Brandywine Family Medicine

Erectile Dysfunction

Published 06.11.2021

About 20% of men at 50 and 40% of men by 70 have erectile dysfunction. You are at increased risk if you have a history of diabetes, cardiovascular disease, depression, sleep apnea, or hypothyroidism. If you are a moderate or heavy drinker, a smoker, obese, or sedentary this also increases your risk of ED. Alcohol can decrease testosterone production causing ED. Drug use can also increase the risk of ED. Some prescription medications can also have ED as a side effect like the SSRI antidepressants. Weight loss and increased physical activity can reverse ED issues for about a third of men. Having sex at least once a week decreases your risk of ED.

Usually, we will check your thyroid, PSA, and testosterone level if you are having ED issues but it is unusual to have these be the cause of the issue.

The phosphodiesterase inhibitors, like Viagra and Cialis, are the most common medications used to treat ED. They can not be taken if you are on nitrates for chest pain because they can drop your blood pressure too low. Sildenafil (Viagra) should be taken after a lighter meal and only a small amount of alcohol to work the best. The medication should be taken about an hour before you want to have sex and the effect lasts about 4-6 hours. Tadalafil (Cialis) can be taken after a regular meal and some alcohol and the effect can last 24 hours or more. It takes about an hour to start working.

The cost of these drugs used to be obscene but now that they are generic the prices have come down tremendously. Some insurances will cover for these meds but usually with quantity limits per month. Check to see with your insurance what drugs are covered and if there is a quantity limit. Some insurances will only cover these medications if you have had prostate cancer surgery. If you download the GoodRx app on your phone you can search for local pharmacies that offer a significant discount on these meds. You can usually get them for about a dollar a pill now at certain pharmacies.

Most of the products advertised online that you can buy to help with ED issues have either prescription meds or other synthetic phosphodiesterase inhibitors in them. These are not licensed meds and may be made in some shady places. Most are worthless.

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