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Welcome to part 2 of "How to win the battle with erectile dysfunction."
For many men over 50, erectile dysfunction (ED) is a growing concern — literally and figuratively.
Estimates of how common the condition is vary widely, but one trusted 1994 analysis, the Massachusetts Male Aging Study, found that around 52 percent of men over 40 experience some form of ED, from mild to complete. It also found complete ED increases from about 5 to 15 percent between ages 40 and 70.
While the actual percentage can vary at any age, depending on factors like underlying health conditions, lifestyle choices, state of mind and medication use, the data makes clear it’s a common condition.
Talking to a doctor is an important first step to addressing the physical and emotional effects of ED and to learn if there are any associated health issues.
LGBTQ Nation spoke with Perry Halkitis, PhD, MS, MPH, Dean and Hunterdon Professor of Public Health & Health Equity at Rutgers School of Public Health, and the Editor in Chief of Behavioral Medicine and Founding Editor in Chief at Annals of LGBTQ Public and Population Health, to find what causes ED, how it’s diagnosed, and what the best treatments are.
In Part 1 of our interview, Dr. Halkitis described the physiology underlying erectile dysfunction, as well as the most effective treatment: ED medications, including Viagra and Cialis, also known as PDE5 inhibitors.
In Part 2, he addresses the psychological benefits of ED meds, how they can be abused and some unexpected health benefits you may not have considered.
LGBTQ Nation: Viagra and Cialis are used by a population of gay men with other recreational drugs to maintain an erection in “party n’ play” scenarios. What are some of the combinations you’re aware of, and what are the risks associated with them?
Dr. Perry Halkitis: I’ve been studying this for decades. When I started doing my work on club drug use in the late 90s and early 2000s, Viagra was used by a significant proportion of people using club drugs. And by that, I mean anywhere from 30 to 50 percent of people who were doing any particular study — and there was a series of studies — we’d see that they were combining with Viagra, especially when they were using methamphetamine, or crystal.
Why is that? Now, to me the explanation is quite simple. If one is desiring a certain kind of sex and being drawn to something like crystal meth or cocaine or other club drugs, to be able to have that kind of sex no one wants to not be able to maintain an erection.
However, as we know, stimulants in particular interfere with that. And so therefore, the use of methamphetamine, crystal meth, with Viagra and Cialis is extremely common, because people are desiring endless amounts of sex, they’re desiring continuous sex, they’re desiring multiple partners and that cannot happen, frankly, when one is high on stimulants.
Cocaine and meth and any other stimulants are going to be the ones to most interfere with the ability to maintain an erection. And it was one of the most common combinations that we see. Ecstasy, also being a stimulant, has the same effect. So those are the drugs that are most commonly used, although not exclusively used, with erectile dysfunction medications.
LGBTQ NATION: What are the dangers associated with mixing ED meds with club drugs?
PH: It’s dangerous and potentially life-threatening in several ways. Both ED medications and club drugs can increase heart rate and blood pressure causing cardiovascular problems — when taken together, they can put a dangerous amount of stress on the heart, which may lead to heart attack or stroke.
Some club drugs, such as ecstasy, can cause severe dehydration, which can be made worse by ED medications and can lead to electrolyte imbalances, kidney damage, and even kidney failure. When combined with ED medications, the risk of overdose increases significantly, as the drugs can interact with each other in unpredictable ways, especially if the club drugs are cut with other substances of which the user is not aware.
Club drugs can also cause a range of psychiatric symptoms, including anxiety, paranoia, and depression. Meth use has also been associated with suicide, and when combined with ED medications, these symptoms can be exacerbated.
LGBTQ NATION: What are some of the other treatments for ED?
PH: Well, there are other treatments that are much more invasive. There’s a medication that individuals can inject into their penis prior to having sex. This was actually very commonly done prior to the development of erectile dysfunction inhibitors. It is still an option for some individuals who are not responding to erectile dysfunction medications, and there are some that are not.
The other thing is monitoring testosterone levels for testosterone replacement therapy. As I said, testosterone levels tend to fluctuate. They tend to go down as people get older. It could be another approach to help people maintain virility and their ability to maintain an erection, although it’s not common, and I think most doctors shy away from doing that. The simplest and least expensive therapy is the use of ED medications.
LGBTQ NATION: Do Viagra and Cialis work for men on just a physiological level, or is there a level of “confidence” achieved just taking it?
PH: I’d say to you the psychological benefits of using erectile dysfunction medications are something that should not be underestimated for people, especially when we think about gay men who have active sexual lives, who are all of a sudden finding themselves, you know, sort of ostracized after a certain age because they’re older, but then ostracized for their inability to obtain an erection. I think that’s an important point to emphasize.
I think the other thing that’s really, really important to emphasize, from a harm reduction perspective, is this: Erectile dysfunction medications actually are probably really helpful, in the absence of PrEP and other treatments, because condom use is facilitated when somebody’s using an ED medication. It’s much harder to use a condom when you don’t have an erection, right? And so, let’s also think about the other prevention benefits probably attributed to that.
I would also say, with a lack of ED medication, we know that individuals are more likely to bottom sexually as a result of that. Bottoming sexually, as we all know, is more likely to lead to the acquisition of HIV. So, there’s other things that are much more subtle that we should think about before we dismiss the role of these drugs in HIV prevention. I think actually they do play a critical role.
LGBTQ NATION: As we talk about these sexual health medications for men, women are under threat with a ruling outlawing medications addressing their own sexual health. Do you see a double standard there?
PH: What’s really interesting I think at this point in this conversation — it’s actually it’s kind of fascinating to me — is this idea that you have a court system right now that’s trying to deny people medications, right? They’re denying women access to a pill that can give them an abortion. In Texas, they’re denying gay men — but it’s everybody — access to PrEP, you know?
It’s interesting to me like, what’s the next step? I wonder if we were to say to men in the United States, “Okay, well, the federal, the judicial system is going to intervene, and it’s going to take your erectile dysfunction medications away from you.” What would the reaction be? It’s an interesting sort of thought experiment.
Source: lgbtqnation.com
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