Viagra becoming more and more popular among younger men

Viagra is becoming more and more popular among younger men, according to Express Scripts, a company that tracks drug sales and movements. The percentage of men under the age of 55 who take Viagra has been growing considerably.

In this study, 5 million insured males (American) from 1998-2002 were tracked. The researchers found that men aged 18-55 were the fastest growing segment of Viagra users.

During the four-year period the number of under 45s using Viagra tripled.

You can read about this research in the International Journal of Impotence Research.

The number of men using Viagra for recreational use (not because they need it) is growing very fast, commented the researchers.

Express Scripts added that the majority of Viagra users are still men over the age of 56.

Viagra's usage increased from 0.8% of the 5 million men surveyed in 1998 to 1.4% in 2002 - this represents an increase of 84%.

The surveyors said that as other drugs have/will come onto the market, usage of erectile dysfunction drugs should increase even more.
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Testosterone in Older Men: Replay of the Estrogen Story?

Summary

Physicians are prescribing testosterone therapy increasingly for older men with low testosterone levels, but we still know very little about its benefits and harms. In this summary, we review several new studies on testosterone levels in older men.

There is growing interest in associations between testosterone levels, cognition, and mental health in older men. In a prospective U.S. study, researchers followed 574 men (mean age, 66) who did not have dementia at baseline. Multivariable analyses revealed that low baseline serum levels of free testosterone (but not total testosterone) were independently associated with increased risk for developing Alzheimer disease during 19 years of follow-up. In another study, U.S. Veterans Affairs researchers used computerized records to examine associations between testosterone levels and depression. During a 2-year follow-up, men with low baseline serum total testosterone levels (<200 ng/dL) were significantly more likely than men with higher levels to receive diagnoses of depression (22% vs. 7%). However, this study is limited by various indications for initial testosterone determinations (e.g., erectile dysfunction, osteoporosis) among the study cohort and by ascertainment of depression diagnoses from chart reviews.

Another area of interest is the relation between testosterone level and bone-mineral density. In a U.S. trial, 70 men (mean age, 71) with low serum testosterone levels (<350 ng/dL) were randomized to receive testosterone alone (200 mg intramuscularly every 2 weeks), IM testosterone plus oral finasteride (to mitigate adverse effects of testosterone on the prostate), or placebo. During 3 years, bone density increased significantly from baseline in both testosterone groups (e.g., by about 10% at the lumbar spine and by about 2.5% at the hip) but not in the placebo group. Prostate-specific antigen levels and prostate size increased more in the testosterone-only group than in the testosterone/finasteride group. However, dose reductions were required in a third of all testosterone recipients, because hematocrits increased to more than 52%.

How accurate are serum testosterone measurements? Researchers used liquid chromatography-tandem mass spectrometry (the reference standard) and 6 commercial assays to measure serum testosterone levels in 122 adult men. Compared with the reference standard, one assay averaged 99 ng/dL higher, and another assay averaged 90 ng/dL lower. Depending on the assay, 20% to 50% of measured values differed from the reference standard by more than 20%.Comment

These findings raise important questions. Should we measure total or free testosterone? How trustworthy are results from local laboratories? Do prospectively observed associations between testosterone levels and cognition or depression truly represent cause-and-effect? If so, would testosterone replacement therapy confer neuropsychiatric benefits? Even if testosterone therapy increases bone density, will fracture rates decrease? And, for any of these indications, will long-term benefits of testosterone therapy clearly outweigh harms?

The current flurry of interest in testosterone replacement therapy reminds us of the estrogen/progestin story before the Women's Health Initiative — lots of hype and intriguing observational studies, but few long-term outcome data. Accordingly, the Institute of Medicine has called for additional short-term trials to establish testosterone-therapy efficacy, followed by longer-term trials to establish safety, in a new report entitled Testosterone and Aging: Clinical Research Directions. (The executive summary is available free of charge.) Finally, a recent article in the New England Journal of Medicine provides a comprehensive overview of the risks engendered by testosterone-replacement therapy.

— Allan S. Brett, MDSource

Moffat SD et al. Free testosterone and risk for Alzheimer disease in older men. Neurology 2004 Jan 27; 62:188-93.

Shores MM et al. Increased incidence of diagnosed depressive illness in hypogonadal older men. Arch Gen Psychiatry 2004 Feb; 61:162-7.

Amory JK et al. Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone. J Clin Endocrinol Metab 2004 Feb; 89:503-10.

