cancer and supports healthy aging.	Plum, blackberry, grapes, blueberry
Green	Supports eye health, arterial function, lung health, liver function and cell health. Helps wound healing and gum health.	Lettuce, broccoli, avocado, celery, brussels sprouts
White	Supports healthy bones, circulatory systems, and arterial function. Fights heart disease and cancer.	Mushroom, cauliflower, garlic
Yellow	Good for eye health, healthy immune function and healthy growth and development.	Carrot, sweet potato, lemon, papaya

Wondering which foods are best for obtaining the above? While it’s near impossible to pinpoint exactly which foods are benefitting you alone or in combination, it’s safe to say that the best approach is to eat as wide a variety of vegetables as possible. A good rule of thumb is aiming to make your plate extra colorful to obtain a diverse array of phytonutrients. Eat the rainbow! The best known sources for nitrates are vegetables such as beets, lettuce, arugula and spinach, but there are many others that are great sources. 

Chew s-l-o-w-l-y

Most of us are shoveling down our meals and snacks subconsciously without any thought to it. But did you know that not taking the time to chew your food at a reasonable pace is doing you a disservice? Not only will this help with signaling fullness, it also enhances salivary flow. Saliva contains a high concentration of nitrate, which is then broken down into nitrite and eventually gets broken down in our gut into NO! In short, the food we eat interacts with our saliva to produce NO but not taking the time to chew your food and activate via your saliva, you could be missing out on some of the interaction.

Stay away…..

On the contrary to consuming food for penis health benefit, choosing to eat foods that do harm is directly detrimental. Processed carbohydrates (AKA sugar) are bad. No way around it! Too much sugar leads to your body storing it as extra fat, which causes inflammation and in turn, releases toxins that also interfere with your NO production! Over time:

Prediabetes -> diabetes -> high blood pressure, clogged arteries, heart disease and/or stroke

And you guessed it, somewhere in the decline in metabolic, your erections are guaranteed to be affected negatively.  Most of us aren’t consuming sugar cubes every hour, so how is it possible for people to identify what they’re eating as dangerous if sugar hides in other forms? Most breads, rolls, pastas, baked goods, cereals and breakfast bars are made of white flour and our bodies turn those processed carbs into sugar, so it is best to avoid foods containing processed ingredients. Of course, the more obvious foods to steer clear of are sweetened foods and drinks like sodas, coffee, ice cream and other desserts. If it comes in a box, bag or package, read your labels; food companies are SNEAKY! Sugar has many alias’ dextrose, corn syrup, maltose, malt syrup, and fruit nectar to name a few. Stick to the outside edges of the grocery store where produce sits – they don’t have food labels for a reason! Rule of thumb, the less ingredients and closest to it’s natural form, the better. Stick to your plant-based foods as much as possible: vegetables, fruits, nuts, legumes and grains.

“The produce section is like nature’s pharmacy.” -Aaron Spitz, M.D

Getting down to brass tacks, it’s unrealistic for humans to abide by these suggestions all the time. Rather than being discouraged from eating processed foods we as humans enjoy, minimizing the frequency or quantity is an excellent start. Research shows that adding more plant-based is not only a good offense for your body, but it actually plays defense for you when you decide to eat something that is not directly healthy for your penis. This protective effect leads to less toxins released into your blood vessels and tissues. So even if you don’t change a thing about what you’re eating and start adding in plant-based food to your current diet, you’re getting benefits! The end goal from this approach would be to eventually cut out processed foods and only indulge occasionally. Luckily for those with a sweet tooth, dark chocolate is a flavonoid-rich food – woot woot!

In conclusion, your best bet to beat ED from a dietary standpoint is to consume a healthy diet that is good for your heart and blood circulation. If you take care of your vascular health, you’re more likely to maintain sexual performance by avoiding common chances of developing ED.

*mic drop*

References

Spitz, Aaron, MD. “Put it in your mouth: How grub affects your nub.” The Penis Book, 159-171.

https://moreforce.com/food-for-erectile-dysfunction/#the-best-food-for-erectile-dysfunction

Every year, 2 million men visit their doctors for complaints of benign prostatic hyperplasia (BPH) AKA, an enlarged prostate. Trouble urinating, frequent trips to the restroom, waking up in the middle of the night to urinate, lower urinary tract symptoms will all without a doubt, impact a man’s day to day routine and overall quality of life. If you are experiencing symptoms, you are NOT alone! Approximately 40-50% of men aged 51 to 60 and 90% in men older than 80 years old are affected. 

So what is a prostate, anyway? The prostate is a small, male reproductive organ about the size of a walnut located in front of the rectum and behind the bladder. If you’re a male reading this sitting down, you’re sitting on your prostate right now. The primary function supports sperm in ejaculate fluid that’s necessary for sperm to find an egg for reproduction. Unlike most other organs in the body, the prostate actually continues to grow throughout life and for some men will cause health issues.

Due to its location, enlargement puts physical pressure on its surrounding neighbor organ, the bladder. This pressure results in constriction of the urethra causing urination issues such as a weaker stream, longer time to fully empty and frequent urination. It can even cause changes to the bladder itself causing the bladder to change in shape, which could be detrimental. Prostate enlargement causes the muscle surrounding the bladder to work harder and scar tissue can begin to develop. Eventually, if it is left unchecked for too long, you can end up with a bladder that doesn’t contract very well and would need to be corrected surgically. 

Prevention is tricky as there aren’t many options to avoid BPH for some men. Age itself is the main risk factor. Additionally, family history increases risk. Men in the obese population who lose weight have shown improvement in lower urinary tract symptoms, which suggests body composition may be relative in prevention. As always recommended, effort to maintain a healthy, active lifestyle is important!

Thousands of prescriptions are written yearly to address BPH that have a fair amount of side effects and only shown to be about 40% effective in the long-term management of the problem! Around 400,000 prostate surgeries are performed annually with an estimate of $2 billion annually in medical treatments for BPH. 

Living a healthy lifestyle can help manage symptoms along with a supplement to work on all facets of this condition. Supplements that can help with symptom management include researched ingredients:

Flowens – Cranberry fruit has been clinically proven to improve lower urinary tract symptoms

Saw Palmetto Extract – inhibits 5-alpha reductase (the enzyme that reduces testosterone to DHT), relieves swelling of the prostate gland and helps maintain healthy fluid balance in prostate tissues. Improves hair loss and growth by blocking DHT.

Beta-Sitosterol – A plant fat that alleviates prostate discomfort, urinary flow improvement and decreased residual urine in the bladder.

Pygeum Extract – African cherry tree that contains phytosterols, which exhibit anti-inflammatory action in the prostate. 

Zinc – Supports immune health and inhibits aromatase-based conversion of testosterone into estrogen. High levels of zinc in the prostate gland have been shown to be an essential factor in preventing the initiation of cancer in prostate cells.

If you are experiencing any symptoms discussed in this post and want to trial a supplement containing all ingredients in one formula, contact 618-632-9000 (O’Fallon, Illinois clinic) or 314-833-9000 (Town and Country, Missouri clinic). 

References

Pohlman, Garrett, M.D. (Host) & Brantley Thrasher, J, M.D. (2021, August 26). So What is a Prostate Anyway? (No. 76) In The Prostate Health Podcast. 

Pohlman, Garrett, M.D. (Host) & Terlecki, Ryan M.D. (2020, December 2020). Benign Enlargement of the Prostate (BPH): How Can a Little Gland Cause So Much Trouble (No. 41) In The Prostate Health Podcast.