The hidden reason why those little blue pills don’t work for more than half the men that take them

Written by: Centre for Men’s Health

For many men having difficulties in getting or maintaining an erection (also known as erectile dysfunction or ED), a problem facing up to 40% of men over 40, the first solution they try is to take Viagra, Cialis, Levitra or their generic versions. These are part of a group of drugs known as PDE5 (Phosphodiesterase type 5) inhibitors and their function is to improve blood flow to the penis.

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But according to some researchers, between 20-40% of men suffering from ED also have low free testosterone – the testosterone that isn’t bound and made ineffective by a protein in the blood called sex hormone binding globulin. Research shows that testosterone levels can affect wider aspects of sexual function like sexual desire or libido.

To quote the late founder of the Centre for Men’s Health, Professor Malcolm Carruthers: “Everybody thinks that Viagra is the panacea for all sexual problems. It’s not. If low testosterone is the problem, then Viagra, as well as Levitra or Cialis which are similar treatments, won’t be the answer.”

“Viagra, Levitra and Cialis will only work if there are sufficient levels of testosterone, so many of the men buying these treatments will be left disappointed and out of pocket if they don’t solve this underlying problem.”

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He added, “Although levels of testosterone in men start to decline with age, some are affected much earlier than others. It can also be a symptom of an underlying health condition such as diabetes and heart disease, so it is crucial that it is properly diagnosed. Yet research at the Centre for Men’s Health conducted with 10,000 men over the age of 50 shows that only 1 per cent of men living with testosterone deficiency have been diagnosed and are on the appropriate medication. Studies show that many GPs have little knowledge of testosterone deficiency. I know from the thousands of patients we’ve seen at our clinics in London’s Harley Street and in Manchester that erectile dysfunction, together with loss of sex drive, are common and distressing features of testosterone deficiency, as well as circulatory and stress-related disorders.”

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The typical symptoms of low T/ testosterone deficiency include tiredness, depression, mood swings, weight gain, night sweats, and insomnia, as well as low sex drive and erectile dysfunction.

Dr Carruthers concluded, “Our research has shown that in around two thirds of cases, treating the underlying hormonal deficiency can restore both libido and potency. In the remaining third, our studies have shown that combining testosterone replacement therapy (TRT) with erection enhancers, such as Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil) brings our success rate with erectile dysfunction to over 95 per cent. For those few patients where erectile function is not fully restored by testosterone replacement in combination with erection enhancers, the Centre for Men’s Health can provide other erection inducing treatments.”

References:

Linghui Deng, Qiu Shi, The Lancet Health Longevity, Volume 4, Isse 10, E524-E525, October 2023. Testosterone Treatment: Who Will Benefit The Most? https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00191-5/fulltext

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Trinick T.R.,Feneley M.R. Welford H, Carruthers M. The Aging Male 2010 1-6 *International web survey shows high prevalence of symptomatic testosterone deficiency in men. A 10,000 Department of Chemical Pathology The Ulster Hospital Belfast, Institute of Urology & Nephrology University College Hospital London, Centre for Mens Health, July 2010 Informa healthcare

Viagra Won’t Work For You, Low Testosterone Men Warned, BBC, September 2010 https://www.bbc.co.uk/news/health-11404927

Jacob Rajfer, MD, Reviews in Urology, 2000 Spring; 2(2): 122-128, Relationship Between Testosterone and Erectile Dysfunction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476110

European Association of Urology Guidelines, 2023

https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2023.pdf

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