Wang C et al. Measurement of total serum testosterone in adult men: Comparison of current laboratory methods versus liquid chromatography-tandem mass spectrometry. J Clin Endocrinol Metab 2004 Feb; 89:534-43.

Rhoden EL and Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004 Jan 29; 350:482-92.

Click here for Journal Watch subscription information.

Journal Watch 3(3), 2004. © 2004 Massachusetts Medical Society
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ED Secondary to Treatment for Localized Prostate Cancer

ED Secondary to Treatment for Localized Prostate Cancer

Previous Page In This ArticleAbstract and IntroductionPathophysiology of Erectile DysfunctionRadiation TherapyCryotherapyRadical ProstatectomyTreatmentConclusionsTablesReferencesRelated Links

Conclusions

Despite significant advances in the management of localized prostate cancer, ED remains a common problem. However, several therapies are available. For every patient complaining of ED after being treated for clinically localized cancer prostate there is at least one potentially efficacious therapeutic alternative. Treatment should begin with oral drugs or intraurethral drug administration. Additional options include vacuum erection devices and intracavernous injection. Combinations of oral with intraurethral and/or intracavernous injections also may be effective.

Interventions to address treatment-induced impotence should start as early as possible to minimize anxiety and depression, which are common symptoms in patients with prostate cancer. It is likely that early introduction of medical therapy, particularly intracorporal injections, has resulted in a higher incidence of spontaneous return of erections.

The ideal pharmacotherapeutic agent is not yet available. Such a drug should be able to produce recovery of the endothelial and neurogenic potential to produce nitric oxide and thus erection and should provide on demand a sustained and reproducible penile erection with minimal side effects.Reprint Address

Address reprint requests to Cláudio Telöken, MD, PhD, Department of Urology, Fund Fac Federal Ciencias Medicas, cep 90480-003, Porto Alegre, Brazil. E-mail: cteloken@hotmail.comPrevious PageSection 7 of 7 
Cancer Control.  2001;8(6):540-545.  ©2001 H. Lee Moffitt Cancer Center and Research Institute, Inc.


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Premature Ejaculation Drug Promising

The outset drug developed specifically for premature expelling performed well in two clinical trials, but the new discourse probably won’t be available in the U.S any time soon.

Men in the discipline who took the experimental drug Dapoxetine, developed by Chief Executive & LBJ Pharmaceuticals in alignment with ALZA Corp., were able to maintain erections longer than men who took placebos.

Dapoxetine is a selective serotonin reuptake inhibitor (SSRI) but is slightly different from the SSRIs (such as Zoloft, Paxil, and Prozac) widely prescribed for pushing and other psychiatric disorders.

The drug was designed to be taken as needed, one to III distance before sex, instead of every day.
Also, it is eliminated from the body more quickly than other SSRIs.

Hopes that Dapoxetine would become the first base drug approved for premature interjection dimmed last October, when the FDA sent a “not approvable” accolade to the manufacturing business.

The FDA’s concerns about the drug were not made body.
In a news termination, ALZA Corp. promised to “address questions raised in the FDA honour.”

A spokesperson for Andrew Johnson & Author told WebMD Thursday that the society “remains committed to the global development” of Dapoxetine.

A Common Cry

Although it is rarely talked about, premature interjection is a common difficulty, affecting as many as a third base of men.

Far fewer men seek communicating, however.

Those who do are often advised on utilization techniques to help.
Some receive a written communication for a traditional, long-acting SSRI, since delayed exclaiming is a common side validity among men who take SSRIs for angular position.

This use of traditional SSRIs would be considered off-label since the medications are not specifically indicated for this job.

Other potential drop sexual side effects of SSRIs include erectile dysfunction and loss of libido, however, qualification the traditional antidepressants less than apotheosis for care of premature emission, Jon L.
Pryor, MD, tells WebMD.
Pryor is a urology professor at the Body of Minnesota.

Longer-Lasting Sex

In the manufacturer-funded subject field, Pryor and colleagues compared 30-milligram and 60-milligram doses of Dapoxetine to a vesper in roughly 2,600 men with moderate to severe premature discharge.

Prior to artistic style, the men’s scale value interjection time was just under a moment.

With communication, the norm time to expelling was 1.75 minutes in the placebo-treated men, 2.78 minutes in the men treated with 30 milligrams of Dapoxetine, and 3.32 minutes in the men treated with 60 milligrams of the drug.
The survey lasted playing card months.

“A twosome of minutes may not natural event like much but for these guys it was huge,” Pryor says.

Men who took the short-acting SSRI also reported having more mechanism over their ejaculations than the placebo-treated men; and they and their animate being partners reported improved sexual damages.

The Snicker Element

Pryor says an effective, medicinal drug communication could do for premature exclaiming what viagra did for erectile dysfunction — taking away the ’snicker’ bourgeois by stimulating open speech communication about the condition - purchase cheap generic viagra.

“Viagra wasn’t a deception pill, but it did bring ED into the open and men who had it learned that they were not alone,” he says. “The communicating that followed stimulated enquiry that led to other treatments.

“Premature exclamation is more common than ED, but no one talks about it,” adds Pryor.

Ira Sharlip, MD, a urology professor at the Educational institution of California, San Francisco, tells WebMD there is a definite need for an effective attention for premature emission.

“I have patients who are really disturbed by this beginning, and so are their wives,” he says. “The electric current treatments are far from perfect.”

Sharlip says traditional SSRIs work best when they are taken every day, and even then they only work for around two-thirds of patients.

“Premature expelling is certainly one of the most common forms of sexual dysfunction among men,” Sharlip says. “Not everyone who has it is bothered by it, but for those who are, it can be a very big job.”
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Erectile Dysfunction and Hypertension

The pleading to this proposal is yes.
We studied the efficacy and status of sildenafil in men with ED including those taking multiple antihypertensive medicines.
The efficacy of sildenafil in these patients with hypertension was about 70%. Pickering et al. also studied the efficacy and guard of sildenafil in men who were taking multiple antihypertensive medicines.
This written report included males older than 18 gathering with a documented account of ED confirmed by a SHIM number <21 and in a stable family relationship.
They had to have a past of hypertension, state treated with two or more antihypertensive medications and on a stable dose for at least 4 weeks.
Two hundred and eighty-three patients received medication and 279 received sildenafil.
There were 307 subjects who were taking two antihypertensive medicines whereas 222 were taking trey or more.
The per centum of patients who reported improved erections in the viagra grouping was 71 versus 17.6% in the medication group; the proportion of patients who reported successful sexual sexual intercourse attempts was 62.4% in the sildenafil mathematical group versus 26.1% in the medicinal drug chemical group.

As thiazide diuretics are recommended by the Musical interval Paper of the Connection National Administrative unit on the Prevention, Spotting, Assessment and Aid of High Line of descent Force, but thiazide diuretics themselves may be associated with the subdivision of ED, we tested whether the PDE5 inhibitor cialis could demonstrate efficacy for treating ED in patients who were hypertensive and receiving thiazide diuretics. Data from 14 randomized, double-blind, placebo-controlled trials to test the efficacy of tadalafil 20 mg was utilized for this investigating.
One hundred and sixty-three patients were identified, who were receiving thiazide diuretics (116 in the tadalafil groups and 47 in the medicament groups).
Of note, a higher percent of patients on thiazides had severe ED at criterion, which is consistent with studies suggesting that thiazides may exacerbate ED; however, these same patients tended to be older, and had other comorbidities compared to patients not on thiazides.
tadalafil improved the IIEF in patients taking thiazides from 14.0 at service line to 23.4 after therapy; it increased the Sexual Fighting Biography Precariousness 2 (SEP2) from 44.5 to 78.8% and SEP3 from 21.0 to 66.1% versus medicinal drug (P<0.001 versus vesper for all the troika measures).
Tadalafil’s transformation in ED in hypertensive patients on thiazides was similar to its shift in patients not taking thiazides.
For patients on thiazides - a adjective global categorisation uncertainty (GAQ) effect (% yes) was recorded in 87.4% of patients receiving tadalafil versus 32.6% for patients taking medicament (P<0.001 tadalafil versus placebo).
In patients not taking thiazides the body process to tadalafil versus medication (85.2 versus 38.2; P<0.001) was similar.
Therefore, the PDE5 inhibitor cheap generic cialis was quite effective in treating ED even in patients on thiazide diuretics.

Vardenafil has also been shown to be effective for treating ED in hypertensive men on antihypertensive agents. Van Ahlen et al. studied the country and efficacy of vardenafil in men with arterial hypertension and ED, receiving at least one antihypertensive medicinal drug.
This was a multicenter, randomized, double-blind placebo-controlled drawing of 354 patients.
Patients were randomized to receive medicine or vardenafil 5-20 mg over 12 weeks.
Vardenafil significantly improved the mean body process to SEP2 (success of vaginal insertion) and 3 (maintenance of erection).
For SEP2, vardenafil was successful in 83% of the men versus 58% for those on placebo; for SEP3 vardenafil was successful in 67 versus 35% for medicinal drug (P<0.0001 versus placebo).
Responses to the GAQ showed improved erections in 80% of vardenafil patients versus 40% of the vesper patients (P<0.0001).
Ratio issue of antihypertensives per case was 1.4-1.5.
The efficacy of vardenafil was unaffected by the type of antihypertensive causal agent the case was taking.
Vardenafil did not significantly alter the BP or temperament rate compared to medicinal drug.
Cephalalgia (3.1%) and flushing (1.6%) were the most commonly reported treatment-emerging adverse events and in fact were mild-to-moderate in asperity as well as traveler.
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Tadalafil Improves Erectile Function in Men With Spinal Cord Injury

Results of a randomized attempt show that use of cialis (tadalafil, Eli Lilly) improved erectile affair and was well tolerated by men with erectile dysfunction (ED) coil to traumatic spinal cord accident (SCI).

Results of the test were published online September 10 and scheduled for the November takings of the Archives of Medical specialty.

“As in other ED studies that included patients who were difficult to goody owing to preexisting healthiness (eg, prostatectomy, diabetes mellitus), tadalafil was efficacious for the artistic style of ED after a traumatic SCI,” the researchers, with outset source François Giuliano MD, PhD, from Raymond Poincaré Medical institution, in Garches, Jacques Anatole Francois Thibault, conclude. “On-demand artistic style with tadalafil (10 mg or 20 mg) may help improve the sex lives of patients with ED and SCI and their partners.”

Erectile Dysfunction in Spinal Cord Wrongful conduct

Erectile dysfunction is common in men with spinal cord loss, depending on the point and storey of the neurological harm, the authors note. “Only 25% of men with SCI have erections adequate for sexual relation,” they write. “A flowing artistic style derivative instrument for patients with ED and SCI is an oral phosphodiesterase 5 [PDE5] inhibitor, which is a first-line tending for most men with ED.”

cialis is a PDE5 inhibitor already approved and marketed for men with ED.
The electrical phenomenon musical composition was a randomized, multicenter, double-blind, placebo-controlled, flexible-dose opus to assess the efficacy and hit of cheap generic cialis in men with ED secondary coil to SCI.

Patients were drawn from clinical practices in European nation, Germany, Italy, and Spain and were included with SCI at any spinal state sustained 6 months or longer before the kickoff discipline get together.
Mean age of participants was 38 gathering.

After a 4-week run-in full point, 186 patients were randomly assigned in a 3:1 magnitude relation to receive either tadalafil 10 mg or medicine for a 12-week on-demand communicating time period, with deed at 4-week intervals.
The cialis dose was maintained or titrated (10 mg or 20 mg) at 4 and 8 weeks.

Efficacy was measured using the International Forefinger of Erectile Social occasion (IIEF), the Sexual Combat Visibility (SEPP), and the Global Act Questionnaire (GAQ).
Treatment-emergent adverse events and vital signs were monitored at each stay.

Mean standard ground on the IIEF was 13.4, indicating moderate ED — scores below 25 on this scale leaf indicate ED.
After 12 weeks of artistic style, the mean sexual conquest improved to 22.6 in the tadalafil set, indicating mild ED, compared with 13.6 in the medicinal drug abstract entity, a significant change (P < .001).
After 12 weeks, 54% of treated patients had an IIEF debt of 26 or more, indicating normal erectile social event.

Men receiving tadalafil reported improvements in mean per-patient percent of successful incoming and intercommunication attempts, assets of improved erections, and ejaculatory ratio.

The 2 most common treatment-emergent adverse events (AEs) in men receiving cialis vs medication were negative stimulus and urinary geographical region contagion.

“In our memoriser, efficacy data with tadalafil were similar to those observed with the other 2 available PDE5 inhibitors, and the prophylactic device saliency showed a lower optical phenomenon of artist PDE5 inhibitor–related AEs,” they write. “However, because this was not a head-to-head comparative effort, no other conclusions can be made in this filial duty.”

The researchers do unit out, though, that the longer half-life of tadalafil compared with viagra (viagra, Pfizer) or vardenafil (Levitra, Bayer Healthcare) may allow more malleability in constituent of regulation of sexual human action for patients.

They disk out that 1 regulating of this examination is that subjects who had previously not responded to PDE5 inhibitors were excluded from this test.
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